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June 21, 2007
Woman with doctor
Since Nepal changed its law earlier this decade, trained physicians can now provide safe abortion care to women.
Photo courtesy of Richard Lord.

Since Nepal liberalized its abortion law in 2002 and introduced comprehensive abortion care to its citizens, more than 105,000 safe abortions have been performed.

Those statistics are more than just a number. They represent what can be done when governments, nongovernmental organizations and the health sectors work together to guarantee women’s reproductive health and save countless lives. And in Nepal, the provision of safe abortion care marks great progress accomplished during a time of civil unrest between the government and Maoist rebels.

Take the case of Sindhupalchowk, a remote district that borders Tibet.  It is home to about 347,000 people, most of whom survive on less than US$ 1 per day.  In 2006, the Technical Committee for Comprehensive Abortion Care (or TCIC, the Department of Health Services body responsible for implementing safe abortion care) trained physicians working in this district and set up the Gaurishanker clinic. 

Before long, the clinic was caught between the army and rebels. Riddled with bullets, it was shuttered, once again cutting off the district’s residents from essential health care.  But in January 2007, TCIC trained two private physicians working in a neighboring area and engaged them to care for Sindhupalchowk’s citizens.

The doctors left their families in the capital, Kathmandu, in order to offer high-quality safe abortions to the poorest of the poor.  As these health-care professionals provided abortion care and managed complications from pregnancy and delivery, they gained the trust of the community and women are increasingly choosing their clinic rather than unsafe providers when they seek abortions. TCIC monitoring suggests that the Gaurishanker clinic is among the best of the 165 approved sites that provide comprehensive abortion services in the country, said Indira Basnett, Ipas’s Nepal project manager.

Before 2002, the Himalayan country of Nepal had one of the world’s most restrictive abortion laws. Under no circumstances were women allowed to terminate a pregnancy, and those who did — or were simply suspected of doing so — could land a sentence in the country’s prisons.  In 2000, it was estimated that up to a fifth of jailed women were incarcerated for seeking abortions.

Not surprisingly, Nepal also had one of Asia’s highest ratios of pregnancy-related deaths; in the late 1990s, the maternal mortality ratio (MMR) topped 530 deaths per 100,000 women and in 1998, it was estimated that more than half of gynecological and obstetric hospital admissions were due to abortion-related complications.

By the time the 2006 Nepal demographic and health survey was released, the MMR estimate had plummeted to 281. Dr. B.K. Subedi, director of Nepal’s Family Health Division, has said that availability and use of safe abortion care might be one of the factors in the significant decrease.  

The provision of safe abortion care and the MMR decrease would not have been possible without legal change. In 2002, the Parliament approved sweeping  legislation to improve women’s status, including allowing abortion in a wide variety of circumstances up to the 18th week of pregnancy.

As part of a Safe Motherhood program, Ipas works with His Majesty’s Government and the Technical Committee for Comprehensive Abortion Care to institutionalize comprehensive abortion care (CAC), a model that includes pre- and postabortion counseling as well as provision of contraceptives to prevent repeat unwanted pregnancies, throughout the country.

Providing more than 100,000 safe abortions — and therefore helping reduce maternal deaths due to botched procedures by traditional or untrained providers — is not the only accomplishment of the partners working hard to implement safe abortion care in Nepal.

As of December 2006, 71 of Nepal’s 75 districts, even those in relatively remote regions, have trained abortion providers — a remarkable achievement of a national training program in which Ipas has been instrumental.  The sites that now have trained staff include government-operated family planning clinics, those operated by nongovernmental organizations such as Marie Stopes International, and private clinics.

Introducing CAC in the public health system has influenced the private health system as well. In the six months between June and December 2004, the number of patients treated using the comprehensive abortion care model  jumped in private facilities, whose caseloads continue to outpace their public counterparts.

Basnett said improving access to safe abortion care is a long-term enterprise.

“Change doesn’t happen overnight, and we acknowledge a long road ahead – in making sure there are enough providers committed to meet demand; that abortion is within reach of poor, marginalized and rural women; and that communities know about the services available to them.”

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258