abortion services in Nepal and legal law to reduce abortion among teenage pregnancy

1. Safe abortion services,
effectiveness of legislation to
control teenage pregnancy
Swornim Bajracharya
067/BPH/19

3. Overview
• Introduction/ Background
• Rationale
• Situation
• Objectives
• Findings
• Conclusion
• Recommendations
• References

5. Introduction
• Abortion is the termination of a pregnancy before the
fetus has attained viability, i.e. become capable of
independent extra-uterine life.
• Induced abortion is the deliberate termination of a
pregnancy before the fetus has attained viability, i.e.
become capable of independent extra-uterine life.
• Spontaneous abortion is the spontaneous termination of
a pregnancy before the fetus has attained viability, i.e.
become capable of independent extra-uterine life. This
is often referred to as a miscarriage.
--WHO, 2006

6. WHO defines unsafe abortion as:
“a procedure for terminating an unintended
pregnancy either by individuals without
the necessary skills or in an environment
that does not conform to minimum
medical standards, or both.”

7. Teenage pregnancy
• Teenagers (adolescent) is defined as being
between 10 -19 years, encompassing the
entire continuum of transition from childhood
to adulthood.
• Teenage pregnancy can be defined as
pregnancy in a woman aged 10–19 years.
• Teenage pregnancy is a rising public health
issue being faced by many countries globally.

8. Abortion legalization
• Abortion was legalized in Nepal under the 11th
amendment to the Country Code (Muluki Ain)
in March 2002, receiving royal assent in
September 2002.
• The law enables women’s rights to control
over and decide on their unintended
pregnancies.

9. Abortion is legal in Nepal on the following
grounds:
1) Up to 12 weeks of gestation for any woman;
2) Up to 18 weeks of gestation if pregnancy
results from rape or incest; and
3) At any time during pregnancy, with the advice
of a medical practitioner or if the physical or
mental health or life of the pregnant woman is
at risk or if the fetus is deformed and
incompatible with life.

10. Abortion will be punishable on the following
two conditions:
1) Sex selective abortion, and
2) Abortion without the consent of the pregnant
woman.
The provision of jail from 3 to 6 months fro the
individual responsible and service providers
and additional 1 year if sex selective abortion.

11. Safe abortion services
• Preventing unwanted pregnancies through
quality family planning services is a first step
towards addressing women's reproductive
health needs
• A comprehensive approach needs to be
integrated between three services, family
planning, safe abortion and post abortion
care.

12. • Ensuring the availability of comprehensive
abortion care (CAC) that refers termination of
unwanted pregnancies through
• safe technique with effective pain management,
• post procedure family planning information and
• service to ensure women are able to plan when
to have children and avoid further unwanted
pregnancies

13. • Only trained doctors or health workers can
provide safe abortion services at the
government accredited health facilities, with
the consent of women and based on the
criterion spelled in the safe abortion service
guideline

14. Rationale
• Unsafe abortion is one of the vital cause of
maternal mortality.
• Teenager’s health is hugely affected by unsafe
abortion.
• The knowledge and information about
legalization of abortion is very low.
• Awareness regarding hugely helps to reduce
teenage pregnancy and reduce complications

15. Situation
Source: ASAP(Asia Safe Abortion
Partnership)

16. Globally
• WHO estimates that globally nearly 68,000
women die from complications of unsafe
abortion each year.( WHO,1998)
• The unsafe abortion rate for Asia is 13 per
1,000 women aged 15-44 years, and the ratio
is 14 unsafe abortion to 100 live births (WHO,
2004).

18. Nepal
• Nepal has one of the highest maternal deaths
(539 per 100,00 live births) among SAARC
countries. It is estimated that over half of the
maternal deaths are due to unsafe abortions.
• Despite the highly restrictive abortion law,
every year thousands of induced abortions are
performed illegally in the country.

19. • As the Nepalese youths are being also
involved in early-age sexual and reproductive
activities, the incidents of unwanted
pregnancies are on rise in our country and
finally the cases of abortions, whether legal or
illegal, are also on rise

20. • The number of teenagers undergoing abortion in
the Valley almost doubled in 2009 as compared
to 2008. Some teenagers undergoing abortion
were as young as fourteen.
A joint study of annual reports of Maternity
Hospital and Family Planning Association of Nepal
(FPAN) shows that 581 teenagers underwent
abortion in 2008, while the number stood at
1,065 in 2009.
Source: Republica,aug 7 2010

21. • Everyday at least 65 teenagers seek for abortion
services in hospitals. This figure has increased
two fold compared to previous years (from 2010).
However, the figure may be an underestimate as
many pregnant teenagers may not seek abortion
care in formal hospital (Nepal Matribhumi
Khabar, 2012)
• Additionally, the Health service division under the
MoHP revealed that 95,000 abortions were
carried out in 2010/11 where 25% of those were
in teenagers

23. Abortion by 14-year-old
Some two years ago, a girl of 14 aborted a fetus
at FPAN. She was seduced by a man who was
much older than her, and whom, she called
elder brother, according to Ashwini Rana, a
counselor at FPAN. Upon getting her pregnant,
the man fled and was no where to be found.
Further details however were not known.

24. Objectives
• To review unsafe abortion practice after the
legalization
• To discuss about the safe abortion services
available
• To discuss about the necessity of safe abortion
to control teenage pregnancy

25. Asap-asia.org

26. Unsafe abortion after legalization era
• Even after a decade of Legalization of abortion
in Nepal, unsafe abortion practices are
prevalent in the society.
• 66% of the women receiving post abortion
care in tertiary hospitals chose unsafe methods
for abortion.
• 44% of the women do not have knowledge
about the legalization of abortion.

27. • Recently conducted study in terai and hilly region
showed that only 61% people know that abortion is
legal and 39% are still unknown about it.(fb page:
nepaliphworkernepal,posted on 19th july, 2014)
• The practices from uncertified institutions that go un-
reported are usually unsafe.
• MoHP revealed that abortion is high and increasing.
There were 95,000 cases reported in 2010/11 where
25% were teenagers but this is only the tip of the
iceberg (Parakhi, 2012a). Despite the legalisation of
abortion, many women risk their health in unsafe and
illegal abortions (Trustlaw, 2012)

28. CAC services
• The increasing trend in abortion utilization
shows that more and more women are
seeking safe abortion services.
• In FY 2069/70 alone a total of 195 service
providers have been trained on safe abortion
services.
• 84,011 women received safe abortion service
from 574 listed sites
Source: annual report 2069/70

29. Safe abortion services
• In public, there are 96 and in private 108 sites are
available during 1st trimester
• Similarly in public, 4 in higher referral hospitals and 2
sites in private during 2nd trimester
• Most Govt. managed abortion clinics (CAC centers at
government hospitals) charge Rs 1,000 as abortion fee.
Few government CAC centers charges Rs 800
• The abortion fee at NGO managed CAC centers range
between Rs. 950 to Rs. 1350 In private CAC centers, it
ranges from Rs 1500 -Rs. 3000
Source: CREPHA COUNTRY PROFILE

30. Trends of Adolescent Fertility Rate,
Nepal
127
110
98
81
0
20
40
60
80
100
120
140
1996 2001 2006 2011
Source: NDHS 2011
Note: The target for 2015 is 70 per 1,000 ABR

31. Legislation control teenage pregnancy
• In 2008 and 2009, Maternity Hospital provided
abortion service to 60 and 191 teenagers
respectively. On the other side, FPAN helped 521
and 874 teenagers undergo abortions in the
respective years.
• "One reason behind the increased rate of
abortion is the availability of safe abortion
services," Ashwini Rana of FPAN, who has been
working as a counselor for the past two decades
said.

32. Conclusion
• Legalization of abortion alone has not made it safe.
• Women today still lack adequate access to safe and
legal abortion.
• Many of them are unaware about the legalization of
abortion and services being provided.
• They need to be aware of the services and legalization
• In 2002, abortion was legalized in Nepal and many
public hospitals since then have been providing the
service. It has become a safe choice for women to end
unwanted pregnancies.

33. Recommendations
• Many women in Nepal are still not aware that abortion
is now legal in Nepal and the stigma attached to it is
still widespread. So they should make aware the
common people of these issues at the earliest
• Education on Sexual and Reproductive Health should
be provided within the family, community and training
institutions.
• Education on SRH should be initiated from school level
• Family planning services should be made available,
accessible and affordable to all women, men and
adolescents of reproductive age;

34. • Youths should be paid with special attention.
• Abortion should not be considered as an ill
method or the murder of an unborn human
being
• Laws concerning rape should be made stricter,
its enactment ensured and furthermore the
punishment should be increased

35. References
• Unsafe Abortion Nepal Country Profile- 2006 MoHP,
Nepal, WHO, CREPHA
• Unsafe abortion after legalisation in Nepal: a cross-sectional
study of women presenting to hospitals 2010-2011
• National Safe Abortion Policy 2002 , MoHP
• Asap-asia.org
• Archives.myrepublica.com
• Teenage pregnancy in Nepal: consequences, causes and policy
recommendations -2012,Akina Shrestha, Nepal
• Annual report 2069/70
• Abortion in context of Nepal-2010, Jaya Jung MAHAT
• http://abortionnepal.tumblr.com/(2014/7/21)

37. Thank you