When a mentally impaired 21-year-old woman from Sindhupalchok was referred to the Paropakar Maternity and Women’s Hospital about two weeks ago for an abortion, doctors at the hospital duly conducted the abortion as the pregnancy was in the second trimester and the woman’s health was frail. But doctors went a step further and implanted the woman with Norplant, a hormonal contraceptive.

“We placed implants in the woman to avoid repeated pregnancies,” Suku Lama, chief of the post-abortion clinic and one-stop crisis management centre at the hospital, told the Post.

According to Lama, the woman had already undergone several abortions in the past, with most of the pregnancies resulting from rape. She had even given birth to a baby girl, who had been sent to an adoption centre. Due to repeated rapes, pregnancies and abortions, she was in a fragile health condition, which is why doctors decided to prevent any further pregnancies, said Lama.

Government officials and human rights activists, however, are alarmed that the hospital went so far as to implant hormonal birth control on a mentally impaired woman. This is a violation of a woman’s reproductive health right and does not address the core of the problem, which is that the woman has been raped multiple times, according to Sarmila Shrestha, an advocate and women’s rights activist.

Shrestha said that placing implants on mentally impaired women is by itself a form of violence.

“Such practices will encourage culprits to continue their violence. Rape cases will not stop,” said Shrestha. “Any physical relation with a mentally impaired woman can be considered rape as she is incapable of giving consent.”

In the hospital’s defence, Lama said the doctors had acted to safeguard the woman’s health.

“We do not know whether it was right or wrong to place implants on a mentally impaired woman,” said Lama. “We acted to avoid repeated pregnancies that threaten women’s health.”

In the Sindhupalchok woman’s case, doctors obtained consent from the woman’s parents, but in a number of other cases, doctors were found to have acted on their own. Nepal’s abortion law prohibits the use of contraceptives without consent.

A month ago, a 15-year-old girl from Dhading had hormonal implants put in, according to Lama. The teenager, who had a speaking disability, had gotten pregnant as a result of rape and was brought into the maternity hospital by a social welfare organisation. As a street kid, she was highly vulnerable to rape and had already undergone abortions, so the hospital thought birth control implants would safeguard her health, said Lama.

Likewise, Sangini, a hormonal injection that prevents pregnancies, was administered to another 22-year-old woman who was gang-raped in Dharan about two weeks ago in Sunsari. The woman was also mentally impaired so consent was taken from the woman’s parents, according to doctors.

Such hormonal implants are not a solution to rape, said one woman who works in the field of reproductive health who did not wish to be quoted as she required permission from the organisation she works in.

“The government should ensure protection for vulnerable women, instead of placing implants as an alternative. Women with mental health problems are highly vulnerable to rape and other kinds of gender-based violence,” she said. “This shows that the government is opting for an easy solution, but it is against the law and only aggravates problems.”

Implanting hormone control to prevent pregnancies is not government policy, said Dr Bhim Singh Tinkari, director of the Family Welfare Division at the Department of Health Services. Tinkari said that he is unaware of such practices at the Paropakar Maternity Hospital.

“We don’t have any policy of placing implants on mentally impaired women. Nor have we directed anyone to do so,” said Tinkari. “Health workers might have acted on humanitarian grounds.”

Section 3 (11) of the Safe Motherhood and Reproductive Health Rights Act, passed by Parliament in September last year, prohibits forcing, coercing and luring anyone into using family planning means. As the consent obtained from intellectually disabled women is not considered valid, placing implants is also against the law, a grave violation of human rights and against medical ethics, according to reproductive rights workers.

The ‘sterilisation’ of mentally impaired populations is condemned around the world. Explicit consent is required from the person involved. In 1990, the American College of Obstetricians and Gynaecologists had explicitly stated: “The primary or contributing indications for sterilisation (particularly surgical sterilisation) based on presumed or anticipated hardships to others must be viewed with great reservation and in light of acceptable alternate care arrangements which might be made for the mentally retarded [sic] individual.”

There is no evidence that permanent or temporary sterilisation prevents or even reduces incidents of sexual violence against women and instead, can have grave consequences on their physical, mental and emotional health.

Dr Sudha Sharma, former health secretary, however, said that doctors must’ve done what they did to prevent future health complications.

“When a mentally impaired woman is brought in for an abortion and gives consent for termination, it sends an implicit message that the pregnancy is unwanted,” said Sharma. “By placing implants, doctors did what they could have done to prevent more pregnancies.”

Sharma, however, said that pregnancies are just the tip of the iceberg when it comes to violence against mentally impaired women.

The intention of doctors might have been good but such implants are no solution to preventing rapes, according to Dr Bikas Devkota, chief of the Policy Planning and Monitoring at the Ministry of Health and Population.

“The government has been spending millions on family planning services and safe abortion services,” said Devkota. “These kinds of problems should be discussed and dealt with at the policy-making level. We need to find a way to ensure the safety of vulnerable groups.”