BY: GARIMA
Nepal’s Unsafe Abortion Emergency
Imagine a young woman, maybe 28, maybe 18, living in a rural village in the hills of Karnali. She missed her period. She’s worried. She knows there’s a health institution somewhere, but it’s a six-hour walk away, the roads wash out in the rain, and she can’t tell her husband. So she does what women in her community with the same situation have always done; she asks around quietly, finds someone who “knows about these things,” and hopes for the desired result.
Nepal made history in 2002 when it decriminalized abortion; one of the first among the South Asian nations. It was a landmark moment, a promise that women would no longer risk their lives in the shadows. More than 20 years later many Nepali women still have unsafe abortions. The law changed. But it did not change much for them.
A law on paper doesn’t always mean it’s easy to access. While Nepal allows abortion under certain conditions, the gap between the law and what happens in reality is still very large. A review published in 2024 found that a lack of trained healthcare providers leads to poor counseling and care. In rural and mountainous areas, women face huge logistical challenges, such as long distances, bad roads, and no certified facilities. This forces them to seek abortions from untrained providers or unregulated pharmacies.
The issue is made worse by misinformation. Pharmacy staff, often without clinical training dispense abortion medications with incorrect dosages and provide no follow-up care, putting women’s lives at serious risk. There is no referral system, no safety net, just a quick transaction and a door that closes after the service is provided.
Studies have shown that poor women are more likely to get abortions. Women from the Dalit community are also more likely to get abortions. Women who live in the mountains are at a risk because it is harder for them to get to a hospital. Women who do not know where to go to get an abortion are more likely to go to someone who is not a doctor.
These are not random statistics. They present the dimensions of inequality, poverty, geography, caste, and education all converging to determine who gets to survive an unintended pregnancy.
In years there has been a worrying trend. According to data from Nepal’s Ministry of Health and Population, over 105,000 women terminated pregnancies in the fiscal year 2023–24, up from about 80,000 just four years earlier, which is a rise of more than 31 percent. Experts suggest this is due to the unavailability of birth control, including injections and implants. With modern contraceptive use among married women of reproductive age at just 43 percent, and half of those users stopping within a year, unintended pregnancies and the desperate choices they entail are on the rise.
When contraception fails or is unavailable, women don’t stop seeking abortions. They just turn to more dangerous methods.
The solutions are known: We need to build hospitals in rural areas. We need to train doctors and nurses. We need to make sure women have access to birth control. We need to educate women about their health. Importantly we need to help the women who are most vulnerable. We need to help women from the Dalit community and women who live in the mountains. They are often forgotten by the healthcare system.
Nepal took a brave step in 2002. The next step is ensuring that the rights written into law are truly available and accessible to every woman, not just those lucky enough to live near a city, afford care, or know where to ask.
Because a law that only protects some women protects no one at all.