Two weeks earlier, Shristi was in Kathmandu Medical College and Teaching Hospital in Sinamangal to get an abortion. Initially claiming a marital status, 19-year-old Shristi later admitted during the course of check up that she was unmarried. She was there with her boyfriend and the doctor advised her, “It’s better to give birth than to abort.” Yet, the problems that would inevitably crop up if she went ahead with the pregnancy were what had brought her to the hospital. Her boyfriend said, “The pregnancy was caused due to the traditional withdrawal method instead of using a condom.”
In mid August, a 20-year-old girl came to Prasuti Griha in Thapathali with the problem of excessive bleeding. She had taken a counter medicine in order to abort the pregnancy, and because she had done so without consulting a doctor, the fetus was not completely washed out, eventually causing excessive bleeding. The doctor cleaned her uterus and warned her that in case of a second unsafe abortion, she could be infertile for life. Hospital Director Dr Pushpa Chaudhary states that there has been a rise in the number of women who come there with problems after consuming abortion medicine without consultation.
Currently, many unmarried young girls visit government and non government abortion centers to terminate unwanted pregnancies. Prasuti Griha sees almost an equal number of patients who visit the hospital for safe abortion as well as post-abortion complications. Just last year, roughly 2,000 abortions were carried out in the hospital. In the same period, almost 1,500 visited the hospital with post-abortion problems, informs the hospital’s Statistics Officer Prabha Shrestha.
According to Jaya Poudel, a safe abortion counselor at Prasuti Griha, last year has seen a rise in the trend of unmarried girls, between 18 to 25 years of age, who come for abortion. Further, she remarks that the number of young girls who consume the variety of different medicines available in the market and suffer from post-abortion problems is increasing greatly. “In a month, about 25 patients come to the hospital with this problem,” she informs, “And the majority of them are unmarried.”
It’s been 11 years since abortion was legalized in Nepal. However, experts state that abortion today has become like a temporary contraceptive method for women.
Senior Gynecologist Dr Bhola Rijal says, “At present, abortion is being taken as a means of contraception. Safe abortion facility has not yet reached the group which it was targeted at, and now young unmarried women in the cities are at the risk of unchecked abortion.” He says that along with the legalization of abortion services, young men and women are indulging in unprotected sex.
Gynecologists state that aborting the first pregnancy is risky for a woman. But the truth is that the easily available abortion medicines and the countless abortion centers are leading more and more women to abort their first pregnancies without considering the pros and cons. And leading the group are unmarried young girls.
Different illegal medicines for abortion are now available in local pharmacies. The Ministry of health states that along with the capital, major cities in Nepal are selling abortion related medicines from different Indian companies like Pregnancy kit, Mifeprin, Mifepristone, Undesired Kit, Pregno 1 Strip, Unwanted Kit.
Experts also say that it is due to the lack of sufficient information on safe abortion from the government’s side that many unmarried girls in cities are opting for abortions. Dr Rijal points out that abortion can lead to infertility in the future. A pregnancy within three months of abortion may risk problems in the uterus. But abortion centers do not inform these young girls regarding such matters. Repeated abortions lead to infertility and there are also other problems like uterine perforation (hole in the uterus) and uterine infection. Excessive bleeding caused by an unsafe abortion might even lead to death. In Nepal, non-government abortion centers do not inform women about the risks regarding abortion but encourage them instead.
Abortion has become an alternative for those indulging in premarital sex, and for married couples who plan to remain childless. The service to terminate unwanted pregnancy in a safe manner is being misused. A survey conducted among the service users of certified abortion centers states that the numbers of those aborting more than once is increasing.
Keeping in mind that reproductive health is a fundamental human right for women, the government made legal provisions regarding safe abortion, 11 years ago in order to decrease the maternal mortality rate. But, the Ministry of Health admits that the number women who opt for unsafe means of abortions have increased.
“The objective of such legal provision is to increase the widespread use of family planning methods and practice safe abortion procedures for unwanted pregnancies,” says Dr Shilu Aryal from the Family Health Division of the Department of Health Services. “But abortion is being treated as a means of family planning. Hence, we’re facing problems,” she adds, emphasizing on the need for the government to create nationwide awareness on the advantages and disadvantages of abortions.
Dr Chaudhary further shares that the easy availability illegal medicines that claim to abort pregnancy are further increasing the risk. “The rise in the number of unsafe abortions is due to factors such as the fear of being revealed when aborting in a certified abortion center, limited access to certified and safe centers, and the easy availability of illegal medicines and establishments of illegal abortion centers,” she explains.
In comparison to government agencies, young girls crowd non-governmental abortion centers. After receiving legal consent, organizations working in the non-governmental area have expanded and provided widespread safe abortion service. However, because these services have heightened the trend of aborting without proper consultation, young girls are at risk. Marie Stopes comes in the top rank of centers that carry out abortions without giving consultation. From an inspection done last year by the Ministry of Health, it has been found that Marie Stopes centers have been providing its representatives with commissions in order to encourage them to bring in abortion patients to the centers.
Aborting, in the case of women who have irregular menstrual cycles, asthma, jaundice, anemia, high blood pressure, sexually transmitted diseases, uterus infection and heart disease, are generally considered to be life-threatening. However, these abortion centers perform abortions without carrying out a detailed health checkup of the patients, and this has lead to women losing their lives at very young ages.
The government implemented a national policy regarding safe abortion in 2060, the very year in which it legalized abortions. More than 500 certified abortion centers and 1,322 doctors and nurses have been permitted to carry out safe abortions, throughout the whole country after the legalization of abortion in Nepal. The law permits termination of eight-week-long pregnancies, and in special cases, up till 18 weeks of unwanted pregnancy. Abortion of above 18 weeks of conception is only carried out in certain hospitals under the recommendation of certain gynecologists and experts. However, for the greed of money, private organizations and some doctors carry out abortions on women who are 18 weeks (or more) pregnant.
A study carried out by organizations working in reproductive health, such as Ipas and Kripa, have shown that, although abortion is legal in Nepal, 24 per cent women of the 11 districts on the border side still go to India for abortion. The study has identified sex-selective abortions and pregnancy due to unsafe sex as two primary reasons behind this. The women surveyed in the study pointed out privacy to be the main reason why they choose to abort in India.
In the same way, according to a study done by Dr Shyam Thapa, women who have already aborted once or more than once are more likely to choose private health institutes rather than government ones, for further abortions. Researcher Dr Thapa shares that increasing number of abortions are opted for by educated women and those who don’t want more children.
The law permits abortion of sex undetermined fetus that is under 12 weeks. However, the sex of the fetus can be determined within six weeks through a procedure known as amniocentesis. Through ultrasound, the sex of fetus that is at least 12 weeks old can be found out. In most clinics run by gynecologists in urban areas, sex determination process is carried for anything from Rs 2,500 to 5,000. Many married couples opt for abortions if they find out that they are going to have a girl child.
Although sex selective abortion is considered illegal in many countries, such abortions are on the rise, observes Dr Rijal. This not only negatively affects women’s health but also imbalances the male-female ratio. Dr Damodar Gajurel from the Nepal Medical Council strongly believes that sex determination is a crime. And, although there have been many instances when such sex selective abortions have taken place in Nepal, except in the case of one doctor, the Council hasn’t take action against those who go against this law.
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