Ten years of legal abortion in Nepal has saved thousands of lives.
Subject: Abortion services (Laws, regulations and rules)
Abortion services (User statistics)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 650 Sales & consumption; 970 Government domestic functions Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Product: Product Code: 8082000 Abortion Clinics NAICS Code: 621498 All Other Outpatient Care Centers SIC Code: 8093 Specialty outpatient clinics, not elsewhere classified
Geographic: Geographic Scope: Nepal Geographic Name: Nepal Geographic Code: 9NEPA Nepal
Accession Number: 296571578
Full Text: Ten years ago, abortion became available upon request in the first 12 weeks of pregnancy in Nepal and allowed up to 18 weeks if there is risk to the woman's life and in cases of rape and incest. Abortion must be carried out in a hospital or clinic run by Health Ministry certified doctors. Before 2002, a woman suspected of undergoing abortion could be jailed and about half of gynaecological admissions in hospital were due to complications of backstreet abortions. A government and UNICEF study estimated that 20% of all maternal deaths in 2000 were due to unsafe abortion. A reported 500,000 women have now received legal abortion services and the rate of complications is low--around 2% according to one 2008 survey of 7,000 women. (1)

Comprehensive planning by a range of stakeholders, led by Nepal's Ministry of Health and Population, enabled the country to introduce and scale-up safe abortion services in a remarkably short timeframe. One key factor was the preexistence of post-abortion care services--health care providers were already familiar with the main safe abortion methods. Government demonstrated leadership in coordinating complementary contributions from a wide range of public and private sector actors and with simple standards for authorising public sector abortion care facilities. Policies, based on public health evidence, authorised mid-level providers to provide medical abortion and integrate abortion into existing safe motherhood and other health initiatives. Challenges remain, including limited access in remote areas, high costs for poor women facing out-of-pocket and hidden costs. Induced abortion is available at a small fee (around $14), while post-abortion care, delivery, pre- and post-natal care, and long-acting contraceptives are free. But the evidence is overwhelmingly positive and there has been a drop in the estimated maternal mortality ratio from 539 in 1996 to 229 in 2009, (2) some part of which is attributed to safe abortions.

(1.) 10th anniversary of legalisation of abortion. Himalayan News Service, 13 March 2012.

(2.) Samandari G, Wolf M, Basnett I, et al. Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care. Reproductive Health 2012;9(1):7.

Doi: 10.1016/S0968-8080(12)39629-8
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