Abortion law, policy and strategies in Nepal

1. Abortion Law in Nepal
By Rashmi Luintel
BN,BA,MPH
Lecturer
National Open College
Pokhara University

2. What is safe abortion
• Abortions are safe when they are carried
out with a method that is recommended
by WHO and that is appropriate to the
pregnancy duration, and when the person
carrying out the abortion has the
necessary skills.

3. Abortion Law in Nepal
• Prior to 2002, Nepal had strict anti-abortion law which
ensured not only the imprisonment of the pregnant
women who seek abortion but also their family members.
• Nepal Government legalized abortion in March 2002,
under the 11th Amendment of Muluki Ain.
• Just recently in 2018, the existing SAS (Safe Abortion
Service) implementation guidelines have been revised to
incorporate the free safe abortion policy and address
barriers in the program.
• Listed medical practitioners will provide comprehensive
abortion care services.

4. The Right to Safe Motherhood and Reproductive
Health Act, 2075 (2018); Chapter-4 Safe Abortion
• To perform safe abortion: A pregnant woman
shall have the right to get safe abortion
performed in any of the following
circumstances:
a) Gestation up to 12 weeks, with the consent of the
pregnant woman.
b) Foetus (gestation) up to twenty-eight weeks with
the consent of the woman who is suffering from
H.I.V. or other incurable disease of such nature.

5. Cont…
c) Gestation remained due to rape or incest up to
28 weeks with the consent of the pregnant
woman.
d) Gestation up to 28 weeks, as per the consent of such
woman, after the opinion of the licensed doctor that
there may be danger upon the life of the pregnant
woman or defects occurred in the foetus or that there
is such defect in the foetus of the womb that it cannot
live even after the birth,

6. • No one shall get the abortion conducted by
forcing a pregnant woman, threatening,
enticing or tempting her.
• The licensed health worker who has fulfilled
the prescribed standards and qualification
shall have to provide the pregnant woman
with safe abortion service in the licensed
health institution.

7. • No one shall commit or cause to be committed an
act to identify the sex of the foetus in the womb.
• A pregnant woman shall not be pressurized or
compelled or intimidated or coerced or enticed or
entrapped in undue influence to identify the sex
of the foetus.
• The licensed health institution or licensed health
worker shall have to keep confidential all
records, information, documents related to
reproductive health of the pregnant woman and
counseling and service provided to her.

8. • The licensed health institution or licensed health worker shall
have to keep confidential all records, information,
documents related to reproductive health of the pregnant
woman and counseling and service provided to her.
• The records relating to such information, document and
counseling service may be made available on the following
conditions:
1. If information is demanded by the investigation authority or
court in course of investigation and hearing of any lawsuit,
2. If it is required to quote without revealing identity of the
related woman for the purpose of study, research or
monitoring relating to safe abortion
3. If the woman concerned demands herself the records.

9. National Safe Abortion Policy 2003

10. Comprehensive Abortion Care
• Pre & post counselling on abortion method
s and as well on contraceptive methods
• ii) Termination of pregnancy as per national
protocol
• iii) Diagnosis and treatment of existing RTIs
and
• iv) Provide contraceptive methods as per
informed choice and follow up for post
abortion complication management

11. Human Resource Development
• Human resource required will be identified , orientation
and competency-based skill training will be conducted.
• CAC curriculum for different levels of health services
providers will be incorporated into training programs.
• Prevention of unsafe abortion shall be incorporated.
• Public , private and NGO institutions will be developed
as training sites.

12. Rights of Women
• Women have the right to continue or discontinue an
unwanted pregnancy.
• Informed consent of the women and the nearest
relative is required for the pregnancy termination
service.
• Women must be informed about the risk, benefits and
alternatives to pregnancy termination and counselled
on other reproductive health needs including FP.

13. Role of NGO and Private Sectors
• CAC will be made available through different
sectors.
• Private, semi-governmental and non-
governmental sectors are encouraged to
provide CAC services in underserved areas.
• The private and non-governmental sectors will
be encouraged to contribute to abortion
information including information on training,
research and IEC/ advocacy.

14. Advocacy, IEC and Social Mobilisation
• Advocacy, IEC and social mobilization on the
prevention of unwanted pregnancy and dangers of
unsafe abortion.
• Advocacy to address stigmatization and
misconceptions.
• Advocacy to promote women’s right to CAC.
• All available media will be used to raise awareness on
the new abortion policy, emergency contraception,
Information on CAC services .

15. Coordination, Planning, Monitoring,
Supervision and Follow-up
• Coordinating CAC trainings and services in Nepal.
• Planning, monitoring, supervision and follow-up of CAC
services at all levels in public sectors.
• Information of CAC will be integrated into existing
HMIS.
• District Health Management team will be oriented to the
management aspects of CAC services.
• External and internal resources will be mobilised.

16. Research
• Abortion related research will be conducted.
• Research results and recommendations will be used to
improve the policy and program management
practices.

17. Institutional Arrangements
• Developed and strengthen for CAC services including
planning, follow-up and networking in accordance
with Safe Abortion Policy.

18. Safe abortion strategies
 Abortion was legalized in 2002 A.D.
 2009, comprehensive abortion care services were
expanded to district hospitals and primary health
care centers all over the country.
 In 2009, abortion service provision was limited to
physicians and staff nurses using manual vacuum
aspiration.
 curriculum development and training center
preparation
 A comprehensive training and support

19. Continued..
• After pilot study in 2009 the government of
Nepal committed to expanding comprehensive
abortion care availability at health posts and
sub–health posts by training auxiliary
nurse‐midwives (ANMs) already certified as
skilled birth attendants in provision of medical
abortion. In Nepal, ANM education comprises
either
• policy change.

20. Challenges of liberal abortion
• Sex selective abortion
Sex-selective abortion is the practice of
terminating a pregnancy based upon the
predicted sex of the infant. The
selective abortion of female fetus is most
common in areas where cultural norms value
male children over female children.

21. Continued..
• Even though the new abortion law legalized
the abortion under specified conditions, the
ingrained fear and stigma still prevails in the
society and many women are still terminating
pregnancy by unskilled persons to maintain
privacy and secrecy.

22. References
• D C Dutta’s textbook of Obstetrics, 7th edition.
• National Safe Abortion Policy, 2003 A D.
• Safe abortion service process 2060 B.S.
• https://www.who.int/news-room/fact-
sheets/detail/abortion.
• https://apps.who.int/iris/bitstream/handle/10
665/338768/factsheet-nepal-
eng.pdf?sequence=9&isAllowed=y