From Shadows to Sunlight: Nepal's Journey to Safe Abortion Access

Nestled amidst the majestic Himalayas, Nepal has embarked on a progressive journey towards reproductive rights, particularly in the arena of abortion law. Decades ago, unsafe abortions plagued the nation, claiming countless lives and pushing countless women into debilitating complications. However, through tireless advocacy and a commitment to maternal health, Nepal has transformed its legal landscape, offering hope and security to women seeking safe and accessible abortion care.

From Shadows to Sunlight: A Historical Perspective

Prior to 2002, Nepal's abortion landscape was shrouded in darkness. Abortion was illegal, forcing women to seek clandestine procedures conducted by untrained providers under perilous conditions. This resulted in a staggering number of maternal deaths and preventable health complications. Recognizing the devastating consequences, Nepal undertook a landmark shift in 2002. The 11th Amendment to the Civil Code legalized abortion on request up to 12 weeks of gestation, marking a monumental step towards protecting women's health and reproductive autonomy.

Expanding the Scope: The Safe Motherhood and Reproductive Health Rights Act

Building upon this foundation, Nepal further solidified its commitment to women's health in 2018 with the landmark Safe Motherhood and Reproductive Health Rights Act (SMRHR Act). This comprehensive legislation broadened the legal basis for abortion, recognizing it as a fundamental human right and essential healthcare service.

Key Provisions of the SMRHR Act

• Unrestricted Access: Abortion on demand is legal up to 12 weeks of gestation without any requirement for justification or spousal consent.
• Beyond the First Trimester: In cases of rape, incest, or risk to the woman's physical or mental health, or if the fetus suffers from severe deformities, abortions are permitted up to 28 weeks.
• Prioritizing Safety: Trained medical professionals, including obstetricians-gynecologists and general practitioners, are authorized to perform abortions depending on the gestational stage.
• Accessibility: The Act mandates the government to ensure nationwide access to safe and legal abortion services, particularly in rural and remote areas. This includes training healthcare providers, establishing dedicated abortion care facilities, and raising awareness about women's reproductive rights.

Challenges and Opportunities

Despite the progressive legal framework, challenges remain in ensuring full and equitable access to safe abortion services. Stigma and social taboos surrounding abortion persist, hindering women from seeking appropriate care. Additionally, disparities in healthcare infrastructure and provider availability, particularly in remote areas, create barriers for many women.

However, amidst these challenges, there are glimmers of hope. Educational campaigns are dispelling myths and promoting reproductive health literacy. Community-based organizations are working tirelessly to expand access to services, particularly in marginalized communities. The government is increasingly focusing on strengthening healthcare infrastructure and training more medical professionals in safe abortion practices.

Moving Forward: A Call for Continued Progress

Nepal's journey towards comprehensive abortion access is a testament to the unwavering dedication of women's rights advocates and healthcare professionals. As the nation navigates this evolving landscape, continued efforts are crucial to ensure complete realization of the rights enshrined in the SMRHR Act. This includes:

• Combating stigma and discrimination: Public awareness campaigns and educational initiatives are essential to break down negative attitudes and empower women to make informed choices about their bodies and reproductive health.
• Strengthening healthcare infrastructure: Expanding access to dedicated abortion care facilities, particularly in rural areas, is crucial to bridging the gap in available services.
• Enhancing provider training: Ensuring adequate training for healthcare professionals in safe abortion practices is key to guaranteeing quality care and reducing complications.
• Promoting data collection and research: Comprehensive data on abortion trends and barriers to access is vital for informing policy reforms and resource allocation.

Some Facts

• Abortion was legalized in Nepal in 2002, after many women died or suffered complications from unsafe abortions. The law allows women to seek abortion for any reason up to 12 weeks of gestation, and up to 28 weeks in cases of rape, incest, fetal anomaly, or risk to the woman's health.
• In 2018, Nepal enacted the Safe Motherhood and Reproductive Health Rights Act, which recognizes access to safe and affordable abortion services as a fundamental human right. The act also mandates the government to provide free abortion services to poor and marginalized women.
• Despite the legal and policy reforms, many women in Nepal still face barriers to accessing safe abortion services, such as lack of awareness, stigma, cost, distance, and provider bias. According to a 2014 study, only 42% of women who had an abortion in Nepal obtained it from a legal and safe source.
• Unsafe abortion remains a major cause of maternal mortality and morbidity in Nepal, accounting for 8% of maternal deaths and 50% of hospital admissions for abortion complications. Women who undergo unsafe abortions are also at risk of legal prosecution, as abortion is still a criminal offense under the penal code.
• To improve the situation, Nepal needs to decriminalize abortion, increase the availability and quality of abortion services, especially in rural and remote areas, and raise awareness and reduce stigma among women, health providers, and the general public. Nepal also needs to ensure that women have access to comprehensive sexual and reproductive health education and services, including contraception, to prevent unwanted pregnancies.

Nepal's story is an inspiration, a testament to the transformative power of legal reform and unwavering advocacy. By addressing the remaining challenges and continuously strengthening its healthcare system, Nepal can pave the way for a future where every woman has the right to safe, legal, and accessible abortion care, empowering them to exercise full autonomy over their bodies and lives.