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 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
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] and medical abortion [MA]) services are available in all 75 district hospitals and over 50 percent of PHCCs. Additionally, second trimester abortion services are available in 24 hospitals where CEONC services are also available and medical abortion services are being expanded in health posts through the additional training of SBAs. Up to the end of 2072/73, 1,020 ANMs and 466 health facilities were listed for providing MA services and 1,414 doctors and 526 nurses as MVA service providers and 538 health facilities were listed as MVA service sites. Medical abortion services have been expanded to 42 districts with the support of various partners. Beginning in 2070/71, the safe abortion programme was prioritised to ensure the availability of five modern contraceptive methods at all safe abortion sites.
A total of 908,904 women have received safe abortion services from certified service sites since the service began in Nepal in 2060/61. The use of safe abortions services has plateaued in the last five years. In 2072/73, 89,214 women received safe abortion services, among whom 53 percent received medical abortions and sixteen percent of safe abortion service users were adolescents (<20 years).
The 11th amendment to the Civil Code on 26 September 2002 opened the way for legal facility for abortion (up to 12 weeks of pregnancy) and up to 18 weeks in unusual cases like rape and incest. But the consent of woman is needed.