Two years after the amendment of Civil Code legalizing the conditional abortion, the government has finally opened up safe abortion service at its hospital. More than 200 women have already utilized the service made available at the Maternity hospital in the last one month. At a time when a large number of women are coming to knock the door of the hospital, it remains to be seen how this new women’s reproductive rights will be exercised. The abortion is now permitted by law but how it will help rescue women from the deathbed is a more important matter in a poor country like Nepal that has one of the highest rates of maternal mortality

By KESHAB POUDEL

Purnima Dhakal (not real name), 24, recently aborted her two-month-old fetus following the recommendation of medical practitioners at Indra Rajya Laxmi Maternity Hospital. A mother of three children, Dhakal, a resident of Kalanki, is happy since her decision to go for abortion was made possible at the safe abortion clinic at the government hospital.

Dhakal is not the only one to have received such service in last one month, more than 200 women have already benefited. “Had the hospital not provided the service, I might have been compelled to approach private nursing homes that charge up to Rs. 10,000 (US$150),” said Dhakal. This amount of money is beyond the reach of most Nepalese women.

Yesoda Tamang (not real name) 21, has another story to tell. A mother of two daughters, Yesoda, aborted her two-month-old girl fetus upon pressure from her husband who prefers a son.

In a country fraught with problems of early marriage, denial of sexual and reproductive rights of adolescents presents a grim picture. According to Nepal Demographic Health Survey, early marriage and early childbirth is common in the country. The average age at the marriage of female is 16.8 years. Twenty-one percent of girls between the age of 15-19 years already bear their first child.

Data shows that one in five women visiting hospitals for abortion related complication is an adolescent. At a time when the unmet need of family planning is high among adolescents, there is high possibility of unwanted pregnancy resulting in unsafe abortion.

As a society with strong bias against the female children, there is also a possibility of misuse of abortion provision by the members of lower income and middle income women upon pressures from their families.” My husband and other family members forced me to perform abortion following the confirmation tests that showed the fetus to be that of a female child,” said Yesoda Tamang.

There is a provision in the law that no women shall perform an abortion after going through an amniocentesis test for identifying the sex of child. Despite such provisions to prevent the abuse of the right of abortion, women are compelled to abort due to various kinds of pressures.

At a time when there are rampant misuse of abortion services that are available in different parts of the country, restrictions placed in the government hospital alone cannot prevent it.

“A large number of women still die because of unsafe abortion. This is a serious concern for us. The time has come to generate awareness among women regarding the safe and legalized abortion,” said Dr. Saraswati Upadhyaya, president of Nepal Gynecologist Society at its eighth convention recently. “We are planning to launch nationwide campaign to generate awareness among women.”

Conditions for Abortion

According to the amended provisions, any person carrying out abortion for any other reason than as specified in the law is subject to legal punishment. The act states that any pregnant woman can procure abortion in up to 12 weeks of pregnancy with the consent of her husband and on her own will.

In case of rape or incest, women can terminate her pregnancy in up to 18 weeks time. And again abortion can be carried out if a woman so desires, without being subject to any punishment, if the pregnancy is fatal to her life, if there are chances that a deformed or handicapped child could be born or if there is danger to her physical or mental health.

Women have demanded the right to take independent decision about their bodies and for a safe and unconditioned right to abortion where it concerns guarantee of safe motherhood.

Abortion Against Girl Child

Like many other countries, the abortion rights, though reproductive right and regarded as human rights of women, often deny right of girl child to born. Being a traditional society, majority of people prefer baby boy against girl. At a time when the gender of child can be identified through tests at very early stage, many men and women choose to abort the baby in case it is girl child.

“Although safe abortion facilities are available, a strong vigilance is required to ensure that the right of a girl child to born is not denied. Some of our women are demanding making abortion unconditional ignoring the reality of society,” said a lawyer. “One of the difficult tasks now is to have careful vigilance to prevent the misuse of abortion.”

Unsafe and illegal abortion is still rampant in society as health clinics and nursing homes provide such services in different parts of the country. Laws have hardly prevented most of the people with economic advantages to undergo abortion. The laws only victimized the people of lower economic groups who were compelled to go for unsafe abortion.

Maternal Mortality
Maternal Mortality Ratio (MMR) in Nepal is one of the highest in the world with 540 deaths per 100,000 live births. In Nepal, the very event of giving life often leads to death. Each year, some 4,500 women die of complications of delivery. According to survey, every two hours, one woman dies of such complications.

Despite some progress and improvement in legal front, women still rely on traditional method for abortion risking their lives.

“The safe abortion facility is still confined to urban areas and it needs to be expanded to rural areas where maternal mortality is very high due to unsafe abortion. Reproductive right is women’s right but many women still do not know where it is available,” said Babita Basnet, general secretary of Sancharika Samuha. “The time has come to disseminate the information to rural areas so that women can exercise their rights.”

According to a study conducted by Department of Health Services, only 17 percent of women make decisions about their own health care and more than 70 percent of women rely on somebody else to make such decisions.

At a time when there is acute non-availability of contraception, many women have to suffer the unintended pregnancy. According to a national health survey, the contraceptive prevalence rate has increased from 34.5 in 1996 to 39.3 in 2001. Total fertility rate in 1996 was 4.64 but it reduced to 4.1 in 2001.

However, the total unmet need for family planning still is 27.8 percent. Because of lack of female health workers, rural women do not get proper counseling regarding the use and side-effects of contraceptive.

Some women activists argue that the law has not been able to provide recognition to the rights of women concerning their bodies and safe motherhood. They argue reproductive right is the basic human rights of a woman and that a woman herself should be the final authority to decide what kinds of rights she wants to exercise.

Others argue that giving complete abortion rights to women may lead to a difficult situation. In a society with low women literacy rate and conservative preference to male child, there is high possibility of misuse of such rights.

“The amendment of Civil Code provides conditional abortion rights to women. This is not to be taken as right but should be taken as safety, legal and rare,” said advocate Lalit Bahadur Basnet, who practices in Supreme Court. “One must look at three issues on abortion: reproductive rights of women, right of life of women and right of child to birth,” said Basnet. “The abortion right must be exercised looking at these three fundamental issues.”

Extension of Services

After formally opening up a legalized safe abortion clinic, the number of women patients coming to Maternal Hospital demanding the termination of their pregnancies has increased by many folds. Within a month of opening legal abortion service, more than 500 women consulted with doctors and 150 women underwent abortion.

According to Hospital authorities, every day 10-15 women are receiving counseling and other abortion-related services. The hospital is considering extending the facilities to meet the growing demand of women.

Following the rush of women seeking legal abortion at the country’s first well-equipped maternity hospital, the government has decided to extend the service to six other hospitals outside Kathmandu and announced a long term plan to provide abortion services in almost all district hospitals within a couple of years.

On March 18, 2004, Maternity Hospital in Kathmandu performed the first case of legal abortion. “Every day, we are approached by more than five dozen women wishing to terminate pregnancy. But we terminate pregnancy only after consultation and fulfilling several conditions,” said Dr. Sabitri Kishore, senior gynecologist at the Hospital. “Mostly women aged between 20-30 come to terminate pregnancies.”

As the pressure increases, the government has decided to extend the service outside the valley including in the well established private nursing homes. “Legal abortion services will be made available to people outside the valley within next month. We are supporting now to develop necessary infrastructures and training medical staffs,” said Dr. Yesho Bardan Pradhan, director of Family Division of Ministry of Health.

Lack of Medical Facilities

Despite the beginning of legal abortion at the government hospital, there is still lack of adequate trained health manpower and medical facilities. Since abortion is a serious and a complicated matter, it must not be performed without knowledge and equipment.