Ensuring Women’s Health and Rights: Navigating the Landscape of Safe Abortion in Nepal 

Writer: Sailtaaj Kunwar

In the domain of women’s health and reproductive rights, the discourse on safe abortion remains a critical and often controversial issue. The conversation around safe abortion has gained prominence in recent years. This article delves into the multifaceted aspects of safe abortion in Nepal, exploring the legal framework, societal perceptions, and the challenges that persist and the stigma around which our society revolves. Through a comprehensive understanding of these elements, we aim to shed light on the importance of promoting safe and accessible abortion services to safeguard women’s health and her rights. 

Nepal has made significant progress in recognizing and addressing the reproductive rights of women. In 2002, the country took a groundbreaking step by legalizing abortion under specific circumstances through the “Abortion Act.” This legislation permits abortion up to 12 weeks of gestation (the process or period of developing inside the womb between conception and birth) on request, up to 18 weeks in cases of rape or incest, and at any time during pregnancy if the woman’s life or health is at risk or if the fetus is found to have severe abnormalities. 

While the legal framework is progressive, challenges persist in ensuring widespread awareness and implementation. Access to safe abortion services can be hindered by factors such as geographic remoteness, limited healthcare infrastructure, and a lack of trained medical professionals. As a result, there is a crucial need for advocacy and education to bridge the gap between the legal provisions and the practicalities of accessing safe abortion in diverse communities across Nepal. 

Healthcare Infrastructure and Accessibility

While the legal framework exists, the practical accessibility of safe abortion services remains a challenge. Rural and marginalized communities often face obstacles in accessing adequate healthcare facilities and trained medical professionals. The lack of comprehensive sexual education further worsen the issue, as women may be unaware of their rights or the available services. 

Investment in healthcare infrastructure, particularly in rural areas, is essential to ensure that women across Nepal have equal access to safe abortion services. This involves not only the availability of trained healthcare professionals but also the establishment of counseling services to support women through the decision-making process. Moreover, investments in healthcare infrastructure, particularly in remote regions, are essential to ensure that safe abortion services are accessible to all. 

Source: WHO website 

Nepal legalized safe abortion service in 2002. The Government of Nepal enlisted reproductive rights in the country’s constitution in 2015. In 2018, Nepal passed the Right to Safe Motherhood and Reproductive Health Act 2018, which ensures the right to safe abortion for all women. 

However, awareness of the legalization of abortion is low. As of 2016, the contraceptive prevalence rate was 52.6% (Nepal Demographic and Health Survey). As of 2014, over 62% of unintended pregnancies ended in abortion, and an estimated 58% of all abortions were unsafe (Source: Guttmacher 2017, Abortion and unintended pregnancies in Nepal). Services including safe abortion are provided without cost in Nepal, but as of 2021, according to the Nepal Health Facility Survey, just 19.2% of health facilities offer abortion care services. 

There is a need for extensive outreach so services can reach everyone, anywhere. 

Through these glimpses into the daily lives of Nepal’s dedicated health workers in rural areas, we understand the critical role they play in providing quality abortion care and post-abortion contraception. These individuals are instrumental in implementing Nepal’s Safe Motherhood and Reproductive Health Act of 2018, ensuring every woman’s access to education, information, counseling, and services related to sexual and reproductive health. Their unwavering dedication and compassion underscore Nepal’s commitment to the reproductive rights of its women. 

What is the Abortion Guideline in Nepal? 

Abortions up to 12 weeks of gestation by surgical evacuation or manual vacuum aspiration can only be provided by trained doctors including MBBS doctors. Beyond 12 weeks and up to 28 weeks of gestation, abortion can only be performed by trained postgraduate doctors including obstetrician/gynecologists or MDGP doctors.

Source: Center for Research on Environment, Health and Population Activities (CREHPA) June 13, 2022. 

Since 2017, all abortions at public-sector hospitals are provided free of cost. 

All public-sector health facilities receive unit costs (as reimbursements) from their respective provincial government for the provision of free abortion care—800 Nepalese rupees (NPR) for abortions up to 12 weeks’ gestation, NPR 2,000 for abortions at 13–28 weeks and NPR 3,000 for management of complications of induced abortion. 

Through all of these efforts, about 90,000 women and girls obtain safe abortion services each year. Maternal mortality and morbidity in Nepal have declined as a result. The maternal mortality ratio has dropped substantially, from 539 maternal deaths per 100,000 live births in 1996 to 239 per 100,000 in 2016. The severity of complications from unsafe abortion has also been drastically reduced over the years. 

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In the case of Nepal, as in many other societies, stigma surrounding abortion is multifaceted and often intertwined with cultural, religious, and patriarchal norms. 

Cultural and Religious Influences: 

Cultural and religious beliefs play a significant role in shaping societal attitudes toward abortion. In Nepal, where Hinduism is the predominant religion, cultural norms often emphasize the virtue of life, which can contribute to the stigmatization of abortion. The idea that terminating a pregnancy goes against religious teachings may lead to judgment and boycotting of women who seek abortion services. 

Patriarchal Norms:

Patriarchal structures within societies contribute to the stigmatization of abortion by perpetuating gender norms and expectations. Women who choose abortion may face judgment for deviating from traditional roles and expectations related to motherhood. The stigma surrounding abortion is often linked to societal notions of women’s roles as caregivers and bearers of children. 

Profit From Limiting Access: 

Various entities, including conservative political and religious groups, may profit from limiting access to abortion. Restrictive abortion laws or social stigma can be leveraged for political gain or to reinforce conservative ideologies. By creating barriers to access, these groups may seek to control and regulate women’s reproductive choices, often under the guise of moral or religious principles. 

Mis- and Disinformation: 

Misinformation and disinformation about abortion contribute significantly to the stigma surrounding the topic. In Nepal, as in many other places, false narratives, myths, and misconceptions about the safety and consequences of abortion persist. This misinformation can be disseminated through various channels, including communities, media, and online platforms, influencing public opinion and perpetuating stigma. 

Disinformation may also be strategically spread by groups with vested interests in maintaining the status quo. Anti-abortion advocates may disseminate false information to discourage women from seeking abortion services, portraying it as dangerous or morally wrong. This intentional spreading of misinformation serves to manipulate public opinion, maintain societal stigma, and limit access to safe abortion. 

Fear of Legal Consequences: 

In some cases, fear of legal repercussions contributes to the stigmatization of abortion. Even when abortion is legally permitted under certain circumstances, the ambiguity of the law or lack of awareness about legal rights may lead women to fear legal consequences. This fear can prevent women from seeking safe and legal abortion services, pushing them towards unsafe and clandestine procedures. 

Societal Norms and Judgment: 

Societal norms and judgmental attitudes towards women who choose abortion contribute significantly to the stigma. Women may fear being labeled as immoral or facing social exclusion if their decision to have an abortion becomes known. This fear of judgment can create a culture of silence, where women are reluctant to openly discuss their reproductive choices, further perpetuating the stigma. 

In addressing the stigma surrounding safe abortion in Nepal, it is crucial to engage in comprehensive education and awareness campaigns that challenge myths, provide accurate information, and foster open conversations. Additionally, advocating for legal reforms and policies that prioritize women’s reproductive rights and destigmatize abortion is essential to create an environment where women can make informed choices about their reproductive health without fear of judgment or repercussions. 

Furthermore, this article advocates for the promotion of safe abortion services through a rights-based approach. It emphasizes collaboration among various stakeholders to ensure that women have the right to choose abortion. The government is urged to incorporate stigma-free and youth-friendly safe abortion services, along with post-abortion care, into Reproductive Health directives at both national and provincial levels. 

In a nutshell,the central point of this article is for strategic investments by the government and civil society to enhance the capacity of both central and local government as well as service providers in addressing the unique needs of young people seeking abortion services. Key considerations include maintaining privacy, reducing waiting periods, adopting a non-judgmental approach, ensuring quality assurance, and promoting a stigma-free environment. The government is urged to regulate abortion services provided by pharmacies and medical stores through appropriate training and registration processes to expand the outreach of safe abortion services. In addition to offering free abortion services, the government should increase the number of safe abortion delivery sites to enhance affordability and accessibility to create a safe psychological space to ensure safe abortion for women in Nepal.