Presentation given to media at PAI.org hosted roundtable in Dubai 19.02.2020 on the impact of the US Gag Rule which ties aid to women's healthcare provision by NGO's. Funds will become unavailable to organizations engaged in providing education and care related to child birth and reproduction.

1. THE GLOBAL
GAG RULE
101
THE GLOBAL
GAG RULE 101
KP Upadhyay, Senior Advisor,
Marie Stopes International
(Nepal)
kp.upadhyay@mariestopes.org.np

2. Nepal landscape
▪ Abortion is legal. Safe Motherhood and Reproductive Health Rights Act allows safe
abortion upto 28 weeks.
▪ Total Fertility Rate – 2.3
▪ Contraceptive Prevalence Rate - 52.6% (modern method 43%)
▪ Unmet need for contraception - 24%
▪ Maternal Mortality Ratio – 239/100,000
▪ 42 abortions per 1,000 women aged 15-49
▪ Only 43% women know that abortion is legal
▪ 6 – 7 % of maternal deaths due to unsafe abortions (MPDSR -2018)
▪ An estimated 323,000 abortions in Nepal in 2014; 58% were clandestine;
▪ An estimated 80,000 women were treated for abortion related complications;
▪ 68% of these complications were due to clandestine abortions

3. Impact of GGR
– Two large projects closed pre-mature (USD 11 million).
– Services in 22 districts out of 77 stopped, especially in public sector.
– Supply of commodities through UNFPA reduced
– CSOs and their downstream partners barred from taking part in bidding of
projects funded by USG
– Threatening the progress so far made in women rights
– CSOs Coalitions effected. Their voices silenced.
– Services to marginalized community effected
– Non-compliant CSOs were excluded from health planning meetings and
trainings
– Anti-choice movement taking ground (News coverage)

4. Mitigation of impact
a.- Limited knowledge about GGR. What was allowed and what was not?
- Partnership, referrals and services affected.
- CBOs who are still allowed, stopped referring their clients
- Substantial reduction of clients
b. CSOs coalition made more effective to deal with the issues jointly more
effectively
c. Harm reduction sessions organized for journalists
d. VCAT organized to service providers and policy makers.
e. WHO (with Foundation’s support) has started supporting Government in
developing country guidelines etc

5. Mitigation of Impact …contd
GoN has taken few initiatives with support from WHO and other partners:
•Integration of SAS into the continuum of RH care at all level
•Decentralization of provider and facility listing process in the current
federal context
•Expanding the service provision by task shifting approach
•Strengthening pre-service education
•Develop regulations and guidelines based on the RH Act
•Addressing market issues around MA drugs
•Inclusion of private sector ( PPP)
•Improve Community level awareness to address stigma around SAS
•Encourage/collaborate with provinces and local body to make program and
budget allocation for SAS
•Strengthen HMIS and data-based planning