Young People and Unsafe Abortion

Recently the National Daily Newspaper- Kantipur published an article with heading “Abortion Among Teenagers On the Rise”. The article shares, “A 17 year teen girl arrived at Lamjung Model Hospital situated at Beshisahar. The girl who had come from rural part of the district did not agree on continuing her pregnancy and demanded to terminate her pregnancy.”  Don’t you think this is a good news. I am really proud that young people are being vocal about their unwanted pregnancies and taking their own decisions  whether or not to continue with their unwanted pregnancies. The headline of the news should have been “AWESOME TEEN GIRLS CALMING THEIR ABORTION RIGHT AND ACCESSING SAFE ABORTION” – simple !!

The article continues and says “It is clear that underage as well as illicit sexual relationships are increasing along with abortions.” Lamjung Model Hospital is the only authorized abortion centre in the district. Dr. Tilak Babu Ghimire said, “Even the teenage girls of 17-18 years are coming for abortion. We try to convince them not to terminate their pregnancy as far as possible, but they are adamant.” I believe that service providers should be non-judgement and maintain confidentiality. The doctor should be proud on providing safe abortion to young girls, else they would have opt unsafe abortion which could have risk their lives. The article also talks about young women visiting neighboring district to access abortion. This clearly indicates that women do not trust the nearest health facilities- the reason might be service providers being judgmental and the facility does not maintain privacy and confidentiality. In Nepal even if abortion has been legalized and government health facilities provide safe abortion, women still have to travel different places to seek abortion. Another reason could be stigma. Stigma related to abortion has forced women to terminate their unwanted pregnancy seeking service from quack doctors or using herbal products.

For young women, complications from pregnancy and childbirth are the leading cause of death, and unsafe abortion is a major contributor to this mortality. Unsafe abortion can also result in lasting and devastating consequences, including, sepsis, peroration of the uterus or intestines, hemorrhage, chronic pelvic infections, and infertility. (1)

Deaths due to unsafe abortion are on the decline, but the proportion of women dying from unsafe abortion globally remains the same. 

  • MSI_Unsafe_Abortion_Infographic_080714_ARTWORKAccording to the World Health Organization, deaths from unsafe abortion worldwide have dropped from 69,000 in 1990 to 47,000 in 2008.(2)
  • Parallel to this decline, there has also been a one-third decline in maternal mortality from 546,000 deaths in 1990 to 358,000 in 2008. (2)
  • Despite the decline in the number of deaths due to unsafe abortion, the proportion of women dying from unsafe abortion has remained the same at approximately 13% of all maternal deaths.(2)
  • The number of unsafe abortions increased from 19.7 million in 2003 to 21.6 million in 2008 while the unsafe abortions per 1,000 women aged 15-44 years. (2)
  • This increase in the number of unsafe abortions without a corresponding increase in the rate is mainly due to the growing population for women for reproductive age.(2)

Young women account for a significant proportion of unsafe abortion worldwide. However, the article reflects that most of the teenagers are seeking services from safe places like, Lamjung Model Hospital and Marie Stopes Centres. This is commendable that young girls in rural areas of Nepal who are stigmatized for being a girl and getting pregnant before marriage accessing safe and legal abortion services. Without projecting this as a success story of Government of Nepal after making history for legalizing abortion 14 years back, our media is only sensationalizing the reality and reinforcing stigma around abortion.

According to the most recent data available from 2003, almost 14% of all unsafe abortions in developing countries were among women under 20 years of age. 

In developing countries, 2 in 5 unsafe abortions occur among women under age 25, and about 1 in 7 women who have unsafe abortion is under 20. Similarly, in Asia 30% of unsafe abortions are among women under 25 years of age and 60% are in women under 30. 

This is a request to all media personnel to analysis on the impact of your article. Instead of presenting data of abortion as terrifying issue, it would have been great if it was analyzed the difference between safe and unsafe abortions.

Even where abortion is legal millions of women across the world, especially young women, face barrier to access. In context of Nepal, many women, especially adolescents and women from rural Nepal cannot afford to access safe abortion. The geography of Nepal is another reason because of which women are deprived of safe abortion services. Unavailability of trained and certified service providers and continuous supply of Medical Abortion pills, women in many places in Nepal could not access safe abortion service. Stigmatizing abortion is discouraging trained service providers and capable human resources from providing safe abortion services. Even, volunteers like FCHVs are stigmatized for providing information on abortion. Marginalized populations like young persons with disabilities, women living with HIV, LGBTI and others are facing stigma and discrimination when seeking safe abortion services, resulting in denial of care or required authorization. Gestational limits, the need for parental consent for service is another barrier to accessing safe abortion services.

This article is an example that really hit me this month. I had discussion and argument on this. One of the people questioned me, “Why are you advocating and promoting abortion for young people? Why don’t you promote contraception instead? Excuse me! While more young women are using contraception in Nepal, there is till a tremendous unmet need for contraception and young women experience higher failure rates than older women. And I am not advocating for abortion, instead I am advocating for Safe & Legal Abortion. SIMPLE

Recently, I had received a call from Radio Station. The radio station is compiling data and information on abortion. They would like to know number of abortion cases. I replied them that I am not the person to talk about numbers on abortion. They should have visited to respective District Public Health Office and talked to concern department. She asked me what percentage of young girls seek abortion and what is the average age. Why these media people are more concern about the data on young girls accessing abortion. They concern and their queries is indeed stigmatizing young girls accessing safe abortion services. Instead for creating content that would provide wrong message to the community, it would be great if media could be sensible in this issue and support on preventing deaths due to unsafe abortion.

Please read this piece as well to get more incite on the articles publish on abortion by Youth Champion Advocacy Network Nepal.

 

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Connection Between SDGs and Safe Abortion

Sustainable Development Goals (SDGs) is a new road map to improve the lives of people throughout the world over the next 15 years. Sexual and Reproductive Health & Rights issues are currently featured on the SDG agenda expands their presence at both the global and national levels, by establishing SRHR specific indicators to measure progress toward the SDGs.

For the field of SRHR, the SDGs include several relevant goals and targets such as those related to health, education and gender quality. The goals and targets encompass many key aspects of SRHR, including access to SRHR services, comprehensive sexuality education, ensure reproductive rights, achieve gender equality as a matter of women’s and girl’s human rights, and the ability to make decisions about one’s own health. The SDGs are ambitious in their size and scope, consisting of 17 goals and 169 targets that are applicable to all countries equally, and take into account the economic, social and environmental challenges of our world.

The major component of SDGs SRHR related target is to advance women’s access to safe and legal abortion, in accordance with the new SDGs focused on health and gender equality.

SDGs Targets By 2030:

TARGET 3.1: By 2030, reduce the global maternal mortality ratio less than 70 per 100,000 live births: The 2030 target calls for a two-thirds reduction in maternal mortality, based on the latest estimate for the maternal mortality ratio globally, at 210 maternal deaths per 100,000 live births. This is well known facts that leasing cause of maternal deaths is unsafe abortion. A report by the United Nations Secretary-General in 2013 highlighted that numbers of unsafe abortion will continue to increase unless women’s access to safe abortion and contraceptives are questioned. Unsafe abortion is entirely preventable through ensuring women’s access to effective contraception together with safe and legal comprehensive abortion care in all regions, countries and among poor, young and vulnerable women. Nepal has announced free abortion service in 2015, and yet not implemented. This decision will definitely push the nation to achieve the target to reduce maternal mortality by 2030.

TARGET 3.5: By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs: Contraception is an essential component of family planning and SRH that allows individuals to determine if and when to have a child.

Unmet need among the adolescent and young is particularly high for spacing with 37.5 and 23.3 percent respectively (NDHS 2011).

Ensuring that SRH services are made available along with other basic health care e.g.immunization services or treatment for TB may increase access to care and information, especially for disadvantaged populations, such as adolescents, people with disabilities and those living with HIV. Access of services especially SRH related is difficult due to geographical areas in Nepal. SGDs planning and implementation will help Nepal Government to identify geographical areas where and types of services for which availability is lagging can help better target resources and technical assistance.

Access to safe, legal abortion has been recognized by the global community as an essential intervention in a package of comprehensive sexuality and reproductive health services that should be available to all women regardless of age, ethnicity, gender identity, geographic location, marital status, race, religion, socio-economic status or migrant status. 

Improved SRHR knowledge can help young people make healthy, informed choices about their reproductive loves. Understanding levels of knowledge among adolescents can help identifying gaps in preparing young people for this important part of life.

cpqnr-1xgaakvkf“Only 38% of women know about abortion is legal in Nepal-NDHS 2011. Knowing the adolescent birthrate and whether those births were planned can help quantify challenges facing young people, including their unmet need for contraception and lack of access to education, information and services appropriate for them. For very young adolescents (ages 10-14), early childbearing can be a marker of forced marriage and abuse.”

And also adolescents in particular need universal access to youth-friendly and non-judgmental sexual and reproductive health services that respect their sexual and reproductive health and rights and their rights to confidentiality, privacy and informed consent.

TARGET 5.6: Gender Equality: Lack of gender quality affects almost every facet of life for women and girls around the world. Gender equality includes recognition of women’s autonomy and capacity to make informed and independent decisions about their sexuality and reproduction through laws and policies allowing access to safe and legal abortion. Women’s access to safe and legal abortion is as relevant to gender equality as women’s equal access to education, employment, adequate food and housing.

In order to protect women’s health and lives, it is critical to promote access to safe abortion and to reduce the incidence of and complications from unsafe abortion. Better data collection is necessary in this area to improve the medical and legal environment for providing safe abortion care and to reduce the stigma surrounding the procedure.

The success of key SDGs will depend in significant part on the extent to which important stakeholders-including governments, UN agencies and non-governmental organizations take seriously the specific SRHR targets and fully implement the relevant policies, services and programs to attain them. All the stakeholders should realize that the success of SDGs depend upon women’s & girl’s access to safe and legal abortion in all region equally.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Let’s Talk Abortion

There is a general logic behind the existence of human-kind in the universe. The logic is human is born to reproduce and continue its generation. Not only humans but animals also have to reproduce because of their sexual instincts. However, we now have birth control and abortion which allows us more control over when and how many babies we will have. Thanks to the advancement in technology to control our own reproduction.

safe abortion-3

I believe that every pregnancy should be wanted rather than an excuse saying it happened accidentally. Don’t you think this excuse is leading to global warming! I mean the planet Earth is already overpopulated and polluted resulting to natural disasters and unknown diseases which will definitely in the future will be a leading reason behind extinction of humans from the Earth. The main reason behind this is due to unwanted pregnancies. The best solution to control our population is to terminate pregnancies which are unwanted.

Thank God! We are in the society where we have the technology to control our own reproduction. This has provided us an advantage to control our own body and have babies when you are ready. This has helped us to have children by choice not chance.

Abortion is also an issue of personal choice. People should have access to safe and legal abortion. When we talk about abortion, we have to face various questions which are linked with social, cultural and religious sentiments. However, the people who arguing about abortion never think about a woman who has to face numerous difficulties to decide and go for termination on her own choice. Someone asked me: Who should make that choice? Her family, husband, state, friends, service providers or herself? The answer is so simple, it’s her body and she has all control on her body which is her human right, then the choice to terminating her unwanted pregnancy, ultimately, needs to be her.

Abortion is not only women’s issue. Whenever I have discussion regarding abortion, people forget that men should be also involved equally. They always rise a question “What if I (man) wanted the pregnancy? Where is my (man) saying on taking decision not to abort?”. This is really painful when people (especially men) do not understand the issue. They should empathize the situation to learn more about personal choice and freedom. I believe that reproduction is a personal right and that it is no one’s business other than the women to make that choice. People should respect and support a woman;s right to have a baby as well as her right to not have one.

Another hot issue you face while you stand for abortion is: Abortion is murder. For god sake please grow up. I am afraid there are people who will punish woman for wasting her eggs very month in the form of menstrual bleeding as eggs are important reason behind life. If we really care about life, why we are silent about Syrian war. Many children have been killed and affected by the war. Is that not murder? If you really care about the life of a fetus not the live one in Syria then please do not argue with me on abortion being murder.

 

safe abortion-10The religious sentiment on abortion is its being immoral. If this is immoral than why don’t you promote family planning. Every time you can’t only object. You need to support as well. If you think abortion is immoral and it is sin then why don’t you preach about use of any form of contraception. This will help to reduce abortion. The less women get pregnant, the less abortions you have. So simple! If you do so, I rally do not have to disagree with you.

imagesPeople come with the idea of adoption when I start to talk about abortion. Oh really, adoption! Is this the real solution? Forget it!! People who object to abortion they really do not care about the welfare of child after it’s born. These people take pregnancy as the punishment for woman. They are indeed sick people who do not support sex, contraception and abortion. Do you believe that we have awesome adoption law that will sort the issue of unwanted child after it’s born? If you really believe that adoption is the solution then request people to be fair and healthy without racist or sexist while adopting a child.

Abortion is not an easy choice to make. Women go through obstacles and challenges to finally choose abortion as an option to move ahead. I guess you do not want a 16 year girl to become mother before she completes her study. You do not want to be pregnancy that results from rape and incest. Also, you do not want to carry your pregnancy at the age of 50.

Therefore, respect the choice a woman makes. I just want her choice to be safe and legal. I request all to talk about abortion and preach accurate information about it. Always support women, to access safe and legal abortion rather than from back street quack doctors.

 

 

 

 

 

 

 

 

 

 

My life At 15

I am born in a middle class family with good reputation and environment. My parents are educated and they are well known in the society. The priority of my childhood was to complete my schooling. Well there has been always a pressure on me and my cousins to score good marks and always be within top 5 in the class. I was in grade 9 when I was just 15. I was messing with my study and my physical changes. I hated going school in my periods. In my fifteen, none shared me that periods are normal and its natural. Nobody empowered me saying it is indeed good to bleed which symbolizes that I am fertile and I am able to give birth to new ones. I felt really embarrassed whenever I had my periods. I stopped playing with my male cousins and stopped siting in same bench with my male friends. I was juggling with my bodily changes and the societial norms. In school I was learning son and daughter are equal, I found its different in my family and surroundings.

In my fifteen I was suggested to join school scout by my principal but my mother denied. She said to become a Girl Scout I need physical strength which she thought I lacked. I had interest in sports. My dad indeed was the best football player in his time. He wanted a son with whom he could fulfill his dream to become national football player. Although he never showed that he actually wanted a son, he supported me to participate in sports. In my fifteen, I joined my school’s basketball team. We were trained for few months and we discontinued with the reason that we had to attempt School Leaving Certificate examination which means a lot. SLC exam was seen as iron gate and my family + my school had great expectation from me to score atleast 80% as they wanted me to join medical line in the future.  

 Even though my family is educated, it is influenced by societial norms and values. It’s a patriarchal community where daughters are believed as the responsibility of parents; to be married off in time. While I was studying in my fifteen, there were my relatives who were eager to fix my marriage. In my fifteen I got my first marriage proposal. I still remember it was winter and it was on holiday when my cousins started giggle. I asked them what’s the matter. They didn’t share instead laughed at me singing songs. My mom didn’t share this to me but my grand mom did. I didn’t know how to react. Is that a good news for me? Should I be happy? Mixed feeling. But my parents were against getting me married in my teen. They said they wanted me to complete my higher education, get job and decide what I wanted in my life. Although my parents stood for me people in my society did not digest that I should take my own decision to decide when, where and with whom I should get married. 

  I would like to thank my parents for standing with me. If they had not decided about my future to independence, I guess today I would have been mother of two children depending totally on my husband and getting drepressed of my life. Today I am a youth activists advocating for young girls and women for their right to access information and services to sexual and reproductive health. I have never regret of being girl. But the story is not similar to other girls. Girls in Nepal are deprived of education, information and health services. 

Today world celebrated International Day for Girl Child. In Nepal 17 percent of girls become pregnant or mothers for the first time as early as at the ages between 15 and 19 and almost 83 percent adolescents of the same age group lack access to modern contraceptives in Nepal. As a result of early and frequent pregnancies, many women and adolescent girls are undergoing sexual and reproductive health problems. Nepal comes to top 10 position among countries in the world and ranks third in South Asia with the highest child marriage rate.

 Stakeholders have said that rampant child marriage is the root cause of many problems such as gender-based violence, reproductive health troubles and school dropout, among others. As a result of rampant child marriage in Nepal, health of both women and girls is at risk.

The data of Nepal Demographic and Health Survey (NDHS), 2011, even suggests only 38 percent of women in Nepal know that abortion is legalized in the country and seven percent of maternal mortality is due to unsafe abortion. Nepal had legalized abortion on September 26, 2002.

So there are unfinished business when it comes to ensuring sexual and reproductive right of girls. Our society must realize that girls are not brides. Gender equality with equity should be ensure for girl. Girls should not hate themselves for being girls. The stereotypical concept of gender should be totally ignored and empower girls in education, sports, technology to achieve national health objectives.  

 

Youth Advocacy Institute & Fertility Dance

Tell me which part of your body you love the most? The answers would be: Eyes-it helps me to see beautiful scenario in Colombo; My nose- it helps me to breathe warm breeze of Indian sea in Sri Lanka; My legs: it helps me to travel wherever I want; My hair: my pictures look amazing with my black & long hair. And what about your genitals??? emmm…. GENITALS? WHAT ESPECIAL ABOUT THAT?? well….. never thought about this….

It has been always great to be part of Youth Advocacy Institute every year organized by Asia Safe Abortion Partnership. This time it is in Sri Lanka. The time for reunion with senior Youth Champions and ASAP team. The joyful venture to meet rising SRHR advocates from various countries. YAI always motivate me to keep on working in SRHR field and advocating for women’s right to safe and legal abortion. This year I am here as peer facilitator and got wonderful opportunity to co-facilitate session on Reproduction and Contraception with Dr. Suchitra.

Coming back to genital organs and the embarrassment to pronounce the part of our genitals in front of other people. We are youth champions. We have taken responsibility to aware 1000s of young people back home regarding their SRH needs, rights and access to services and information. How could we be embarrassed to say “PENIS”, “SPERMS”, “VAGINA” ??? We should shout it loud and inspire people to demystify the myths related to these terminologies.

I believe unless you know the subject in reality it would be difficult to teach other people. After introductory session on reproduction & contraception, we moved to a session which termed as “FERTILITY DANCE”. A huge uterus was drawn on the floor. This session is generally a role play. Lets do this…. what… lets have sex….. well I am kidding…. but lets learn reproduction and mechanism on women’s body. Various cheats were distributed to youth champions which says IUCD, IMPLANT, OCP, CONDOM, PENIS, OVA, SPERMS, etc. Now they had to enact the characters.

Talking about sperms, they are active, fast and clever as they have to fertilize ova for reproduction. IUCD, its probably T-shaped and has to be fitted in the uterus in T shape and fight with sperms. Hormonal contraceptives like OCP, IMPLANT and Shot they could hold ova so tight that it won’t be able to release in Fallopian tube. The enthusiastic YCs acted so well that the session turned to be fun and infotainment.

This session is in deed interesting and full of energy. This helps you to understand how fertilization takes place in uterus and how a woman conceive. Even convincing when you facilitate session to women’s groups, youth groups, mother’s groups to make them understand the mechanism and clear their myths related to contraceptives, safe abortion pills and other.

To know more about Youth Advocacy Institute click here.

“Mom I am not ready”

Today I am going to share with you the tragedy of growing up. My childhood, I believe was better than getting into adolescent and now youth category. I had happy and enjoyable life being first daughter of my parent where there was huge appreciation of getting good grades and being obedient. Enjoyed in home based game station with my cousins. Grew up learning nursery rhymes and bed time stories which now if I recall, feel sorry for dreaming to be one of the princess who lost her shoe and was waiting for her prince charming. Yes, my mom as any other mothers shared her best stories of princess who struggle to make her dream come true whether kissing a frog, losing a shoe, brightening her hair or being whitest ever. The reason behind these bed time stories was to make me understand a social phenomena “Marriage is compulsory”. During those days as child, these stories fantasies me and I could not say “Mom I am not ready” to dream a prince.

My bed time stories ended when I reached my puberty. I remember my first day of menstruation. I was frightened, holding my underwear inked red with blood and searching my mom for rescue. I was much terrified to know my private area was bleeding and all my bed sheet turned to be red. The I met with reality that even in this situation when I am traumatized there was not any prince to secure me with correct information or holding my hands with hope to never let it go away.  Now I realized that my mom wasted time finding those fancy bedtime stories. It did not helped me instead made me imaginary to imagine a prince. My mom was comfortable to give me indirect hints saying “Marriage is made in heaven” but she was uncomfortable saying what happens after marriage. As I look behind into my puberty my mom never talked about menstruation before I faced it as tsunami in my life. Neither my sisters nor aunts talked about enlargement of my breast before I felt embarrassed. When I asked why I am bleeding four days a month, the reply was it is consequences of my bad deed in previous birth. What? Exactly same response.

As I grew up to my teen and doing most of the household works like assisting family members to cook food, washing dishes, cleaning, washing, sweeping and behaving a typical Newari girl; my relatives started to tease me saying “thulo vaye cha choori aba bihe gardinu parla” (Now she is grown up she is eligible to marry), “keta khojyo uskolagi” (Did you search groom for her?) etc. Remembering those embarrassing moments where I could not reply to those relatives and say “Mom I am not ready” for those comments, make me want to reverse the time and shout on those relatives saying it’s non of your business. With all those teaching from my parents and being totally feminine with smile on my face I had to dissolve those comments. And I could not day “Mom I am not ready“. My family was much more interested to find me a groom than asking me about my bra size or getting me sanitary napkins or teaching me how to use home made pads. Here in Nepal marriage is taken as license to get indulge in sexual relationship legally and having babies no matter how  many.

Our culture does not allow talking about sex and sexuality. But the intention behind marriage proposal during first age of girl’s teen is indirectly talking about having sexual relationship with a guy. How could a girl take this? I am not allowed to talk about bodily changes during puberty but I am forced to meet a stranger to get arranged marriage. This time I go to one of my cousins wedding reception wearing sari or kurta, all my relatives are much more interested on news When I will be getting engaged than my cousin’s wedding. Someone says “aba ta timrai pali, koi cha vane hamilai na lajaikana vanna la” (Now its your turn to ring the bell. Let us know if you are in relation without hesitation) as if they are going to accept my relationship with a guy of another caste. My parents will be listening to those comments and keep smiling with hints as they want to relay same message to me that I am eligible to get married. That is why I have stopped going to any relatives’ parties and they say I am being unsocial. My relatives are more interested on my growing age than my family. I got my first marriage proposal when I completed my school. Everyone was positive about the proposal, do you believe this? Even my dad and mom. I was just 16 years old back then. The thing I regret is I could not say ” Mom I am not ready”. Since then there was open gate for someone in my family for getting marriage proposal.

My parents are thinking about my better and secure future. But they have not realized how I could, when we are not discussing about my sexual life. They want me to choose a stranger and want me to say “Yes” meeting him for first time. They are not thinking my compatibility with him and how I could trust him. The culture of marriage in my family is going like this. Parents fixed the meeting of potential bride and groom, expect “yes” from both of them as soon as possible, get engage and finally marriage happens. None has argued on this and raised question. In defense my parents said the marriages happened are successful. I am not allowed to date my friend but I am allowed with a strangers and the excuse from my parents is “His father is my childhood friend”. What an excuse!! Another scenario is my cousin has a boy friend and she had already shared this with her parents. Although my family has given her green signal inside they are not happy with her relationship. Families have had their meetings and finally they are going to engage. Still my family has objection on her getting close to her boy friend or frequently staying late evening with him. Don’t you think its funny? My cousin who has shared her status of being in relationship with a guy and family agreed their engagement in near future are objecting them for spending time with each other. But I who is not in relationship is forced to meet a stranger, spend time with him, talk or phone him frequently and without asking me they announce my relation status with him……. emm….. not happening. This is because I did not say “Mom I am not ready“.

The message I am trying to relay is  marriage is not simply handing daughters to a stranger. It not about celebrations and parties for more than seven days or up to month. Marriage come with responsibility. Before that it’s a girl decision whether to get married or not. She has right to decide with whom, when and where she gets engaged with. Before than she should have accurate information about her body and changes, sex and sexual relationship, emotions and pleasures, contraception and abortion. In our society daughters are taught how to impress her husband, compromise in relationship and at the end most of the marriage fail within and none stays happy. Daughters should be empowered by giving her higher education due to which she would be able to take her own decision, negotiate and compromise on her own cost. These lessons should be provided by parents but it lacks in our society which is leading huge generation gap. There should be culture of saying “Mom I am not ready“.