Advocacy regarding induced abortion


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Advocacy regarding induced abortion

  1. 1. Public Education and Advocacy Against Unsafe Abortion Mukesh Mishra
  2. 2. <ul><ul><ul><li>Nepal has one of the highest maternal mortality (539 per 100,000 live births). </li></ul></ul></ul><ul><ul><ul><li>Over half of the maternal deaths are due to unsafe abortions. </li></ul></ul></ul><ul><ul><ul><li>Induced abortion is a criminal act in any circumstances, even in case of rape or incest. </li></ul></ul></ul><ul><ul><ul><li>Both women and service providers are punishable by imprisonment </li></ul></ul></ul>ISSUES CONCERNING ABORTIONS
  3. 3. ISSUES CONCERNING ABORTIONS (Contd…) <ul><li>Despite legal restrictions, every year thousands of induced abortions are performed illegally. </li></ul><ul><li>Nepal is the probably the only country in the world where women are incarcerated for abortion </li></ul><ul><li>Prevention and Management of complications of abortions is one of the eight components of National RH Strategy 1998 of Ministry of Health/Nepal </li></ul>
  4. 4. <ul><li>1. Determinants of Abortion and Subsequent Reproductive Behavior Among Women of Three Urban Districts of Nepal 1991-94 (Tamang, et al , IIDS) </li></ul><ul><li>2. Opinion Polls on Abortion Rights for Women. 1996 </li></ul><ul><li>3. Induced Abortions and Subsequent Reproductive Behavior among Women in Urban Areas of Nepal, Nov. 1996 ( Published paper) </li></ul>RESEARCH ON ABORTIONS Between 1991-2000, a number of abortion related research conducted and their results disseminated by CREHPA:
  5. 5. <ul><li>4. Factors Behind Women’s Imprisonment in Nepal with Special Reference to Women Imprisoned for Abortion, Sept. 1997-98 </li></ul><ul><li>5. A Study on Implications of Restrictive Abortion Law on Women's Social Status and Health 1998 (Published Paper and Advocacy Paper in Nepali) </li></ul><ul><li>6. Knowledge and Perception of Rural Married Women on Abortions in Seven districts of Nepal. 1999 </li></ul><ul><li>7. Perceptions on Safe & Unsafe abortions among frontline health providers and village opinion leaders in Eastern Development Region of Nepal. 1999 </li></ul>RESEARCH ON ABORTIONS (Contd..)
  6. 6. <ul><li>8. Management of abortion related complication in hospitals of Nepal: A Situation Analysis. 2000 </li></ul><ul><li>9. Unwanted Pregnancy, Sex Determination Tests and Abortion Seeking Behavior in Private Clinics of Nepal. 2000 </li></ul><ul><li>10. Extent of Contraceptive Failure, Unwanted Pregnancy and Induced Abortions Among Married Couples in Kathmandu Valley. 2000 (Analysis on Progress) </li></ul><ul><li>11. Role of Private Pharmacist in Preventing Pregnancy related Complication Including Unsafe Abortions. 2000 (Analysis on Progress ) </li></ul>RESEARCH ON ABORTIONS (Contd..)
  7. 7. <ul><ul><ul><li>The large majority of the women are unaware of the legal status of abortion </li></ul></ul></ul><ul><ul><ul><li>The 1997 nationwide prison survey reveals that 80 women (20%) as against 14 men were imprisoned for charges of abortion or infanticide (CREHPA, 2000). </li></ul></ul></ul><ul><ul><ul><li>20% and 60% of all obs & gyne admissions in six major hospitals are abortion complication cases. </li></ul></ul></ul>KEY ISSUES EMERGED FROM RESEARCH
  8. 8. <ul><ul><ul><li>Women with abortion complications occupy hospital beds for about 3 days to over 7 days and spend on an average Rs. 3,918 for treatment. </li></ul></ul></ul><ul><ul><ul><li>Most women resorting to unsafe abortion procedures were unaware about the possible health risks of the act. </li></ul></ul></ul><ul><ul><ul><li>Majority of the government hospitals lack sufficient manpower, equipment, space, beds, etc., to deal with abortion related complications. </li></ul></ul></ul>KEY ISSUES EMERGED FROM RESEARCH (Contd…)
  9. 9. FELT NEEDS <ul><li>Advocacy for Legalizing abortion </li></ul><ul><li>Education about health implications of Unsafe abortions </li></ul><ul><li>Enhancement of providers' skills and services at government hospitals to deal with abortion complications </li></ul><ul><li>Discouragement of abortion services by Unqualified persons </li></ul><ul><li>Periodic updates of abortion data </li></ul>
  10. 10. <ul><li>Planning and strategies development workshop organized in October 1998 to initiate PUBLIC EDUCATION AND ADVOCACY PROGRAM (PEAP) </li></ul><ul><li>Purpose: </li></ul>STRATEGIES DESIGN & NETWORKING <ul><ul><li>To develop appropriate advocacy messages and slogan </li></ul></ul><ul><ul><li>To develop logo for PEAP </li></ul></ul><ul><ul><li>To develop non-threatening messages </li></ul></ul><ul><ul><li>To identify the medium for disseminating advocacy messages </li></ul></ul><ul><ul><li>Networking with Ministry of Health (MOH) </li></ul></ul>
  11. 11. <ul><li>To identify and analyze strengths and weakness of district level NGOs and explore the ways and means of empowering them under PEAP </li></ul><ul><li>To plan appropriate supervision and monitoring mechanism for PEAP </li></ul><ul><li>To prepare suitable strategies for reopening policy dialogue with law makers at district and central levels </li></ul>STRATEGIES DESIGN & NETWORKING (Contd…)
  12. 12. THE FRAMEWORK Action Evaluation Situation Analysis Strategies Mobilization Continuity / Expansion PEAP
  13. 13. <ul><li>&quot;Do not rely on unqualified Persons </li></ul><ul><li>Do not resort to unsafe abortions&quot; </li></ul><ul><li>&quot;Unsafe abortions can claim women's lives </li></ul><ul><li>Abortion is not a method of family planning&quot; </li></ul><ul><li>&quot;Unsafe Abortion may put women's lives at risk&quot;. </li></ul><ul><li>&quot;Healthy life of mother and child, </li></ul><ul><li>Use methods of family planning, </li></ul><ul><li>Avoid Unsafe Abortions&quot; </li></ul>ACTION : Slogans & Text Messages Developed Appropriate non threatening advocacy messages and slogans developed in Nepali :
  14. 14. ACTION: Medium of Communication & Dissemination Identified Printed Communication & Dissemination Media Press Electronic Community - Posters - Brochures - Banners - Policy Briefs - Advocacy Papers - Photo story - Articles - Advertisement - Press Conference - Journalists Forum - Radio Program - Web-site - Advocacy workshops - Educational Workshop - Street Drama - NGO Empowerment
  15. 15. ADVOCACY STRATEGIES: Media Coverage
  16. 16. Target Audience for PEAP Advocacy - Parliamentarians - Political Parties - Policy Makers/ Administrators - Lawyers - Women Associations - Journalists - NGO/INGOs Education - Women Groups - Social Workers - Community Health Providers - Pharmacists - Community Leaders - School Teachers / High School Students
  17. 17. <ul><li>Technical advisory committee with representatives from NHEICC/MOH formed for IEC development </li></ul><ul><li>Formal launching of the posters and brochures by representatives from NHEICC/MOH </li></ul>ACTION: MOH Involved From the Start
  18. 18. <ul><li>More District level NGOs identified and trained </li></ul><ul><li>District level advocacy workshop held by partner NGOs </li></ul><ul><li>Village level PEAP activities launched by partner NGOs </li></ul><ul><li>Demand created for replication of the program </li></ul><ul><li>Formation of Network : SMHEAN (Safe Maternal Health Education and Advocacy Network) </li></ul>ACTION & OUTCOMES OF PEAP-I
  19. 19. <ul><li>INFLUENCING POLICY </li></ul><ul><li>Acceptance and ownership of the IEC materials (Posters) on abortions by MOH </li></ul><ul><li>Inclusion of PEAP related strategies in government's 15 years health plan </li></ul><ul><li>District Health office (MOH) demand orientation training for TBAs against unsafe abortions </li></ul><ul><li>Formation of seven member committee (with the inclusion of CREHPA) by MOH for advocacy towards legalization of abortion (submission of a separate abortion bill by MOH) </li></ul>
  20. 20. LESSONS <ul><li>Research is key to influence Opinion & Policy. </li></ul><ul><li>Since abortion is highly divisive issue, sensitization should start from the top. </li></ul><ul><li>Wide range of Approaches needed. </li></ul><ul><li>Cost-effective yet expensive </li></ul><ul><li>Concerned Policy Makers' involvement required from planning stage </li></ul><ul><li>Credibility of the organization </li></ul><ul><li>Creativity & Continuity Necessary </li></ul>
  21. 21. Thank You NEPAL