Safe Abortion Policy in Nepal

Safe Abortion Policy in Nepal

In the past before enactment of safe abortion law in Nepal, many women were incarcerated for different durations for abortion related crimes as the act of abortion was considered a criminal act in Nepal before its legalization in March 2002. The bill received Royal Assent in September 2002 with the Procedural Order enabling the implementation of the new law receiving final approval in December 2003. First safe abortion was carried out in 2004. (Note: Procedural Order authorizes the implementation of legal services and specifies the required conditions and framework before final parliamentary approval)

The Muluki Ain 1854, the basic legal code for the kingdom of Nepal, prohibited and characterized abortion as an offense against life, making no exception even when pregnancy threatened a woman’s life. Jail punishment of 1 year, 3years or 5 years for committing abortion with pregnancy of 12 weeks, 25 weeks and beyond 25 weeks respectively was provisioned in the Muluki Ain. The revision in 1963 banned abortion except when the woman’s life was at risk. Up to one-fifth of women in Nepali prisons before 2002 were convicted on the basis of illegal abortion, with many branded as murderers (homicide).

Even though the new abortion law legalized the abortion under specified conditions, the ingrained fear and stigma still prevails in the society and many women are still terminating pregnancy by unskilled persons to maintain privacy and secrecy. Nonetheless, legalization of safe abortion in Nepal in 2002 has gradually paved its way in our nation. 

First National Safe Abortion Day was celebrated on 26th September 2015 in Nepal. Safe abortion care is integrated in safe motherhood program of Nepal to make it more accessible and acceptable. Safe abortion service is scaled up in all the districts up to primary health care center level (PHCC).

Abortion law:

The new law legalizes abortion under the following conditions:

·      Up to 12 weeks of gestation on the request of the pregnant women.

·      Up to 18 weeks of gestation in case of rape or incest.

·      At any gestation if the pregnancy is detrimental to the pregnant women's physical and mental health as certified by an expert physician.

·      At any gestation if the fetus is suffering from a severely debilitating or fatal deformity as certified by an expert physician.

·      Listed medical practitioners will provide comprehensive abortion care services.

·   Only the pregnant woman holds the right to choose to continue or discontinue the pregnancy. 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.

·      The law prohibits termination of pregnancy of any gestation for the sole purpose of sex selection and there is provision of punishment to parties, care provider and the individual doing abortion if this is done with sole purpose of sex selection.

Picture 1: Nepali Safe Abortion Logo

All the pregnancy doesn’t end into a viable baby. From the period of conception to the full term of the pregnancy, various outcomes might occur. One of the outcomes of the pregnancy is abortion. Abortion might be induced or spontaneous. Many women conceive unwanted and untimely pregnancy as they lack comprehensive knowledge to practice contraceptives and they will be obliged to induce abortion. Likewise ignorance, unavailability and inaccessibility of contraceptive services, failure of contraceptives force many couple to have induced abortion. Unlike the past period when the fertility was very high and joint family was almost universal, nowadays our desire of children is determined by the decreasing fertility trend. There is a social pressure to small family norm and having a child is economically challenging as well as the steep childcare cost and women’s involvement in the formal employment sector equally pressurize the need of small family size demanding careful family planning and contraceptive utilization.

We must celebrate the national and international commitment to make abortion care accessible to its citizen in short span of time after legalization of abortion through the efficient utilization of existing health workers such as staff nurses and ANMs as service providers in the health system. Legalization of safe abortion has certainly played pivotal role in decreasing pregnancy associated mortality and morbidity, reducing fertility and alleviating many other complications. However, Abortion shouldn’t be used as a method of contraception and family planning. It is not totally free of adverse effects. Occasional hemorrhage, accidental uterine injury, infections and stress and anxiety may deteriorate women’s health sometimes. Abortion is an option but not the solution. Effective use of contraceptives, its easy availability and accessibility assist in averting many abortions and its complications.

What is unsafe abortion?

An unsafe abortion is “a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both” (World Health Organization 1992). About 20 million, or nearly half, of the induced abortions annually are estimated to be unsafe. As opposite to unsafe abortion, safe abortion is a medical intervention to terminate the pregnancy by skilled trained health care professional in a well-equipped environment meeting all the minimal medical standards.

Why right for Safe abortion is required?

·      Every year 22 million unsafe abortions occur in the world, resulting in the death of an estimated 47000 women and disabilities for an additional 5 million women (Source: Safe abortion: technical and policy guidance for health systems, WHO 2012).

·      Everyone is entitled to sexual and reproductive rights.

·      Clinical indications like

o   Genetic abnormality in the fetus

o   Gestational

o   Cardiovascular diseases such as sever hypertensive disorders

o   High risk of uterine injury

o   Trophoblastic disease

o   End-stage cacers, end stage AIDS

o   Rupture of membranes befor fetal viability

o   Intrauterine infection

What are the consequences of unsafe abortion?

When the abortion was not legalized, it was difficult to estimate the maternal mortality related to abortion. However, many of the deaths were associated with unsafe abortion. Many of the deaths and complication might have gone undocumented.

The common complications following unsafe abortion are Hemorrhage, infection, sepsis, trauma, necrotic bowel, poor wound healing, infertility, consequences of internal organ injury (urinary and stool incontinence from vesicovaginal or rectovaginal fistulas and bowel resections), phychologic damage

Concept of reproductive health rights

International Planned Parenthood Federation (IPPF) recognizes and believes that the right to decide whether or when to have children is implied by the right that all persons have, to decide freely and responsibly the number and spacing of their children and to have access to the information, education and means to enable them to exercise this right, and further recognizes that special protection should be accorded to women during a reasonable period before and after childbirth, and, therefore, commits itself to the following: (IPPF Charter on Sexual and Reproductive Rights, 1996)

1. All women have the right to information, education and services necessary for the protection of reproductive health, safe motherhood and safe abortion and, which are accessible, affordable, acceptable and convenient to all users.

2. All persons have the right of access to the widest possible range of safe, effective and acceptable methods of fertility regulation.

3. All persons have the right to be free to choose and to use a method of protection against unplanned pregnancy, which is safe and acceptable to them.

Reproductive rights, according to the ICPD, "rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health." There should be equality of men and women with regard to "the same rights to decide freely and responsibly on the number and spacing of their children, and to have access to the information, education and means to enable them to exercise these rights." Reproductive rights, according to the ICPD, also include the right "to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents."

Sources:

Lisa B Haddad, Nawal M Nour. Unsafe Abortion: Unnecessary Maternal Mortality. Rev Obstet Gynecol. 2009; 2(2): 122–126.

Family Health Division, Department of Health Services, Ministry of Health and Population. National Safe Abortion Policy. Final Draft, August7, 2003

 Ghazaleh Samandari, Merril Wolf, Indira Basnett, Alyson Hyman, Kathyryn Andersen. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care. Reproductive Health.2012. 9:7.

Center for Research on Environment Health and Population Activities (CREHPA): Women in Prison in Nepal for Abortion: A Study on Implications of Restrictive Abortion Law on Women’s Social Status and Health Kathmandu; 2000.