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Tuesday, March 19, 2019
KATHMANDU, Nepal, Jun 6 2018 (IPS) - Less than thirty years ago the likelihood of a mother dying due to pregnancy or childbirth in Nepal was one of the highest in the world. In 1990 UNICEF estimated that the rate was 901 women or girls out of 100,000 – significantly higher than any of its neighbours.
Since then the country has been somewhat of a global success story in maternal health. By 2015 the rate had been reduced to 215 and it is hoped that it has fallen even further in the last three years.
In the 1990s over half of maternal mortality instances were due to unsafe abortions. Still illegal in most circumstances women often sought backstreet options carried out by untrained personnel. Abortion laws were strictly enforced to the point that pregnant women sometimes feared they would be charged with homicide – even if they miscarried.
I grew up in Kathmandu and have worked on this issue for more than 15 years. I’ve seen how the lives and well-being of Nepalese women and girls were being put at serious risk during a time when they needed support. Thankfully, others were in agreement.
Responding to months of lobbying and coalition-building Nepal’s Parliament passed a bill in 2002 which legalised abortion without exception for 12 weeks. Services to enable women to access reproductive health care were also scaled up in quite a short time frame. Nepal had achieved a minor miracle.
Although a conservative country in many ways the transition was relatively smooth.
But making sustained progress in this landlocked and developing nation, where most people live in a remote or rural area, was not easy. In the past legal abortions were difficult for most women to access and the financial cost in a public hospital was often more than a month’s salary, meaning that some women were either forced to continue with an unintended pregnancy – or avail of an unsafe abortion carried out by somebody without proper medical training.
In the mid 2000s an estimated 4,000 Nepalese women were still dying each year as they were being forced to undergo unsafe abortions.
Coming from a poor household in Western Nepal a young woman called Lakshmi had little hope of being able to pay for an abortion after becoming pregnant. Like many other women her realistic choice was to either get an unsafe abortion or to continue her pregnancy.
She chose the latter, but in 2007, along with our partner the Center for Reproductive Rights and my organisation the Forum for Women, Law and Development (FWLD), she brought forward what would turn out to be a landmark case.
Lakshmi maintained that Nepal’s government had failed to enforce its own law on reproductive rights and that safe and legal abortion was extremely difficult to access for most Nepalese women and girls – including herself. She argued that it was not sufficient that abortion was technically legal, but that reproductive health care was a basic constitutional right, which should be affordable and easily accessible.
In May 2009 the Supreme Court of Nepal agreed with her and called on the government to promote the availability of safe and legal abortion in Nepal, to enact a new separate act addressing the issues of women’s reproductive health rights, to ensure personal information of women who get abortions remains confidential and to inform, educate and increase awareness among the general public.
This was a major step forward, but it has only partially come to pass. Abortion services are currently available in 75 district hospitals and also in a limited number of primary health check locations. Since 2016 the Nepalese government has also provided free abortion services through Government Health institutions.
However, only 41% of women of reproductive age know that abortion is legal, it is still seen as a social taboo – and even when they do avail of it it is still treated as homicide in some cases. I know of at least 13 women who are serving prison sentences, including Meera, a young woman from Biratnagar, who is currently serving a seven year sentence for infanticide after she had a miscarriage in 2015.
The government has failed to make it possible for women to be able to afford to pay for abortions, a significant number still do not know that abortion is legal, information on contraception is still not properly communicated, and midwives and other medical personnel have yet to be properly trained on reproductive health and rights.
Out of the 323,100 abortions which took place in Nepal in 2014 only 137,000 were safe and legal. Untrained health workers are still carrying out the majority of abortions here.
Following the devastating 2015 earthquake in Nepal that killed over 9,000 people up to 90% of birthing centers in the 14 most affected districts were either seriously damaged or destroyed. During this time abortion was next to impossible to access. Three years on not all have been re-built, meaning that the challenges already faced by pregnant women have been exacerbated.
However, things may finally be about to change for the better. A new bill on reproductive rights has been recently approved in principle by the Office of Prime Minister and Ministers Council, which will respond to the concerns highlighted by our Supreme Court nine years ago and will separate reproductive rights as a distinct legal issue. It will ensure that women have much better access to information on their rights and that a fund is set up for women who cannot access free abortions, carried out by only qualified health personnel.
We are hopeful that the government will formally enact this into law in the coming months, which will also finally make it impossible to convict a woman of homicide if she has an abortion or suffers a miscarriage. This would provide a context for securing the release of those who are still in prison for very unfair reasons and transform the futures of millions of Nepalese women and girls.
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