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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Denial of Abortion Service in Nepal

In 2002, abortion was legalized in Nepal and made widely available. Abortion is permitted up to 12 weeks gestation on request and up to 18 weeks in cases of rape, incest, and health risks to the woman or fetus. Abortion services were established at most government hospitals, private hospitals, and non-governmental organization clinics. The government of Nepal has taken important steps to include abortion as a component of women’s reproductive health services, enabling nearly 800,000 women to obtain safe, legal services between 2004 and 2014. The government has recently announced that abortion services will be made available free of cost in the public facilities but this will take time to implement.

We, Nepali women are living in most privilege country where abortion is safe and legal. The government of Nepal has respected the women decision to have choices and decisions on their own body. Nepali women make their own decision to terminate their unwanted pregnancy on their own consent.  However in other countries like England, Wales or Scotland a woman must ask a doctor to make that decision to her. Similarly in the country where abortion law is restricted, Government takes decision for a woman whether she could or could not terminate her pregnancy. In most cases, women are denied of abortion services. This is the violation of Human Right.

For example, Northern Ireland where women are denied of abortion. In Ireland, abortion is all but outlawed. For decades, women have traveled to England to access abortion services. You can read an article where titled: Irish woman live-tweets journey for abortion from Ireland to England. Dr. Suchitra Dalvie talks about musings on women’s right to safe abortion questioning “Is it not a modern form of slavery to force a woman to have or continue a pregnancy she does not want? Should a woman’s reproductive function take priority over her own aspirations and desires and capacity to fulfill her own highest potential?

Talking about Nepal and the situation of denying abortion, people are shocked to know when I share them about denial of abortion services in unrestricted environment like Nepal. According to our National Demographic Health Survey (NDHS-2011), only 38 percent of women are aware that abortion is legal in Nepal. In addition, their knowledge of the specific circumstances under which abortion is legal is poor. For rural Nepali women, it is difficult to identify whether they are pregnant or not. Most of the women who reach health facilities for abortion service are of high gestation which means above 12 weeks. Most of our Government certified health facilities are authorized to provide comprehensive safe abortion service till 12 weeks of gestation.

One of the leading NGO in Nepal, Centre for Research on Environment, Health and Population Activities (CREHPA) had conducted a study in 2013 which aimed to examine how often women are being denied care, reasons for denial of legal abortion, options considered after denial, sources of information about illegal abortion, experiences seeking illegal abortion and complications experienced. The study showed that denial of legal abortion is common in Nepal. It is common among women from poor family and marginalized communities. Some of the reason for denial of abortion service could be:

  1. High gestational age is the reason for denial of abortion as service providers hesitate to go against laws and they are not competent enough to terminate pregnancy of high gestation.
  2. Most of the government health facilities are authorized to provide safe abortion services. However, women have been denied of the service due to absence of trained and skilled service providers. Most of the time lack of continuous supply of medical abortion in health facilities is another reason for denial. This has led women to buy unauthorized drugs over the counter which has led to complications among women.

12289746_873703786077111_2078844530607308059_nThe study has also explained that denial of abortion service has forced women to continue with their pregnancies. Evidence has suggested that children fare best when they are wanted and loved. Similarly, rejection of abortion is leading women to access illegal abortion by self inducing unauthorized drugs and going for traditional methods which can result in incomplete abortion or complications.

This means even if the law is liberal, in certain condition we are forcing women to seek illegal and unsafe abortion. I believe that abortion should be accessible in any gestation age. However, the abortion procedure should be safe which does not keep women at the risk to lose their lives.

Recommendation for improving women’s access to legal care:

  1. High impact awareness campaign on pregnancy, abortion, abortion law and services available. For example: interactive radio programs, street dramas
  2. Reduce stigma related to abortion.
  3. Mobilizing Female Community Health Workers or community mobilizers door to door with interpersonal communication approach to orient people about early detection of pregnancy.
  4. Train more providers at all levels to provide abortion and to refer appropriately
  5. Promote free helpline numbers like Meri Saathi Free Helpline no. 16600119756 or 9801119756 in community level to call to get detail information on safe abortion, procedures, laws and service centres.
  6. Introducing mobile health application like one initiated by Marie Stopes Nepal to registered through SMS and get instruction and information on using self induced medical abortion pills.