Nearly half of the pregnancies in Nepal are unintended and close to two-thirds of them ended in abortion, according to a recent report by the United Nations Population Fund (UNFPA).

The UNFPA’s “State of World Population 2022” report titled, “Seeing the Unseen”, says half of the 1.2 million pregnancies in 2017 in Nepal were unintended and nearly 359,000 were aborted.

“Unintended pregnancy is a reality for millions each year, accounting for nearly half of all pregnancies,” reads the UNFPA’s report. “Sixty percent of these unintended pregnancies will end in abortion.”

The UN agency’s report stated that the toll of these pregnancies is — and has long been — unseen.

Though we can estimate health-care costs, monitor school drop-out rates and project levels of workforce attrition due to unintended pregnancies, these only scratch the surface. No number could adequately represent the loss of life, agency and human capital that result from unintended pregnancies, the report says.

The report stated that many unintended pregnancies occur because a woman has lost, or never had, autonomy over her own body. Together, these numbers point unequivocally to persistent levels of gender discrimination and to deficits in human rights and development. These must be addressed to achieve the Sustainable Development Goals.

“Unintended pregnancy must not be framed as solely a women’s issue. Unintended pregnancy should not be seen as acceptable, inevitable or even desirable — as is at times suggested in places with concerns about falling population numbers,” reads the report.

Unintended pregnancy is often, tragically, linked to violence. Some 13 percent of ever-partnered women and girls, aged 15 to 49 years, have been subjected to intimate partner violence in the past 12 months, according to the report.

The report shows how unintended pregnancies result in additional social and fiscal burdens, including through greater demand for health care, unsafe abortion, loss of income and productivity, fewer resources for children in a family, and more fraught and unstable family relationships.

Nepal’s Ministry of Health and Population, however, said that it is unaware of the source of the data in the UNFPA report. Officials said that less than 100,000 women receive abortion services from across the country every year.

“So far no study has been carried out on the number of abortions being carried out in the country and on whether pregnancies are intended or unintended,” said Nisha Joshi, a senior Public health administrator at the Family Welfare Division under the Department of Health Services. “We are planning to secure funds to carry out such a study in the country but have not been able to do so as of now.”

Health Ministry officials say data on Nepal’s abortion status being used by many organisations and reports is based on a report published by a non-governmental organisation in 2014.

Abortion was legalised in Nepal in 2002, a milestone for women’s reproductive rights, their empowerment, and their right to bodily autonomy. The government provides free services and travel allowances from the many state-run health facilities throughout the country.

Pregnant women can seek termination of their fetus of upto 12 weeks and service providers have to assist them without questioning.

Safe Motherhood and Reproductive health Rights Act, endorsed by Parliament in 2018, allows abortion up to 28 weeks of pregnancy in case of rape, incest, serious health risk to the mother or if the fetus is found to have genetic defects.

Doctors have to certify that their pregnancy poses a serious risk to their lives or could seriously affect their mental and physical health, if the baby will be born with deformities, or if they are infected with HIV or similarly incurable diseases to undergo abortion after 12 weeks.

With legalisation, persecution and jail terms for women who terminated unwanted pregnancies ended and unsafe abortions decreased dramatically.

Consequently, between 1996 and 2016, the maternal mortality rate fell from 539 to 239, achieving the Millennium Development Goal—a feat for which the legalisation of abortions played a significant role, doctors say.

The report also stated that about 44 percent of women of reproductive age who want to avoid a pregnancy are not using a modern contraceptive method in Nepal. Use of modern methods of contraception among married women of reproductive age stands at 43 percent, leading to high rates of unintended pregnancy and unsafe abortion. Half of contraceptive users discontinue use within 12 months, according to the UNFPA report.

“Gender norms that prevent women and girls from exercising their reproductive rights is a key factor causing alarming rates of unintended pregnancies.”

Humanitarian emergencies including the impact of Covid in Nepal create conditions for unintended pregnancies to climb further, the report said.

Despite the legalization of abortion in Nepal, which contributed significantly to a decline in maternal mortality, the majority of abortions continued to be provided by untrained providers or induced by pregnant women themselves, the report stated, adding, many women and girls still face considerable structural and informal barriers to accessing safe abortion services in Nepal.

The report warns that this human rights crisis has profound consequences for societies, women and girls and global health. Over 60 percent of unintended pregnancies end in abortion and an estimated 45 percent of all abortions are unsafe, causing 5-13 per cent of all maternal deaths, thereby having a major impact on the world’s ability to reach the Sustainable Development Goals.

“This report is a wake-up call. The staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights,” says UNFPA executive director Dr Natalia Kanem.

“By putting the power to make this most fundamental decision squarely in the hands of women and girls, societies can ensure that motherhood is an aspiration and not an inevitability.”

Maternal health experts in Nepal said that whatever is mentioned in the UN agency’s report, does not match in Nepal’s context. They said that Nepal’s law empowered women to take the decision and has ensured autonomy about whether or not to continue pregnancies.

“Women in Nepal have the right to decide whether or not to continue a pregnancy and have access to services if they want an abortion,” Dr Bhola Rijal, a consultant gynocologists. “Many possible deaths from unsafe abortions have been avoided due to the legal provision.”