Safe abortion Services in Nepal

Safe abortion services in Nepal: Global and national evidence shows that many women face unwanted pregnancy including due to limited access to family planning information and services. Such women who cannot access safe abortion services in a timely way are at a high risk of developing complications due to unsafe abortions, or in the worst case, suicide due to social pressure. Thus, there is a need to make safe abortion services available, accessible and affordable to all women with unwanted pregnancies. Family Health Division (Now FWD) has defined the four key components of comprehensive abortion care as:

• Pre and post counselling on safe abortion methods and post-abortion contraceptive methods;
• Termination of pregnancies as per the national protocol;
• Diagnosis and treatment of existing reproductive tract infections; and
• provide contraceptive methods as per informed choice and follow-up for post-abortion
  complication management.

Nepal legalized abortion in September 2002  the procedural order was passed in 2003, and the first ever Comprehensive Abortion Care (CAC) service was started at the Maternity Hospital, Kathmandu, in March  2004. The new law grants women the right to a legal abortion on the following grounds:
1) Up to 12 weeks of gestation for any woman;
2) Up to 18 weeks of gestation in case of rape or incest.
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.
(National Safe Abortion Service Policy 2060 B.S.)

Comprehensive abortion care (manual vacuum aspiration [MVA]) services are available in all 75 district hospitals and majority of PHCCs. Additionally, second trimester abortion services are available in 30 hospitals where CEONC services are also available. Medical abortion (MA) services are being expanded in health posts through the additional training of SBAs. Medical abortion services have been expanded to 60 districts with the support of various partners. In FY 2074/75, a total of 282 ANM, 50 nurses, 112 doctors were listed for providing safe abortion services. A total of 158 sites for MA and 33 site for MVA was listed to provide safe abortion services in Nepal. 61160 women received MA and 37480 received surgical abortion services.

[DoHS, Annual Report 2074/75]

The Right to Safe Motherhood and Reproductive Health Act, 2075 (2018)

15. To perform safe abortion: A pregnant woman shall have the right to get safe abortion performed in any of the following circumstances:
    (a) Fetus (gestation) up to twelve weeks, with the consent of the pregnant woman,
    (b)  Fetus (gestation) up to twenty-eight weeks, as per the consent of such woman, after the opinion of the licensed doctor that there may be danger upon the life of the pregnant woman or her physical or mental health may deteriorate or disabled infant may be born in case the abortion is not performed,
    (c) Fetus (gestation) remained due to rape or incest, fetus (gestation) up to twenty-eight weeks with the consent of the pregnant woman,
    (d) Fetus (gestation) up to twenty-eight weeks with the consent of the woman who is suffering from H.I.V. or other incurable disease of such nature,
    (e) Fetus (gestation) up to twenty eight weeks with the consent of the woman, as per the opinion of the health worker involved in the treatment that damage may occur in the womb due to defects occurred in the fetus (gestation), or that there is such defect in the fetus of the womb that it cannot live even after the birth, that there is condition of disability in the fetus (gestation) due to genetic defect or any other cause.

16. Not to get abortion conducted forcefully:
    (1) Except in the circumstance as referred to in Section 15, no one shall conduct or get abortion conducted with an intention to get the abortion conducted or knowingly or having reason to believe that the abortion can occur.
    (2) No one shall get the abortion conducted by coercing a pregnant woman, threatening, enticing or tempting her.
    (3) If any of the following acts is committed, it shall be deemed to have got abortion performed:
    (a) Getting abortion conducted pursuant to sub-section (2),
    (b) Miscarriage that occurs while something is done to the pregnant woman with some enmity,
    (c) Making assistance to commit acts referred to in clauses (a) and (b),
    (4) While conducting abortion, in case the abortion does not occur instantly but a living infant is born, and if the infant, which is born as a result of such an act dies immediately, it shall be deemed to have got the abortion conducted for the purposes of this Section.

17. Not to commit abortion upon identifying sex:
    (1) No one shall commit or cause to be committed an act to identify the sex of the fetus in the womb.
    (2) A pregnant woman shall not be pressurized or compelled or intimidated or coerced or enticed or entrapped in undue influence to identify the sex of the fetus.
    (3) Conducting abortion or causing it to be conducted, by identifying the sex pursuant to sub-sections (1) and (2), is prohibited.

18. Safe abortion service:
    (1) The licensed health worker who has fulfilled the prescribed standards and qualification shall have to provide the pregnant woman with safe abortion service pursuant to Section 15 in the licensed health institution.
    (2) Appropriate technology and process of the service to be provided as referred to in sub-section (1) shall be as prescribed.
    (3) The pregnant woman who wants to obtain the safe abortion service shall have to give consent in the prescribed format to the health institution which has obtained a license, or to the health worker who has obtained a license.
    (4) Notwithstanding anything contained in sub-section (3), in the case of a woman who is an insane, who is not in a condition to give consent instantly or who has not completed the age of eighteen years, her guardian or curator shall have to give consent.
    (5) Notwithstanding anything contained in sub-section (4), in the case of a woman who is below the age of eighteen years, safe abortion service shall have to be provided by considering her best interests.

19. To maintain confidentiality:
    (1) The licensed health institution or licensed health worker shall have to keep confidential all records, information, documents related to reproductive health of the pregnant woman and counseling and service provided to her.
    (2) Notwithstanding anything contained in sub-section (1) the records relating to such information, document and counseling service may be made available on the following conditions:
    (a) If information is demanded by the investigation authority or court in course of investigation and hearing of any lawsuit,
    (b) If it is required to quote without revealing identity of the related woman for the purpose of study, research or monitoring relating to safe abortion,
    (c) If the woman concerned demands herself the records thereof.

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• Safe abortion Services in Nepal
• Worldwide, an estimated 25 million unsafe abortions occur each year- WHO
• Free Safe Abortion Service Guideline – 2073
• International Safe Abortion Day 2017 #LeavingNoOneBehind
• WHO calls for global action on sepsis – cause of 1 in 5 deaths worldwide
• Interim Guidance for RMNCH services in COVID 19 Pandemic
• Right to Safe Motherhood and Reproductive Health Act 2075