Safe Abortion Day

Nepal celebrated its first “Safe Abortion Day” today. The celebration has actually #BustTheMyth regarding policy makers are not positive to abortion laws and policies. Also, it has #BustTheMyth on government officials not being positive to safe abortion law. The event was formally inaugurated by honorable health minister of Nepal Mr. Khag Raj Adhikhari. He shared his experience on abortion topic in parliament where few renown policy makers are still against abortion. The celebration has also brought all the partner organizations and stakeholder together with media to work together for betterment of the safe abortion laws and policies in Nepal.

The program was jointly organized by Family Health Division and partner organization like Sunaulo Parivar Nepal/ Marie Stopes International, Ipas Nepal, Centre For Reproductive Rights, Family Planning Association of Nepal, FWLD, action works, Beyond Beijing, Safe Motherhood Network Federation and Youth Action Nepal.

Youth Champion Advocacy Network Nepal also participated in the program. The slogan for the Safe Abortion Day 2015 address importance on family planning to avoid unwanted pregnancy and emphasis on safe abortion service if needed in safe and legal service sites.

Sharing about abortion scenario worldwide:

  • estimated 22 million unsafe abortion every year
  • nearly all unsafe abortion (98%) occur in developing countries
  • 13% (47000) of the pregnancy related death is due to complication of unsafe abortion (WHO 2012)
  • 5 million are estimated to suffer disability as a result of complications due to unsafe abortion

Safe Abortion program helps government focus on indicators like it helps to reduce MMR and morbidity and helps in creasing CPR and reduction of TFR. Preventing abortion related morbidity and mortality by increasing access to safe abortion services which leads to decrease in MMR. Likewise, preventing future unintended pregnancies by increasing access to post abortion modern contraceptive methods increase CPR and decrease TFR.

Nepal: From Law and Policies to Programs 

  • 2002- Abortion legalization
  • 2003- Procedural Order & Safe Abortion Policy
  • 2004- National Standards, protocol, guidelines, training materials and training centres and first SAS maternity hospital
  • 2007- Introduction of CAC by nurses
  • 2008- Introduction of 2nd trim services
  • 2009- national MA scale up strategy
  • 2011- National SAL implementation guideline
  • 2015- Announcement of free service by government

Facts on Abortion- Current Status in Nepal

  • 25% of pregnancies are unplanned in Nepal (NDHS 2011)
  • Only 38% of women Know that abortion in Nepal is legal
  • Knowledge is very low among no education (20%) and lowest wealth quintile (20%)

Safe Abortion Services: Achievements

  • CAC service is available in government health facilities. CAC is available in all 75 districts at district and upper level health facilities. MA service at health post and primary health post level in 41 districts and second tri are available in 22 hospitals. In addition to Government, NGOs and certain private institutions are also providing safe abortion services.
  • Safe abortion service was started in Nepal in 2004. Since then about 7 lakh fifty thousand benefited from safe abortion services. This saved many deaths of women and morbidity of women also reduce the cost of health services.
  • A study was conducted in 2004, 2007 and 2010 to access the impact of abortion legalization. It was found that by 2010 the percentage of severe complications due to unsafe abortion decreased significantly post abortion legalization.
  • As part of CAC, safe delivery sites also office family planning counseling and services to women after abortion. In Ipas supported 15 districts it was found that among the women who received safe abortion service, 80% use any kind of FP services.

Major Achievements:

  • More than 2245 health care providers trained in SA care under NHTC
  • 809 sites authorized for SA
  • All 75 districts of Nepal has SA sites- even the most remote areas
  • Abortion care is part of HMIS
  • Over 7,00,000 Nepali women have received SA care services
  • About 80% of women also received post abortion contraception
  • Less than 2% experience complication
  • Medical Abortion introduced in 2010 and available in 41 districts in PHC and HP level. (Data up to June 2014, FHD)

There still challenges that Nepal needs to over come like how to address few emerging issues such as abortion as method of contraception, use of emergency contraception as regular contraception particularly among adolescents, sex selective abortions. Another challenge is to provide free abortion services and further scaling up of program ensuring equity and quality. Similarly, we should ensure post abortion contraception particularly LARC and monitoring of free abortion services.

10 Things You Should Know about Abortion Service in Nepal

This has been my tagline from my first blog post till today “Abortion is Safe and Legal in Nepal”. Nepal has passed its glorious 10 years and more after liberalizing abortion laws and respecting women’s rights to control their own body. It’s icing on the cake when recent national budget 2015/16 announced abortion service in government institutions being free of cost. Also, the NEW CONSTITUTION DRAFT of Nepal has “Guaranteed women’s right to reproductive health and has removed of the term BHRUN HATYA.”

The previous article 43(2) had stated…every women shall have right to safe-motherhood and reproductive right. Bhrun Hatya done on the basis of sexual identification will be punished. Now the new and current provision in the constitution draft in the very same article number i.e. 43(2) states EVERY WOMEN SHALL HAVE THE RIGHT TO SAFE MOTHERHOOD AND THE RIGHT TO REPRODUCTIVE HEALTH.

map-about-bigtext1Yes, it’s my body and I’d rather not have anyone telling me what to do with it. Motherhood is an especial feeling but women could not only be judge on the essence of pregnancy and delivering babies. Unwanted pregnancies can cause many issues and effect health of women as well. But even if the pregnancy is not caused by a rape or causing health issues on woman, my body is mine and i have full right to decide what I want. I know that this is very hard concept for many people to grasp but it’s just the way I feel.

Having said that I am a pro-choice and I support women’s right to safe abortion, I would like to share 10 things you should know about abortion service in Nepal.

  1. Legalization of Abortion:

You should be aware of legal conditions for safe and legal abortion in Nepal. There are legal conditions under which you can go ahead with abortion service in Nepal.

Abortion http://www.asap-asia.org/country-profile-nepal.html is legal in Nepal on the following grounds:

  • Up to 12 weeks of gestation for any women,
  • Up to 18 weeks of gestation if pregnancy results from rape or incest, and
  • At any time during pregnancy, with the advice of a medical practitioner or if the physical or mental health or life of the pregnant woman is at risk or if the fetus is deformed and incompatible with life

Abortion is punishable on the following conditions:

  • Sex selective abortion, and
  • Abortion without the consent of the pregnant woman

Sex selective abortion is big “NO”. This is  important for everyone and especially for young people to be aware of legality of abortion in Nepal. Young people are innocent and often they seek abortion service beyond legal limit. OR they are subject to family and society pressure to keep their pregnancy secret, pushing those who ultimately decide to seek abortion beyond legal limit. Because of this many young people have been denied of abortion. Therefore, awareness on safe and legal abortion among young people is must so that they go to abortion service centres within legal time frame. The denial of abortion service beyond legal limit has lead to unsafe abortion.

2. Abortion procedures:

In Nepal, as is true for most other countries of the developing world, women are rarely given the opportunity to voice their needs concerning health matters. But legalization of abortion in Nepal undoubtedly has empowered women and health status of women. Comprehensive Abortion Care Services is an additional powerful tool in addressing high maternal mortality.

There are two types of medical procedure that is used in Nepal: MVA-manual vacuum aspiration and MA- medical abortion. Medical abortion is performed within 9 weeks of gestation. Medical abortion is a method of using pills to end a pregnancy through a process similar to a miscarriage. Like vacuum aspiration, medical abortion is very safe and effective. It offers unique advantages. It provides a non-invasive method of ending an unwanted pregnancy that women can use in a range of settings, often in their homes.

Safe and legal abortion services providers should counsel its clients regarding the methods of medical procedure being available in the service centre. It is the choice of woman on going through medical procedure via MVA or MA.

3. Identify safe abortion service centres:

cac

Safe Abortion Logo

Comprehensive Abortion Care Services are made available through the private, non private, semi-governmental sectors to provide abortion services in under served areas and to marginalized populations. Government of Nepal has developed a safe abortion logo. It is a visual symbol to designate facilities offering safe abortion services that is prominently displayed at all abortion service sites. Through its extensive incorporation in safe abortion IEC materials and programs. the logo has been a widely recognized symbol of safe abortion in Nepal, particularly among vulnerable populations such as illiterate women. Perhaps have also used behavior change communication strategies- including evidence based community discussion groups and a serial radio drama to foster discussion about sexual health and to challenge commonly held negative beliefs and stigma around induced abortion.

Likewise, the Government of Nepal certifies the health facilities as well as health service providers with trained human resources (doctors, nurses, ANMs) to provide abortion services to women. Abortion service and care is now available in all 75 districts of Nepal, many of which are in remote, mountainous areas, reflecting the government’s emphasis on rapid decentralization.

4. Privacy and Confidentiality and Counseling:

Quality service is the integral part of abortion service centres and it is right of women to receive standard sexual and reproductive health service. Abortion is very sensitive issue to be talked and decide to go for the procedure. Before safe and legal abortion, counseling regarding abortion and its procedure is the most. Woman has right to choose the correct abortion procedures: MVA or MA. For this proper balanced counseling is the most. Similarly privacy and confidentiality is the most. There are evidence which states that young people and women do not prefer to visit their nearby health facilities for any sexual and reproductive health services as they might meet their relatives and friends or service providers might know their family. They prefer travelling far to next districts for even simple SRH service due to lack of privacy and confidentiality in their nearby health facility.

So it is necessary that health facilities and even service providers maintain privacy and confidentiality. If they do not, everyone has right to ask for and if not maintained legal action could be preferred.

5. Hotline service:

Meri Saathi Free Helpline In Nepal, there are limited hotline service centres which offer information on safe abortion: legality, procedures, dos and dons, queries, safe abortion services. But Marie Stopes Nepal offers range of sexual and reproductive health counseling over phone. They have trained and skilled counselors who are available six days a week and provide information on safe abortion. It is call Meri Saathi Free Helpline. You can dial 16600119756 or 9801119756 to get accurate information on abortion service centers. These numbers should be saved in your cell phone. In any emergency regarding sexual and reproductive health issues, the solution could be a dial away.

6. Abortion service centres- Youth Friendly 

All abortion service centres should be youth friendly. Safe and legal abortion is young people’s sexual and reproductive health rights. The service providers should be youth friendly. They should not have their personal values which hold them back when it comes to providing abortion service to young girls. Even the service centres need to be youth friendly with IEC materials being demonstrated, well received in the centre, non-judgmental, privacy and confidentiality.

7. Abortion and Consent:

This is an important topics to be discussed widely. When it comes to abortion and consent, most of the people think that consent from husband, boyfriend, family, etc is compulsory. But in our abortion law it is clear that “Only pregnant woman holds the right to choose to continue or discontinue the pregnancy.” This states that only pregnant woman’s consent is enough to get abortion service. If the pregnant woman is less than 16 years of age or not in a position to give consent (mentally incompetent), the nearest guardian or relative can give consent for abortion services.

8. Accessibility and Affordability:

Abortion should be accessible and affordable. As mentioned above abortion services in Nepal are available in all government institutes like Primary Health Care, Health post and Sub health post in all 75 districts. Service providers are trained to provide both MVA and MA services to women in urban as well as rural areas. Even various organizations like Ipas Nepal has been training Female Health Volunteers to aware community about safe and legal abortion services being available in their nearby health facilities. This is indeed good initiation to prevent unsafe abortion. The fee structure established for public-sector maternal health services set a standard fee of about Rs. 1000 for induced abortion. Although modest, this fee was in contrast to free provision of post-abortion care, delivery, pre-and post- natal cares, and long-acting contraceptives. The safe abortion policy does stipulate that services be provided free of charge to poor or otherwise marginalized women. With continuously advocacy by women’s health advocates, women’s right activists and health organizations “Abortion has been free of cost in government institutions”.

9. Post Abortion Family Planning counseling:

Safe abortion needs good quality abortion services incorporating counseling training human source, infection prevention practices and adequate logistic support. Abortion is also supported by contraceptive services to prevent further unwanted pregnancy. Post abortion family planning benefits individuals, families, communities in many ways: increased modern contraception use and decreased abortion, reduced maternal and child mortality, prevention of mother- to -child HIV transmission and new HIV infections. After abortion procedure, post abortion family planning counseling is the most.

10. You are a champion:

Now you are aware of all the abortion related information, you are indeed great messenger and champion who is responsible to relay accurate message on abortion being safe and legal in Nepal to other people in your circle. You are a Champion.