Eliminate unsafe abortionIn Nepal, abortion is legal and provided free of cost in government health centres.
An abortion is the ending of a pregnancy by the removal or expulsion of the embryo or fetus before it can survive outside the uterus. Nepali women were granted abortion rights in 2002; and in 2004, abortion service was expanded throughout the country. In 2009, medical abortion service was introduced. There were 1,124 government and non-government hospitals and health institutions providing safe abortion services as of 2016-17. Both manual vacuum aspiration and medical abortion services are used for safe abortions in Nepal. All legal provisions need to be fulfilled in order to perform abortions, and the health institution should have the logo of safe abortion service.
Between 2002 and 2017, almost 1 million women received safe abortion services. Research conducted by the Centre for Research on Environment Health and Population Activities in 2014 revealed that 42 percent of the women who received an abortion chose safe abortion while the rest went to unregistered health institutions and health workers. Why? This is a big question, but there might be different answers. No one has thought why women choose unsafe abortion at illegal centres despite the right to safe abortion. According to the World Health Organisation, common barriers to accessing safe abortion are restrictive laws, poor availability of services, high cost, stigma and conscientious objection of healthcare providers. In Nepal, abortion is legal and safe abortion service is provided free of cost in government health centres.
Who chooses abortion? The answer might vary depending on the case. It is commonly believed women who become pregnant from illicit physical relations have abortions. Most people ask about the number of women who come for abortion under different circumstances. However, the reality is different. Rita Ghimire (name changed) is 35 years old and lives in a nuclear family consisting of her husband, 15-year-old daughter and 12-year-old son. Due to a financial crisis, her husband recently flew to the Gulf for employment. After her husband obtained his visa, she stopped taking pills and became pregnant. She was in a dilemma about what to do next. As her daughter was in her mid-teens and her husband was abroad, she did not have any option but to have an abortion.
Ramila is a 25-year-old working person. She delivered a child a year ago via C-section. As she was lactating, she did not see the need to use temporary family planning, and she became pregnant. The danger of delivering another child via C-section within a year and difficulties in getting maternity leave at the office compelled her to choose abortion. Rita and Ramila are just a few examples. Many women choose abortion for various reasons. Some might have office and leave problems, others might have exam stress, domestic problems and other issues, including financial problems. Different problems and different circumstances lead women to choose abortion.
There are examples of divorced women with money problems choosing abortion. There are a few cases of pregnancy resulting from the failure of family planning methods or rape, or an unwanted child, leading to abortion. There are only a few cases of unmarried women, widows and women having extra-marital affairs or illicit relationships choosing abortion. Whatever be the reason, social stigma pressures women into having unsafe abortions. Sometimes ignorance about safe and legal abortion services too leads women to go for unsafe practices.
What the law says
The law allows a woman who has crossed 18 years of age to have an abortion within 12 weeks of pregnancy. If a woman is pregnant because of rape, or if the mother or child will have a life-threatening or mental problem, she can have an abortion within 28 weeks of pregnancy upon the recommendation of a registered medical officer. Whatever the reason for having an abortion, the law has provisions for safe abortion from licensed institutions and authorised medical officers. Unfortunately, only 41 percent of the women are aware that they have a right to have safe abortions, according to a survey. As they are not well acquainted with their legal right, there is a high possibility of unsafe abortions from unregistered medical officers in unauthorised institutions. In such a situation, they may not only face health issues and sometimes even life-threatening risks, but they could be cheated financially.
Safe abortion is the only option. One should choose abortion to avoid the birth of an ‘unwanted’ child. However, we can avoid the need to have abortions by using various family planning methods. It is not necessary that all couples should or need to use similar family planning methods or have similar circumstances. They should consult an expert to choose the best option for them. If a couple have a complete family and do not want another child, they can go for permanent family planning methods.
Shah is an obstetrician/gynecologist at Morang Cooperative Hospital.