Making abortion safer in Nepal
19 December 2008 (Updated 30 December 2008)
Although it was made legal in Nepal only as recently as 2002, and the laws prohibiting it were among the most draconian in the world, women still sought abortions in this poorest of all Asian countries in the years before.
Not even prison sentences of up to 20 years could deter them from seeking the terminations which, in the absence of safe services, often cost them their lives.
In those days, about half of all hospital admissions for gynaecological problems related to complications around abortion. When you consider the methods of abortion that were employed, this statistic is unsurprising.
Sharp objects were sometimes inserted into the uterus to break the amniotic sac containing the foetus; other women opted to end their pregnancies by swallowing ground glass or toxic herbal mixtures. The ban on induced terminations, as strictly as it was enforced, was not working.
Help whenever it's needed
Now, thanks in part to DFID funding, the country is moving farther and farther away from the pre-2002 situation. A national programme backed by DFID and other national and international partners, such as Ipas and Marie Stopes International, is working to ensure that the option of a safe abortion is available to all women, regardless of how poor they are, whether they belong to marginalised groups - or the circumstances of their pregnancy.
In Kathmandu's Maternity Hospital, the safe abortion unit recently treated a 20-year-old, unmarried woman who became pregnant when she was gang raped by thieves who broke into her family's home.
While the law passed six years ago permits abortion on demand for any woman aged 16 and above up to 12 weeks into her pregnancy, rape and incest victims may request an abortion during the first 18 weeks.
The woman's father, who had heard about the availability of safe abortion services, brought his daughter to the hospital, where she received a safe termination. Although the woman was still very traumatised by her experience, the family as a whole were grateful that she was at least spared having to carry the pregnancy to term.
Women decide for themselves
In a country like Nepal, where deep-rooted religious beliefs and social norms do not support women's rights to even discuss, let alone control, their reproductive health, the number of women making use of legal abortion services in recent years has been astonishing.
Between April 2004 and July 2007, 145,966 women received safe services, with minimal complications (less than 0.09%). These figures are all the more remarkable given that many people in Nepal live in remote and difficult-to-access areas.
In Bardiya district in the west of the country, a Marie Stopes clinic was recently visited by an unmarried student whose affair with a fellow student had resulted in an unwanted pregnancy. The young woman had been told about the safe abortion services available at the Stopes clinic by a local health volunteer.
Later, she returned to thank the volunteer, saying that the service had been good, there were no complications, everything was confidential and the fees were not too high. Improving reproductive health advice and education - by using, for example, printed materials, radio and television - is an essential component of the safe abortion programme.
As the programme continues, empowering Nepal's women to make the right choices will remain a priority. At the same time, it will increase the choices open to them - by reducing costs, training nurses as service providers and providing non-surgical abortions and second trimester abortions when necessary. This should help make sure that the days of underground, unsafe abortions remain firmly in the country's past.
Facts and stats
- Safe abortion services are now available in all of Nepal's 75 districts, provided by either the government, private companies or non-governmental organisations (NGOs). There are 224 officially registered service sites and two public and two NGO training sites.
- Five hundred and fifty five doctors and nurses have received training in safe abortion techniques. The programme has also made available contraceptives and reproductive health advice.
- DFID has been a consistent supporter of safe abortion in Nepal through the Nepal Safer Motherhood Project (1997-2004) and the Safe Motherhood Programme (2004-), working with the Nepalese government, international development agencies, national NGOs and professional associations.
- DFID is currently a major donor to the national safe abortion programme, providing funds to the women's health organisation Ipas for their technical assistance (contributing £6.5 million to the organisation in 2007).
- Globally, around 70,000 women, often the youngest and most vulnerable, die needlessly each year as a result of unsafe abortions.
