Kathmandu, Sept. 15: Many women and girls of reproductive age who undergo unintended pregnancy for various reasons often come across difficult decision making: whether to continue with pregnancy and give birth or terminate it. The matter for women with unwanted pregnancy has been made worse by several pharmacies who provide medicines for aborting fetuses without a physician’s prescription. “I had an unwanted pregnancy, and I went to a medical shop and asked for medicine to terminate pregnancy, and the pharmacy gave me abortion medicine without any counseling, so it was quite simple as that, however sadly, later I had to visit hospital for excessive bleeding,” said Malati Chaudhary, a mother of three hailing from Siraha. “I do know about contraceptives and abortion services available at the health facilities, but I feel awkward to go and buy contraceptives and feel shy to talk about these things,” she added. “My periods were irregular for last three years, so I came to know about my pregnancy only after 10 weeks, which shocked me,” said Rojisha Shrestha, 22, (name changed), a college student of Kathmandu. “I told about my pregnancy to my boyfriend who suggested me abort foetus taking medicines, we both went to a medical shop and bought medicines,” Shrestha shared. Although the government provides free service for the safe abortions, more than 50 per cent women and girls are reportedly found to be resorting to unsafe abortions. Experts are worried about the undocumented unsafe abortions, as it is deteriorating the health of the women and girls at large. Unsafe abortion leads to problem such as unusual bleeding, infection in uterus and infertility among others. The Annual Report 2018 of the Ministry of Health and Population (MoHP), notes that 13 per cent of maternal mortality was due to unsafe abortions. According to gynecologist Dr Jageshwor Gautam, Director of Paropakar Maternity and Women’s Hospital (PMWH) in Kathmandu, an average of two women per month visit PMWH due to complications arising from unsafe abortions. According to Dr Gautam, complications may include vaginal bleeding, infection, injury in the uterus and injury to the intestine. The ones opting for unsafe abortions seem to generally include pregnancies arising from illegal relationships, he added. The women and girls, who practice unsafe abortions, are found visiting the hospitals only after they experience serious complications, shared doctors. Even after the legalisation of abortion in Nepal, unsafe abortion is rampant among women and girls, said a senior gynecologist Dr. Jyoti Agrawal. The decrease in official data reported on abortion cases at the hospitals may reveal the other side of the coin: that most of women and girls are probably adopting unsafe abortion methods. The Nepal Population and Health Survey-2016 revealed that in the last five years, from those opting for abortion, half of the women opt for abortion due to unintended pregnancies. Medical abortion medicines are easily available in the Nepalese market at majority of pharmacies or medical shops, which is encouraging the unsafe abortion among women and girls putting their life at risk, said Dr. Agrawal, speaking to The Rising Nepal. “It’s like buying a chocolate for them” she said, adding that it is very unsafe. ‘Educated women and college-going girls generally visit my clinic only after experiencing complications due to unsafe abortions, said Dr Agrawal and warned, “Medical abortion pills shouldn’t be taken as a means of contraceptives,” she added. According to World Health Organisation (WHO), unsafe abortion is a procedure for terminating an unwanted pregnancy either by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. WHO data shows that 25 million women practices unsafe abortion globally. According to various studies, 44,000 deaths occurs due to unsafe abortions while five million suffer from various health complications. Monitoring Unregistered Abortion Drugs Pan Bahadur Chhetri, Director General of the Department of Drug Administration (DDA) said that during the monitoring carried out by DDA, pharmacies were found to be selling unregistered medicines for abortion, and it was mainly high in rural areas. One of the reasons for such easy availability of such medicines was due to the open border with India, he added. The DDA under the MoH has approved only four types of medical abortion drugs. However, a study conducted in two eastern region districts, revealed that medical shops were selling different 18 brands of tablets meant for abortion. The easy access and availability abortion medicines in pharmacies that even sell without medical doctor’s prescriptions, means women and girls can easily buy them and this leads to unsafe abortion resulting in many complications in women and girls health.
According to gynecologists, most women and girls seek abortion services at private hospitals and clinics rather than at the government hospitals and health facilities. A study by CREHPA showed that among the total abortion cases, around half of the abortion seekers practiced unsafe abortion at private health facilities. The sexually-active girls must be aware of the fact that their nearby health institutions can provide safe abortion, contraceptives and counseling as per their needs and they must be encouraged to seek proper services, if they so require. Legalisation of Abortion A landmark for women’s reproductive rights in Nepal, in 2002, abortion was legalised in Nepal. The law finally provided women’s right to autonomy on their own bodies. The law was hailed as positive revolution and a step forward on women’s empowerment. The law allowed abortion in cases of pregnancy due to incest, critical condition to mother’s health, and pregnancy up to 18 weeks caused due to cases of rape. Last year the law was amended and according to section 4 (15) of the Safe Motherhood and Reproductive Health Rights Act, passed by the Parliament in September last year, abortions are now allowed up to 28 weeks in cases of incest, rape, serious health risks to the mother or if fetus is found with genetic defects. The new Act of 2018 allows women to terminate pregnancies of up to 28 weeks fulfilling following conditions: if a doctor decides that their pregnancy poses a serious risk to their lives or could seriously affect their mental and physical health, if the baby will be born with deformities, or if they are infected with HIV or similarly incurable diseases. Abortion practices in Nepal The Department of Health Services (DoHS) Annual Report, released few months ago, showed that 3000 women below the age of 20 terminated their pregnancies across the country, in the fiscal year 2017/18. According to the DoHS Report’s, a total of 1,86,144 women and girls opted for abortions during the last fiscal year. Based on this number, a simple estimate shows that around 15000 abortions occur in a month; which comes down to 509 women and girls terminating pregnancies in a day. The DoHS Report for the fiscal year (FY) 2074/75 (2017/18) data for abortion cases in 77 districts, shows that the highest number of abortion cases were found in Kathmandu district, with 11,8,16 women and girls to have undergone abortions. The data indicates, there was no case of abortion in Rukum East and Manang districts. Province-wise, the highest cases of abortion were reported in Province 3, while, Karnali Province had the least number of cases.