Safe abortion in Nepal: A success story © Ipas 2013 Used for “International Women’s Health and Human Rights” with the permission of Ipas [Text on screen] Before 2002, abortion was illegal in Nepal. Women were imprisoned, half of all hospital admissions were due to complications from clandestine abortions, and hundreds of women died each year. If a woman is good, if a woman is sincere, if a woman is healthy—the family is good, you know. And then the country is good. Nepal was one of the countries where abortion was illegal in any circumstances. DR. INDIRA BASNETT: Before legalization, the situation was really horrible, particularly when we look from the perspective of women’s lives and health. DR. CHANDA KARKI: As a service provider, if you ask me, I have seen many women die from unsafe abortion. They come with multiple injuries, which you can’t even think of. DR. SHEELA VERMA: She came in a very serious condition, so we did the laparotomy for her. And we found a stick—a long stick—inside the abdomen cavity. So we took that stick and we did a hysterectomy for that patient. She survived. DR. ARZU RANA DEUBA: We have statistics to prove that a lot of women died because of botched abortions. SAPANA MALLA PRADHAN: Fifty percent of maternal deaths were due to unsafe abortion, and unsafe abortion because it’s illegal. Out of those women in prison, twenty percent were due to abortion or abortion-related crimes. RAM MAYA TAMANG: If it had not been for this service, it would have been a big problem for me. I already have five children. I even used to have fearful dreams about giving birth to another child. I would feel stressed in my dreams and upon waking. If I had given birth to another child, it would have been an extra burden to me. I couldn’t have afforded the child’s education costs or even food expenses. Now I am very relaxed and very happy. I feel very satisfied. Ipas is supporting . . . the main role of Ipas is to support the government in policymaking, and in strategy formulating, and also implementing the safe abortion services in the country as a whole. BUDDHA LAXMI LAMA: I find that the most satisfaction I get being a FCHV (female community health volunteer) is because, when I became an FCHV, we used to hear a lot about and saw the high rate of child mortality in our village, as well as in our neighboring village—both of which are part of the Thakre Village Development Committee, Naubise. We often heard the sound of conch shells blown from both villages, announcing the death of another child. There were cases like these every month. We even saw a woman die just next door. Now, since the FCHV program was introduced in Nepal, and has spread widely, the rate of infant and maternal mortality has decreased drastically. CHANAMATI GIRI: I was interested in joining the FCHV because I wanted to serve my community, my sisters in the community and my own children. This gives me lots of pleasure. I like the abortion program very much because many of the village sisters fall in love with the ones they like. And when such a thing happens, many boys engage in physical contact as well. Many of these women find themselves in a mess. When they approach me for consultation and help, I take them myself to our health post and they get rescued for just 500 Rupees. And I keep this very quiet and do not disclose it to anyone. I am doing all this, so I am happy. DR. SHEELA VERMA: Ipas has developed the standard guidelines and training guidelines. So according to those guidelines, we train our nurses and doctors. Because our nurses and doctors who are giving the CAC services, the safe abortion services, they are now trained for the family planning services also. So the client, they are getting family planning services inside the building of the safe abortion care. DR. SENENDRA RAJ UPRETI: Well, after we started safe abortion services in the country, the complications arising from unsafe abortion sites have dramatically come down. This used to be a major cause of maternal mortality and morbidity. The figure has gone down, and you have a scale-up to all 75 districts. We have a variety of abortion services - medical abortion, surgical abortion, thousands of trained service providers, and this way we feel that we are improving maternal health statistics in the country. DR. CHANDA KARKI: Safe abortion service has become a very successful story in Nepal, I feel proud to say that. And organizations like Ipas have worked very much to support the government to provide this safe abortion service to the full extent. DR. ARZU RANA DEUBA: I think Ipas has played a key role. Despite the change in governments, despite the change in systems, Ipas has been there like a real pillar. I’d like to request Ipas to still be around in Nepal, because the next generation is going to need a lot of advocacy, a lot of attention to this service, to the whole issue of safe abortion, because it could be derailed at any time. DR. INDIRA BASNETT: Our society is a patriarchal society, and men play a vital role in making decisions. So even if a woman is educated or she has got financial access, even then she has to take permission from her husband to make decisions for her body. DR. ARZU RANA DEUBA: This is going to be a very big challenge, and if we don’t overcome the challenge of getting women to control their reproductive health and have control over their bodies, it’s going to be very difficult for the society to progress. SITA PATHAK: We did not inform anybody in the family about our decision. Only my husband and I decided to have the abortion service. If we had asked our family members, they would not have let me to do this. This was my decision. I think this is totally a woman’s right and I can decide this. I asked my husband and decided to do this. DR. INDIRA BASNETT: For each of Nepali women, she thinks that her children she gives birth to have better access to education, better access to health, and they are leading a really quality life. So that is a great happiness for a mother. I want to see that, in the next ten years, there’s no statistic saying that women are dying from unsafe abortion complications. I want to see that all needy women whoever needs safe abortion services, they have access to the safe abortion services. And when I do interact with women in the community or in the clinic, I always see the happiness in her eyes when she can really control her fertility within her limited resources. Because she knows how much resources she has, and how much she can really manage. So this is all about things that are going to lead to a happy life. [Text on screen] Today, all 75 districts in Nepal have at least one health-care facility providing safe abortion services. But there is still much work to be done to ensure that women have access to contraception and safe abortion services throughout Nepal and around the world Join us today. Support Ipas’ work with your passion, your voice, your resources. Because every woman should have access to safe abortion and contraception no matter where she lives. Learn more: www.ipas.org/nepal
