Rajon Shrestha
Abortion has long been a sensitive and controversial issue in Nepal. Once criminalized, it pushed women to undergo unsafe and life-threatening procedures. Many paid the price not only with legal consequences but with their lives.
Before abortion was legalized, it was illegal under the Muluki Ain 2020. Both the women who terminated pregnancies, even in cases of rape or health risks, and those who assisted them could be jailed. As the saying goes “Desperate times call for desperate measures”, many women tried unsafe methods like consuming toxic substances (herbal concoctions, crushed glass), inserting harmful objects (knife, blade, skewers “jheer”), or visiting unqualified providers (Dhami, Jhakri, Quacks). These harmful practices significantly contributed to maternal deaths in Nepal
Abortion was legalized in Nepal in 2002 and further consolidated under the Safe Motherhood and Reproductive Health Rights Act, 2018. It recognized abortion as a fundamental right and essential health service. Currently, the law permits:
- Abortion up to 12 weeks of pregnancy with the consent of the pregnant woman
- Up to 28 weeks of pregnancy with the consent of pregnant woman in cases of rape, incest, risk to physical, or mental health of pregnant woman, or if the fetus has a genetic disorder and is unlikely to survive outside the womb.
For minors and those with mental disabilities, a guardian’s consent is required.
There are two medically approved abortion methods:
- Medical Abortion (MA): A combination of pills (mifepristone and misoprostol) is used within the first 9 weeks of pregnancy.
- Surgical Abortion: Typically, Manual Vacuum Aspiration (MVA) is done in the first trimester, and Dilation and Evacuation (D&E) in the later trimester.
Nepal has expanded safe abortion services through a network of over 1500 Safe Abortion Service (SAS) sites. They provide
- Abortion services
- Post-Abortion Care (PAC)
- Counseling and family planning services
Since legalization, safe abortion services have been provided to tens of thousands of women. Induced abortion rates have increased from 0.4% in 1996 to 8.8% in 2022. Awareness campaigns and integration into reproductive health services have reduced incidence of maternal deaths due to unsafe abortions. Yet, stigma, poor services, and lack of information discourage many, especially adolescents and marginalized women from accessing the services.
Nepal’s journey from criminalization to recognition of abortion as a fundamental right is a significant step forward. Nevertheless, much more remains to be done to ensure safe, equitable access to all women. Addressing stigma, increasing awareness, and expanding services, especially in rural areas are critical to reducing the risks of unsafe abortion and safeguarding reproductive rights of women.
We suggested that she visit a hospital and consider terminating the pregnancy. Hearing this, she yelled, “No, I can’t! It’s a crime. If the police arrest me, my parents will never forgive me!” We explained to her that abortion is not a crime in Nepal if it’s done with the consent of the pregnant woman and within the legal provisions. It becomes a crime only under certain restricted circumstances.