Let’s get our medicines from the pharmacist!

Shreejana Bajracharya, ASAP Youth Champion, Nepal


The International Day for the Eradication of Poverty falls on the 17th of October every year. On this ocassion, Sreejana reflects on whether poverty is the only factor that influences access to safe abortions for women in Nepal. 


“It’s a culture.” I tell one of the freelance journalists. “When you have a headache or something you don’t rush to the hospital. You go directly to the pharmacist.”

This article talks about the clandestine procedures that are still common in Nepal even though abortion is legal. The abortion law in Nepal does not permit pharmacies to sell abortion pills without a prescription. However, thousands of women are easily accessing Medical Abortion (MA) pills via medical shops/pharmacies nearby.

Even if it is mentioned strictly that abortion should be performed within a standard health protocol by authorized/certified health facilities and by trained medical professionals, women continue to access services through unregistered medical shops and untrained medical professionals. A study done by the Center for Research on Environment, Health & Population (CREHPA) shows that nationwide, fewer than half (42%) of all abortions were provided legally in government-approved facilities. The remainder (58%) were clandestine procedures provided by untrained or unapproved providers, or induced by the pregnant woman herself. While it is true that when taken correctly, self-inducing abortions using misoprostol and mifepristone can safely terminate a pregnancy, beyond a certain gestational period, the woman may need medical support in case of bleeding or any other complication.

Studies have also shown that women prefer visiting pharmacies rather than any Government authorized health facilities for abortion service. Nepal’s pharmaceutical industry is difficult to regulate. Only four brands of misoprostol and mifepristone abortion kits are legal in the country, but at least 20 different brands are smuggled across its porous border with India. The pharmacists have a high incentive to sell them since they can pocket hundreds of rupees each time they sell medical abortion kits.

If women are willing to pay high amounts then clearly cost is not the only barrier that keeps them away from facilities?

I had casually discussed with them the reasons behind accessing MA pills in pharmacies rather than authorized health facilities with the women who used self-administrated drugs. Most of them shared that pharmacies are convenient as they do not have to go through paperwork; no forms, no personal information needs to be provided, and the guarantee of privacy.

In the meanwhile, an estimated 80,000 women were treated in health facilities in 2014 for complications related to unsafe abortion and miscarriage. Sixty-eight percent of these women had complications that resulted from a clandestine abortion. Forty-four percent of women receiving post-abortion care were treated in private facilities, 41% in public facilities and 15% in NGO facilities.

Various organizations like Marie Stopes Nepal and PSI Nepal have recognized that working in partnership with pharmacies could result in women being provided with accurate information and instructions to reduce complications while self-administering drugs. Marie Stopes Nepal has been closely working with pharmacists and orienting them about their mobile health program “Mero Swastha Mero Haath ma”.

How does this work?

  • The pharmacists provide stickers and wallet cards to the client accessing medical abortion pills.
  • The client registers on a mobile health platform; types MA and sends it to 35565, and they receive SMSes free of cost.
  • It has clear stepwise instructions on how to use medical abortion pills.
  • It discusses the expected results and instructions on what to do in case of any complications.
  • The SMS also provides information on Contact Centre numbers for emergency and complications
  • It SMS also has information on post-abortion family planning and information on Marie Stopes’ clinics.

Recently Government of Nepal has provided free abortion service in Government health facilities- District Hospitals, Primary Health Care and via Health/sub-health posts. This is indeed great progress while recognizing women’s health and prioritizing abortion to be safe, legal and accessible. However, to measure the impact of the provision of free safe abortion services the number of women accessing abortion without stigma in health facilities resulting in a reduction in clandestine abortion should be performed.

What else can we recommend to the Government of Nepal?

  • Take into account the fact that pharmacies are more accessible for women than health facilities.
  • Reform its policy; either resulting in stricter punishment for pharmacies selling unauthorized medical abortion pills (besides the four registered MA drugs),
  • Or work in coordination with Druggists and Chemists Association to regulate the drugs and make abortion pills accessible to women all over Nepal with clear instructions, at a reasonable price.
  • Increase the awareness around the legality of safe abortion
  • Actively conduct stigma reduction programmes in the community and through the media to ensure that the women in Nepal can benefit from the legal safe abortion services.

So, the next time a woman goes to the pharmacist to get a medical abortion pill, she will get one which is safe and effective, price controlled and with a set of instructions which will ensure that she understands the complications and has access to a service centre if she needs one!

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Saima’s Dilemma

Naureen Lalani, ASAP Youth Champion, Pakistan.


On the occasion of International Day of the Girl Child, 2017, Naureen reflects on the need to provide access to safe abortion services so that girls grow up with the ability to make the best decisions they can for their own bodies. 


Imagine that you are Saima from Pakistan.

Saima is a house wife, her husband doesn’t have a permanent job, and they can barely make ends meet. She has five children, the youngest child is a year old, and Saima has just found out that she is pregnant again. Saima already finds it difficult to take care of her children and attend to their needs. At the same time, she is unable to take care of her own health. She does not want to continue this pregnancy, and as the days pass her stress levels increase,  and she is unable to perform her household chores and give her family the attention they deserve.

Saima decides to have an abortion.

It takes her 2 hours to reach to the nearest healthcare provider. After reaching to the clinic she explains the entire situation to the healthcare provider, and asks for an abortion. Instead of providing her with an abortion; the healthcare provider forces  her to continue the pregnancy, and counsels her on contraception to keep this from happening again. When Saima insists that she wants to terminate the pregnancy, the healthcare provider denies her medical care, and asks her to leave the clinic.

A few days later, Saima starts to experiment with several remedies that she has overheard older women discuss during her childhood. Great! Bleeding starts! However, she starts experiencing dizziness, fever, and abdominal pain. She thinks she’s getting better, but as the days pass her condition is getting worse and she is unable to get out of bed or do any work. With great difficulty, Saima re-visits the healthcare provider and explains her condition to the provider who starts insulting and scolding her for what she has done. Later, she examines Saima, and says that she has a severe infection, and cleaning of the uterus is needed since this is incomplete abortion. She provides her with care, but during the course of procedure, the healthcare provider keeps cursing her for whatever she has done. Both Saima and her family suffer a lot due to all this. The healthcare provider could have saved Saima from all the suffering if she had provided Saima with a safe abortion when she asked for it.

Throughout the world, instances such as these are very common, and women try to terminate their unintended or unwanted pregnancies in conditions where access to safe abortion is illegal or restricted , often jeopardizing their safety and health. Each year several million women experience complications due to unsafe abortions, even though this is a preventable cause of maternal morbidity and mortality.

Abortion is legal in Pakistan under many conditions. In 2002, Pakistani women experienced about 2.4 million unintended pregnancies; nearly 900,000 of these pregnancies were terminated by induced abortion. [1]

Doctors in every country should provide the full range of care that they can and not stand in moral judgement or take decisions on behalf of women.

Read more about it in this comic book.

 

[1] https://www.guttmacher.org/report/abortion-pakistan

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My Journey Towards Becoming an Agent of Change

Shreeya Mashelkar, ASAP Youth Champion, India.

fedabc5cc005f8ef49b34c2a37aba4b5--quotes-for-change

It has just been 1 year since I came in touch with the Asia Safe Abortion Partnership.

I had never had reason to have any opinion about abortions before that since I had never personally encountered anyone seeking it in my life. Neither my school nor my junior college curriculum ever brought up this topic, which I now realize affects so many lives on a global level.

From googling abortion and thinking of it as a miscarriage alone to understanding the term medically, legally and ethically now I feel that I’ve come quite a long way!

Revolutionary ideas are always resisted at first I feel. Any change which shakes the very basis of one’s deeply set beliefs is unwanted. But the YAR taught us ways in which we can take small measures which will lead us closer to our goal- women’s right to access Safe Abortion. The YAR mentored us in a way that we could get our facts straightened out, tactfully debate on conflicting views and share our experiences with people from other Asian countries.

We had so much to take from this experience. Meeting the other Youth Champions and being amazed by the novel ideas and ways in which they were trying to make a profound impact in their countries. Rola Yasmine, who took such amazing interactive sessions which stirred our minds. Her ‘A project’ is an inspiration as to how the strong will to prove something can affect lives and help the ones that need it. Dr Amar Jesani’s session on ethics which always makes us question our actions and how deciding between right and wrong isn’t always as easy as we think it should be.

Vandana Khare ma’am who literally reached out to the masses enlightening them through theatre. Having always loved theatre and how simply it can convey a strong idea to the crowd, is why I really loved this session. Anubha Rastogi ma’am’s session on legal advocacy was an eye opener for me, as I had minimal knowledge on the legal intricacies and specifications of our own Indian law. Paromita Vohra ma’am’s Agents of Ishq was such a creatively designed “Desi” niche for the Indian audience to connect immediately. Shreya Anasuya’s views and how she is building on a feminist internet and creating content that is user friendly yet politically just, setting an example of how words are mightier than swords.

And to meet and have a session with Manisha Gupte Ma’am was enthralling as usual. Brainstorming about possible solutions in real life to prevent barriers in safe abortion. Group activities, the interaction with other participants and the organizers, it was a memorable 3 days experience that I will always treasure.

And lastly, the reason why I could be a part of all this, Dr.Suchitra Dalvie and Shilpa Shroff ma’am. You have been with us, teaching and guiding us from the very beginning. Providing us with information, instilling ideas and helping us be the positive change in the society we want to see.

These are just the first steps of my journey and I look forward to walking with ASAP and the other Youth Champions for a long time to come!

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Romantic proposals 101 from Asia

romantic proposal

“Son, it is time for a young man’s thoughts to turn lightly to marriage. Who better to guide you than Sukhan Uncle?? He has so much experience. He has three sons who were married and now despite the pending court case for suspected dowry death by burning of his second wife, he has a third wife for himself also. And he has been to foreign and knows all about these romantic things. ” wink wink.

“So Uncle what is the best way to propose?”

“Well, you know that in the foreign they make the man go down on one knee and offer a ring or flowers at a romantic spot? Nonsense. Not in India. We are not like them. We have a deep and wonderful culture, where the girl’s family has to go on its knees. All of them. And offer us the girl along with a hefty contribution towards the new extension to the house or down payment on the car (since dowry is illegal now).

Some of your ‘modern’ friends may tell you to build a toilet inside the house so that it will send a message that you are progressive and caring. Or they may tell you to say you will not take dowry or will allow her to work after marriage. Don’t listen to those foolish young men. What have they seen of this world??

The top five methods to propose are

  1. Keep giving her a missed call. Everyday. Girls love that mysterious bad boy vibe.
  2. Whistle and call out random stuff when she passes you by on the road. Girls love that kind of attention.
  3. Offer an exchange for your sister to marry her brother. But if she is from an unfortunate family that has no sons then that is not possible.
  4. Offer her five times the love by asking her to marry all five of you brothers. Which woman would refuse such a magnificent offer?

If she refuses these charming offers, then you must first decide if you really want her. If you do then arrange to have her kidnapped.

http://www.crimehilore.in/gang-involved-in-kidnapping-for-forced-marriage-of-poor-girls-of-jharkhand-west-bengal-and-bihar-busted-3-arrested/

Once she is in your custody her parents will be too shamed to ask her to come back because who in their right mind will marry her after this? Don’t worry about her not growing to like you. She will grow to love you and even look after you. The syndrome is named after Stockholm but it works very well here in India.

Of course if you don’t want her now that she has refused you then you could consider pouring acid on her face. Arrogant b**h. That way she and all the women in her family and community will learn a lesson. Never say no to a man. Justice must be done. That is our way.”

“But Uncle…”

“ Son, when elders are talking young people must only listen !

  1. The top of the list, the most romantic way to propose to her is to rape her. Not only in India. This works in Pakistan, Bangladesh, Malaysia and even many countries in the Middle East.

https://www.theguardian.com/world/2017/apr/05/victims-should-marry-their-rapists-malaysian-mp-tells-parliament

http://www.reuters.com/article/us-bangladesh-child-marriage-idUSKBN16855I

It’s the best plan. Listen to her scream. If you are a real man who has drunk his mother’s milk then you will end up making her pregnant also. Then not only the girl’s parents will be begging you to marry her but the village elders will also endorse.

khap-1_660_020413113123

http://www.smh.com.au/world/rape-victim-told-to-marry-to-become-respectable-20150703-gi4xn6.html

All old men of the village, yes, why should women be involved in such decisions? Of course they may also offer your sister to her brother to rape in front of the whole village …..but that’s ok. Honour rests in the woman’s vagina. It is written in the books. Kitabon mein likha hai. And justice must be done.

http://www.hindustantimes.com/india-news/panchayat-orders-man-to-rape-girl-in-front-of-family-in-pakistan/story-PCgpqMgY0cg7loTzjAlDAL.html

In India marital rape is not even criminalized, so you can continue raping her if she doesn’t come to her senses and agree to it on her own.

https://blogs.wsj.com/indiarealtime/2015/04/30/modi-governments-reasons-why-marital-rape-is-not-a-crime/

This is our culture and our civiliation. “

http://www.independent.co.uk/news/world/asia/rape-survivor-kills-herself-forced-marriage-india-a7380536.html

“But Uncle……….”

“Listen son, always make sure she is of the same caste as you or then we will be forced to hang both of you from the tree outside the village. We are nothing if not believers in gender equality and justice.

http://timesofindia.indiatimes.com/city/delhi/Intercaste-couple-shot-dead-4-years-after-marriage/articleshow/6076777.cms

http://www.deccanherald.com/content/487675/newlywed-inter-caste-couple-murdered.html

Our culture runs really deep you know. “

“ Yes, Uncle. I can see that. It is deep. Down to the seventh circle of hell.”

 

 

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Heal Your Hymen

-Shristi Mainali, Youth Champion Nepal

The blog was originally posted here- https://uncurtainedvoices.wordpress.com/  

Image

Few days ago, as I was surfing the internet and going through some interesting YouTube videos, a suggested video named “Hymen can be healed” caught my attention. I was really taken aback by the video title and decided to be one of the thousands viewers of the video. I was both curious and furious about the video. Curious, because I wanted to know what nonsense stuff was there being preached and furious, because the title itself gave me the impression that how blatantly gibberish it was about. No wonder the video was watched by thousands and there were equally large number of reactions in comments’ section especially from females.

Then I questioned myself, why does a girl need to heal her hymen? Just to prove to her partner that she is a virgin? What if she isn’t? Why does virginity matter, anyway? If it matters, how does a man assure his partner the same thing? Or is it applicable just for females? Why virginity of a man is least thought about and why is it the character defining ‘tool’ for women? I was fuming.

Hymen is still a great concern (especially in south Asian countries) where large numbers of girls marry a complete stranger. Some minor enquiries about family, wealth, guy and his occupation, it is deemed favorable to marry the guy. In arranged marriage like such, knowing about the partners in detail is rare. Moreover, in a male dominated society, women are often judged by what they wear, how they present themselves, their previous relationships (if any) and their virginity. Thus, many females try certain capsules to fake bleeding after the intercourse, some use artificial hymen whereas some choose whole surgical process to repair their hymen. Having had many social issues to deal with, the matter regarding virginity and hymen adds to their already piled up stress.

Women need to understand that hymen doesn’t cover the whole opening of the vagina but it is just a thin layer of muscular membrane at the wall of vagina which gets stretched during a female’s first intercourse. Very few percentage of women bleed during this event and for rest the hymen gets adjusted towards the edges of vaginal wall which prevents the bleeding. Hymen can’t measure or decide the virginity of a woman rather this myth is created to control a woman’s sexuality. People might now think what can be the alternative way to know about the sexual activeness of a woman. I would ask you to think some ways to know about the sexual activeness of a man. Can you know if a man is a virgin or not unless you ask him about it? No, you can’t! Thus, same thing applies for a woman too. You know about her virginity status only if she tells you, and telling the truth or choosing not to tell is solely her own decision/right. Lastly, if a guy searches for blood stains on the white bed sheet after you do your thing then here’s a suggestion ladies, let him go and find someone who loves you not your hymen. Hymen and bleeding is not the proof of your virginity but the so called “Modern Society” will often find ways to either prude-shame or slut-shame a woman and disrespect her dignity. Thus, stop thinking about your hymen and just enjoy who you are.

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