Nepal Medical Council, which formed a six-member team to investigate the death of a woman earlier this month following an abortion, suspended the licence of Dr Satish Rupakheti, who carried out the procedure. The council also recommended sealing of the clinic and pharmacy with immediate effect.

A member of the team dispatched to Butwal for the investigation said that abortion was not carried out in accordance with standard treatment protocols. The clinic, where the abortion was carried out, and the pharmacy that sold medicines were not registered, and treatment records were not maintained properly.

“The clinic, which has been running illegally, poses a serious threat to the safety of other patients as well,” said council registrar Dr Satis Kumar Deo, who is also a member of the probe team and was on his way to Kathmandu from Bhairahawa. “So we have suspended the doctor’s licence and recommended sealing of the clinic.”

A virtual meeting of the Council’s office bearers and officials was held on Saturday following the preliminary probe report. The meeting decided to suspend the doctor’s licence and take action against two health facilities—Zonal Pharmacy and Indulekha Health Clinic.

A 29-year-old woman from ward 2 of Bagnaskali Rural Municipality in Palpa died on April 19 while undergoing an abortion procedure at around 14 weeks of pregnancy. Her family, however, has claimed that the pregnancy was 12 weeks.

The probe report indicates that the gestation period exceeded 13 weeks.

The investigation found that Zonal Pharmacy had supplied abortion medication, and that Indulekha Health Clinic was involved in the procedure despite not having official approval to provide such services.

According to Deo, the probe team has also recommended actions against health workers involved in the case. He said that the decision to suspend the doctor's licence was in line with the Medical Code of Ethics 2017 and will remain in place until the final report is prepared.

The Butwal case has once again renewed concerns among doctors and public health experts to the unsafe use of medical abortion kits and gaps in abortion services in Nepal, despite the procedure being legal for over two decades.

Doctors say hundreds of women across the country suffer from serious side effects, or even die, after using medical abortion kits or seeking abortion services at under-equipped health facilities. Even so-called “safe abortion” is never completely risk-free and abortions carried out by use of over-the-counter medicines are unsafe, which must be stopped immediately, according to doctors.

Abortion was legalised in Nepal in 2002, a milestone for women’s reproductive rights, their empowerment, and their right to bodily autonomy. With legalisation, persecution and jail terms for women who terminated unwanted pregnancies ended and unsafe abortions fell markedly.

According to the latest census report six percent of maternal deaths are linked to abortion or miscarriage.

Every year, around 100,000 women undergo abortions at legally-authorised clinics and health facilities in Nepal. Gynaecologists, however, say the actual number could be much higher, as many abortions, especially the medical abortions, go unreported.

According to a recent UNFPA report on the “neglected crisis of unintended pregnancy”, half of the 1.2 million pregnancies in Nepal in 2017 were unintended and nearly 359,000 were terminated.

The report further stated that “the toll of these pregnancies is—and has long been—unseen”.

Doctors suspect that ‘medical abortion kits’—designed to terminate pregnancy within nine weeks—are being misused as a contraception tool.

Between 1996 and 2016, the maternal mortality rate in Nepal fell from 539 to 239 per 100,000 births, with the country achieving the Millennium Development Goal—a feat for which the legalisation of abortions played a significant role, doctors say.

Nepal has reduced maternal deaths by over 70 percent since 2000, according to a WHO report.

The UN health body’s report says that 142 Nepali women currently die from maternity-related complications per 100,000 live births.

Under the UN’s Sustainable Development Goals, the target is to reduce the maternal mortality rate to 75 per 100,000 live births by 2030.

Doctors say it will be difficult to further reduce maternal deaths unless deaths caused by abortion and unsafe abortion are prevented.

Section 4 (15) of the Safe Motherhood and Reproductive Health Rights Act allows abortions as late as 28 weeks in cases of rape, incest, serious health risks to the mother or if the fetus is found to have genetic defects. General abortions can be conducted at up to 12 weeks, according to the Act.