The Helms amendment is a law barring U.S. foreign assistance from being used for abortion services. This fact sheet describes the negative impact of the Helms amendment in Nepal. The country liberalized its abortion law in 2002 and the right to safe motherhood and reproductive health was guaranteed by the 2015 Constitution. In 2018 the Right to Safe Motherhood and Reproductive Health Act further ensured that women and girls in Nepal have the right to access safe, legal abortion free of charge at public health facilities. Yet due in great part to U.S. funding restrictions like the Helms Amendment, Nepal’s reproductive health care provision is fragmented and needlessly inefficient, putting the most burden on women and girls seeking abortion care.
This policy brief has been developed in consultation with experts in India after a careful review of the Indian context and mapping it with the WHO Guidelines on ‘Health worker roles in providing safe abortion care and post-abortion contraception’ released in 2015. The policy brief highlights legal and policy recommendations for strengthening women’s access to comprehensive abortion care in India.
For women in India, access to abortion has been marred by extreme stigma, lack of awareness about its legality, unavailability of safe services near the community, and high costs charged by providers. Unsafe abortion practices were the third largest contributor of maternal deaths in India. However, over the last decade, women who cannot access safe and legal services have moved to self-use of medical abortion (abortion with pills) — perhaps a better option than resorting to life-threatening means.
The pregnancy of a 10-year-old presents a complex and unprecedented situation but laws sensitive to the needs of the women and girls involved could make a world of a difference.
Determination of medical abortion eligibility by women and community health volunteers in Nepal: A toolkit evaluation
The objective of this study was to determine if pregnant, literate women and female community health volunteers (FCHVs) in Nepal can accurately determine a woman’s eligibility for medical abortion using a toolkit, compared to comprehensive-abortion-care-trained providers.
The shortage of trained providers and lack of facilities offering safe abortion services are two of the key contributors to unsafe abortion in India. Unfortunately, the one policy action that could address this acute public health crisis is yet to be taken – making the necessary legal and policy changes to permit nurses and non-allopathic doctors to offer early abortion services, after suitable training.
A mixed methods evaluation of the Youth Focused Social Network Initiative for safe abortion in Rupandehi, Nepal
The Youth Focused Social Network Initiative was a program to increase young women’s knowledge of and skills in accessing comprehensive abortion care in Rupandehi, Nepal from 2012-2014. The program trained peer educators to provide information and support related to comprehensive abortion care and encouraged adults to support youth in their communities. This study evaluated the effectiveness of the program and found that it had produced positive results in youth knowledge of and attitudes about comprehensive abortion care. Program expansion should be considered in light of continued need in Nepal.
While the courts deliver pro-women judgements around abortions, parliament has delayed passing much-needed amendments to the MTP Act.
Since the liberalization of Nepal’s abortion law in 2002, intensive provider training and facility support have proven successful strategies for increasing the availability of comprehensive abortion care (CAC) services in the country. However, little is known about the pathways through which women access safe abortion services. This publication presents research on how women in Nepal access safe abortion information and services, including evidence-based recommendations indicating that increasing contraceptive education and access to female community health volunteers can improve women’s ability to manage their reproductive health.
Improving health worker performance of abortion services: An assessment of post-training support to providers in India, Nepal and Nigeria
This paper reports the results of an intervention with 3,471 abortion providers in India, Nepal and Nigeria. Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period. The intervention also included technical assistance to and upgrades in facilities where the providers worked.
The Rohingya women and girls who have suffered sexual torture and humiliation and have now fled their homes most certainly deserve whatever care may alleviate some of their suffering. By not providing comprehensive reproductive health care, including contraception and safe abortion services, humanitarian agencies have taken a side, the side that opposes women’s human rights, the side that opposes science and common sense, the side that flies against established international agreements. Doing nothing speaks volumes.
Developing mHealth messages to promote postmenstrual regulation contraceptive use in Bangladesh: Participatory interview study
This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Participatory interviews were conducted with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh.
What factors contribute to postabortion contraceptive uptake by young women? A program evaluation in 10 countries in Asia and sub-Saharan Africa
This evaluation assesses the factors that influence contraceptive uptake among adolescents and young women seeking abortion care in health facilities. We analyzed client log book data from 921,918 abortion care cases in 4,881 health facilities in 10 countries from July 2011 through June 2015, and found that programmatic support to health systems, including provider training in contraceptive counseling and provision, was associated with women’s higher acceptance of postabortion contraception.
Gender biased sex selection and access to safe abortion: Frequently asked questions on interlinkages
This is an advocacy tool for implementing authorities, service providers and NGOs on safe abortion and sex selection.
This publication highlights the work in Nepal since legal reform a decade ago and puts a spotlight on the key ingredients for successful scale-up of abortion care, including partnerships with government and NGOs and integration of abortion within the country’s Safe Motherhood program.
Empowering women workers through youth-led education on reproductive health and safe abortion in Nepal
From 2011-2012, Ipas and our partners implemented a series of classes on sexual and reproductive health and rights (SRHR)—including information on safe abortion—for women who work at factories across Nepal’s Kathmandu Valley. This report explains how our project increased women workers’ knowledge of SRHR topics so they can better manage their own health and relationships and serve as resources for their families and communities. The report includes background information on Ipas’s work with youth, the context of sexual and reproductive health services for women workers in the Kathmandu Valley, details on the project’s various components, and explanation of key outcomes.
Enhancing the quality of abortion care: Successful initiatives to improve clinical skills and facility services
This report looks at initiatives in four countries—Nigeria, Nepal, Ghana and Zambia—where Ipas is working with governments, communities and other partners to provide clinical and programmatic support to providers and health-care facilities.
Correlates of contraceptive use four months post-abortion: Findings from a prospective study in Bangladesh
This study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions, and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling.
Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: A pre-post evaluation
In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care.