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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

 

 

 

Media Sensitization on Safe Abortion

Youth Champion Advocacy Network Nepal, YOUTHCANN had received a small grant from Asia Safe Abortion Partnership to organize various advocacy session on safe abortion to different groups like young people, service providers and media people. On the occasion of September 28, Global Day of Action for Access to Safe and Legal Abortion, YOUTHCANN organized half day sensitization program on safe abortion to media persons from print and radio.

Media is one of the most powerful instruments of communication. It plays a very constructive role in today’s world. As we know media plays an important role in increasing of public awareness and collect the views, information and attitudes toward certain issues. It presents the real stage of society. Without the media, people would be isolated, not only from the rest of the world, but also for the total formation of creditable world.

The media has got a vital role in molding positive perspective on abortion among people and spread positive message in the society to #BustTheMyths. But there is a myths on media

Myths: Most Media People Object the Abortion.

Facts: Media People are Often leading Advocates for Safe & Legal Abortion

Resource person Ms. Madhabi Bajracharya from Ipas shared that Ipas Nepal also closely works with media people and organize sensitization program for them regarding abortion. It has been observed that media people have their own values and they rarely accept abortion a woman’s right. Holding ones values on abortion might give rise to bias news and information which simultaneously lead to #abortionstigma and discrimination.

Likewise, one of the Youth Champions shared that she has been following various articles been published in newspaper and online news regarding abortion, the media always covers news on women deaths and complication due to abortion but they never specify where the deaths and complications are due to safe or unsafe abortion. There is difference between safe or unsafe abortion and reporting accordingly.

LM-abortionStigmaSP-info3-130915_02-1024x1024There was very good discussion among participants and facilitators. One of the media person asked what YOUTHCANN is doing to avoid abortion? Avoid Abortion…….. Well YOUTHCANN never promotes abortion. We are pro-choice and we respect informed choice and decision of every woman. We encourage young people to use modern contraceptive to prevent unwanted pregnancy which may lead to abortion. Even if Government has been giving more emphasis to contraceptive and it is free in almost all the health facilities, women do seek for abortion services. We encourage women and men to have safe and legal abortion which has less complication instead of unsafe traditional abortion which leads to death.

The participants were more curious to know about data on abortion and its failure rate. Also, they were keen to know the percentage of young women going for abortion. They perceive various myths on abortion like:

  • Infographic-2Most of the young unmarried women undergo abortion.
  • Abortion is a crime.
  • Fetus has its right of survival
  • Young people are using abortion as family planning.
  • Repeated abortion is dangerous.
  • Service providers do not want to perform abortion
  • INGOs are promoting abortion.
  • Abortion leads to infertility.
  • Woman needs husband consent for abortion.
  • Young people should not be given SRHR information and access to service.

All these Myths are cleared by the resource person Madhabi and Deepndra Khaniya. Deependra Khaniya is Managing Director of nation’s leading radio station Radio Audio which supports young people’s SRHR and on-air program on safe abortion. Deependra shared that his team receives more than 200 SMS daily from young people between 15 and 24 years which is mostly related to SRHR. Even if we do not allow young people to talk, listen and see SRHR stuffs they will definitely receive information from somewhere which might be incorrect and lead to unexpected situation. These days young people are more prone to social media and it is not always necessary they absorb only good information. Even we are helpless to block or stop the inaccurate information to reach our young people. Therefore, it is our job: media people’s job to clear our own values regarding abortion and provide reliable information to them.

Media should be sensitive when they write articles, news and on-air program on safe abortion. No woman undergoes abortion with her interest. It’s due to some reason and media should analysis those situation. One of youth champion shared that she had read an article which says, “Young girls in school uniform goes to abortion clinics and its increasing.” Well most of our government health facilities are Youth Friendly Service centres. It remains after school to reach most of the young people with information on SRHR. It’s government’s initiation. The YFS centres are in health institutes which provides safe abortion service as well. So, it would be discrimination to young school going girls if we publish on one sided information. May be she was there in health facilities for science project work or her regular meeting with community girls. This kind of bias information only hampers young girls and our country will never progress.

Youth Champion Prabina Sujakhu led value clarification exercise. Upon asking the statement: HIV infected woman should not give birth, most of the participants raise their hand in favor to the statement. The concern was if mother is infected she is not health enough to give birth to healthy baby. Some said infected mother gives birth to infected baby. Upon asking what if she knew pregnant. Most of the participants replied abortion is best option for her. But we facilitator shared its her right whether or not she wants to have her baby and knowing about safe procedure now we have in medicine which protect baby form HIV infection, the participants were forced to rethink.

Likewise, on asking whether husband’s consent is necessary for abortion most of the male participants were in favor to the statement stating mutual decision is the best which won’t lead to disturbance in family. Due to conflict in family, the marriage ends in divorce. But female participants shared that its woman’s body and she has her full right to decide about her pregnancy. There were argument between male and female participants on this statement.

Similarly, on asking abortion is killing fetus all most all the participants agreed upon address fetus as baby and life starts from conception. But the participants seem to be convinced when facilitator shared that there is not any study to show when life begins. Fetus depends on woman’s body as parasite. Life is only counted when it survives with its own.

At the end of the program, a video was shown “News Room Bahira”. The video talks about Sushila Jaisi’s death due to unsafe abortion. This video make the participant realized that even if there is availability of contraception for free of cost, abortion occurs. Abortion is always woman’s last decision. Use of contraception leads to prevent abortion.

The participants shared that this was the first time they had attended session on abortion. They realized bias information leads to #abortionstigma and discrimination. They also promised to contact YOUTHCANN for accurate information and resource materials on abortion as well as SRHR. In deed it was a fruitful orientation.

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.

#AbortionStigma free world

Few days back I had causal discussion with group of  grandmother who shared their experience on keeping the pregnancies even if their first child is only a year old. They shared they never heard of contraceptive methods. There were no such kind of things when they were married and they rarely talked with their husbands as they never got alone time with them to discuss about their future and having babies. Over discussion I asked them whether they know about abortion and whether those abortions were safe.  Hearing abortion they hesitate to talk about that they still have traditional mind set. Further probing they said they had heard and also experienced abortion. One of the grand mom shared, “Abortion is not new, its old! During the period of Gautam Buddha: Ajatshatru’s mother  tried her best to abort her child when she came to know her child will kill her father in near future. She used unsafe methods like asking her slaves to kick in her stomach and keeping heavy stones on her stomach. But she could not succeed.”

” People in non western region take “Abortion” being western stuff!! This proves that from ancient time abortion is privilege and I do not think people then had any stigma against it.  Even if abortion is legal in countries women have to face stigma. Stigma has lead to unsafe abortion and many women have lost their life. As abortion being stigma even government could not get real data on abortion safe vs unsafe. People are not freely talking about abortion and abortion related deaths. In my personal experience where abortion has been legal and has been more than 10 years i.e. Nepal many people especially youth do not know about it. It is mostly due to stigma surrounding abortion. Therefore on 28th Sept, 2014 Global Day of Access to Legal and Safe Abortion, Bhaktapur Youth Information Forum with Beyond Beijing and Youth Champions of ASAP organized a documentary screening and discussion.

The documentary is entitled “News room Bahira” which tells the story of Sushila Jashi was died due to unsafe abortion. It had great impact on the participants. Observing the discussion, it was noticed that only few participants aware of abortion legalized in Nepal and about abortion laws. The discussion was followed by Value clarification activity where most of participants discussion on abortion should be taken as alternative to family planning. They also shared that young people should be taught in their schools and colleges about sexual and reproductive health before they step to unsafe sex and result into going for abortion. The event concluded with positive note that all should start spreading information on safe abortion and minimize stigma against abortion.