Dr. Anu Kumar, president and CEO of Ipas, an international NGO advancing reproductive justice, visited Nepal last week. Ipas Nepal focuses on improving sexual and reproductive health and rights for women and adolescents through access to safe abortion, contraception and gender-based violence prevention. An internationally recognized advocate for women’s rights, Dr. Kumar holds advanced degrees in public health and anthropology. During her visit, she met with government officials and members of the diplomatic community to discuss Nepal’s health system, which receives only 4.6% of the national budget—far below the WHO-recommended 10%. Republica’s Correspondent, Samiksha Shrestha, interviewed Dr. Kumar, covering issues surrounding sexual and reproductive health in Nepal. Excerpts:
How has Nepal’s approach to abortion evolved over the years compared to global trends?
Nepal has actually done extremely well. One of the things about abortion globally is that the trend towards liberalization of abortion is unmistakable. Over the last 30 years, 60 countries have liberalized abortion. Only four have gone backward. And, of course, Nepal is one of the 60 countries that has really moved ahead. It’s because the Government of Nepal sees the impact of unsafe abortion on the lives of women; it results in reproductive morbidity and maternal deaths, and it is completely preventable. The Government of Nepal has seen that as an important public health and gender issue and Nepal is very much in keeping up with what other countries are doing.
Another important step that Nepal has taken forward is the operationalization of the law. What the Government of Nepal could do better is to add additional resources to expand safe abortion services. The fact that it does allocate funding to provide safe abortion service free of cost in public institutions and budget for VCAT (Value Clarification and Attitude Transformation) training in Redbook, is positive. Still, the resources that are at the disposal of those who are working on sexual and reproductive health are small, and they are expected to do a lot with those resources. So, additional investment is needed in this area. The country has made much progress, but it has not fulfilled its entire promise.
What progress have you observed in advancing women’s rights and SRHR in low and middle-income countries over the years?
Improving SRHR Access for Adolescent Girls, Women with Visual I...
I am glad that you asked that question because often, we focus on what is not working. There is a lot that’s not working. But there is a lot that is working. So, as I mentioned, 60 countries have liberalized their abortion law. This is fantastic, and in addition, we’ve had many more countries that are supportive of sexual rights and same-sex marriage. We have seen the development and the use of more technologies, so there are more medical drugs available, there are more contraceptive methods available, and more information available.
The advent of cell phones, mobile phones, and telephones has been a game changer. You can now provide information to people directly in the palm of their hands. The progress that we have made in information delivery is huge. In my sector, there are so many young people who are very committed to gender equity. It is really hopeful and exciting to see young people getting so engaged and being clear about their priorities and what kind of world they want to see.
What are the key legal, cultural, or systemic barriers that hinder safe abortion services in Nepal?
The regulatory environment in Nepal requires that facilities be listed as designated abortion care facilities. That is unnecessary. It adds a burden to the process. That actually slows down progress. Abortion care is not complicated. It is a very simple procedure. When it’s done early, it can be done at all levels of the health system, including at the primary level. So, we need more facilities that are available and delisting them will be helpful. The other thing is that there is overregulation of medical abortion pills. Women are using medical abortion pills all over the world, and we have known that the use of Mifepristone alone is safe and effective. There is no reason to regulate it as heavily as it is done. The laws are incredibly positive, but the details are such that they constrain access. I would say one of the most pressing challenges is the lack of knowledge still among people about the availability of abortion care. A national level study conducted jointly by the Family Welfare Division and Ipas Nepal highlights that over half of Nepalis still don’t know that abortion is legal and available through the public health system. The best way of ensuring that a woman doesn't suffer or die from unsafe abortion is to make sure she is not pregnant in the first place when she does not want to be. So, the contraceptive prevalence rate has stagnated in Nepal, and that needs special attention.
What lessons can be learned from Nepal’s experience in linking SRHR and climate resilience for other countries facing similar challenges?
The fact that the Government of Nepal and we are working at the lowest level (municipal level) is a really interesting innovation. It is a strategy that could be replicated elsewhere. Working with community organizations is another aspect that other countries could learn from Nepal. In Nepal, there is openness to learning and hearing about this and working on it, which is refreshing.
Ipas Nepal has been active since 2002. Could you share some of its major achievements in areas like safe abortion, contraception, humanitarian support, and gender-based violence prevention and response?
Some of the major achievements have been to operationalize the law. It's one thing to have a law on paper. It's an entirely different thing to make it a reality. Ipas Nepal partners with the government and other partner organizations to really ensure that the law is a reality. That is our biggest achievement. Ipas Nepal is working closely with the government at all levels to provide technical assistance for health care providers’ training on contraception, Minimum Initial Service Package (MISP), safe abortion and GBV response. Similarly, Ipas Nepal has also supported the revision and formulation of SRHR policies and guidelines, integration of gender and health in climate and humanitarian policies and programs and it has been working closely with multi-stakeholders to prevent and respond to gender-based violence in Nepal. The work of Ipas Nepal has contributed to the reduction of maternal mortality, prevented unintended pregnancies and unsafe abortion and reached out to women, girls, men and boys with SRHR related messages in Nepal.
What are the key legal, cultural, or systemic barriers that hinder safe abortion services in Nepal?
The regulatory environment in Nepal requires that facilities be listed as designated abortion care facilities. That is unnecessary. It adds a burden to the process. That actually slows down progress. Abortion care is not complicated. It is a very simple procedure. When it’s done early, it can be done at all levels of the health system, including at the primary level. So, we need more facilities that are available and delisting them will be helpful. The other thing is that there is overregulation of medical abortion pills. Women are using medical abortion pills all over the world, and we have known that the use of Mifepristone alone is safe and effective. There is no reason to regulate it as heavily as it is done. The laws are incredibly positive, but the details are such that they constrain access. I would say one of the most pressing challenges is the lack of knowledge still among people about the availability of abortion care. A national level study conducted jointly by the Family Welfare Division and Ipas Nepal highlights that over half of Nepalis still don’t know that abortion is legal and available through the public health system. The best way of ensuring that a woman doesn't suffer or die from unsafe abortion is to make sure she is not pregnant in the first place when she does not want to be. So, the contraceptive prevalence rate has stagnated in Nepal, and that needs special attention.
What lessons can be learned from Nepal’s experience in linking SRHR and climate resilience for other countries facing similar challenges?
The fact that the Government of Nepal and we are working at the lowest level (municipal level) is a really interesting innovation. It is a strategy that could be replicated elsewhere. Working with community organizations is another aspect that other countries could learn from. In Nepal, there is openness to learning and hearing about this and working on it, which is refreshing.
How can partnerships between governments, NGOs, and media strengthen advocacy for SRHR in Nepal and globally?
The media plays a critical role in informing people. The more accurate the coverage of sexual and reproductive health and rights, the better. We see that the media can also spread disinformation and that can be really dangerous. We certainly saw that during the COVID-19 pandemic, and we see it repeatedly with abortion.
When I talk about the media, I also mean social media. I read somewhere that Facebook and Meta have been blurring and then making information about abortion pills disappear or remove entirely. Why? That is not the role of the media. The media plays a very important role in terms of spreading information accurately and making sure that information is accessible to people.
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