What to Expect when you’re not Expecting!

Srushti Mahamuni


5 key questions to ask yourself before having an abortion or taking an unplanned pregnancy to term.

Discovering you are pregnant when you were not planning to get pregnant can be extremely stressful. Carrying the pregnancy to term or considering an abortion can be a highly emotional decision.  The internet is not always super helpful, given the highly politicised nature of this intimate dilemma!

Of course, a woman has a total and complete right to her body, and while this decision should involve or at least take into account the partner’s opinion and feelings with regards to the pregnancy, at the end of the day, it is completely the woman’s choice.

So, allow yourself the space and time to make the best decision for yourself.

x———————-x———————-x

Here are 5 objective questions to ask yourself before you make a decision

Is your body prepared for a pregnancy?

Carrying a pregnancy to term can have a lot of health repercussions on your body. Those 9 months takes a lot physical, emotional and mental strength. Is your body in a healthy enough state for it? Are there any health issues that you are suffering from that could get aggravated and even endanger your life?  Depending on your age, reproductive history, sexual health history, prior history of abortions or pregnancies, having another abortion or carrying a pregnancy to term can have health consequences on your body.  It is important to ask your doctor all the health risks involved.

Do you see a future for your relationship with your partner?

Is your relationship with your partner stable enough to move forward to this next step? Is your relationship healthy? Are you feeling pressurized by or pressuring your partner to sway the decision in either direction? Do you see yourself having children in the future? With this person? What kind of family structure do you want to raise a child in? While a child can be raised in a variety of family structures and households with love and care, these questions are a guiding light for you to figure out if the family structure you want to raise a child in would be possible for you with or without your partner. Open and frank communication is key to teasing out the answers that will help you make your decision.

How would this decision affect your career goals/ financial situation?

Having a child can seriously delay if not modify completely, your education options, career goals and financial situation, especially when the pregnancy is unplanned. What are your career goals? How do you see a baby fitting into the picture? How will this change modify your goals? How do you feel about that? Furthermore, a child costs money. Are you and your partner currently in a position to afford a child? If not, are there support systems you can rely on while you become monetarily stable? Financial stability is something that can always be achieved at a later stage in life; however, being able to fulfil basic needs of your new family is something to consider before making the decision to have one. Also, having an abortion in a private facility can sometimes be expensive. This also needs to be taken into account and both partners need to discuss their contribution to the financial expenditure of the procedure.

 Can you rely on support systems for help?

They say it takes a village to raise a child. Who is your ‘village’, your support system? Are you in a position to rely on the different people in your life, to support you in the different ways you may need – emotionally, financially, mentally and physically? Are you and your partner willing to take responsibility and this decision together? How will your family react to this news? Who do you need to support you in making a decision, no matter what it is? Do you/your partner or your family share any religious/ moral values that would affect your decision and their support for your decision? Even in cases where you decide to have an abortion, a support system is helpful to deal with the physical and emotional repercussions. Who will accompany you to the clinic? Will you have someone to talk to after? An unplanned pregnancy, especially in certain cultures can take a toll not only on the couple but also on their family ties. In some cases revealing to your family that you are pregnant can even be life-threatening. In this case, look for the women’s support groups in your area and trust in them to help you deal with your situation.

 Are you ready to be a parent? 

Most importantly, realize that parenting is a serious, lifelong commitment. It is hard work. But it can also be exciting, fun and rewarding. It helps to have a partner or a support system you can rely on to the make the journey smoother. If you are not ready to be a parent at the moment, (or ever), that is okay as well. Take time to think and feel for yourself where you stand. Discuss openly with your partner and talk through all the possibilities with an open heart. Allow yourself to feel without judgment because, at the end of the end of the day, you are the best person to make this decision for you.

Every situation is different and every decision is personal, allow yourself the possibility to imagine either reality and trust that the decision you make will be an informed one, that is best for you at this point in your life.


About the author: Srushti Mahamuni is an anti-capitalist, free-spirited sorceress who strives to practice an intersectional- feminist, queer, anti-white-supremacist, decolonial politics. She was born and raised in Pune, India and grew up in France, the Netherlands and Congo and continues to grow evermore. Academically trained in gender studies she works to create an equal world for all. She blogs about an array of topics, ranging from sexuality, body politics to navigating complex identities in a changing world. Get in touch at srushtimahamuni@gmail.com 

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Removing Abortion Stigma among Young People

Rupesh Thapa, ASAP Youth Champion, Nepal


Coming close on the heels of his participation in YCAN’s Youth Advocacy Institute, and a broader, sectoral push to include adolescents in the conversations on SRHR, Rupesh reflects on the impact that a lack of SRHR can have on youth, and the role that they can play in advocacy.


As a Youth Champion, after attending the second National Youth Advocacy Institute in Nepal, I have come to realize the tremendous strength youth have in shaping their own path and destiny, whether be it their dreams, career or be it related to their bodily autonomy.

Asia today has the largest number of young people in its population than it has ever had in history. Youth today are not only present in numbers but are actually contributing to growth and development. They are a heterogeneous group of people with different needs and desires. Ignoring their needs, particularly Sexual and Reproductive Health needs, will hamper their full growth and development and therefore their capacity for contribution to society. Besides which, these are part of their human rights!

It’s not that Sexual and Reproductive Health and Rights of young people have not been addressed in policy. The first time young people’s SRHR needs were realized was at the International Conference on Population and Development in 1994, to which our country Nepal is a signatory. As a result of which we have an adolescent reproductive health strategy. However, the proper implementation of these policies is yet to take place.

So what is stopping young people from access to safe abortion services?

Stigma is one of the main barriers that keeps young people from accessing their SRHR and stems from social and cultural values and beliefs. Stigma has its root in the need for patriarchy to control sexuality, particularly that of young women, and maintain its hierarchy in many ways. Many upper and middle-class family stigmatize abortion and emphasize the need for ‘good girls’ to not interact with boys before marriage. Due to a lack of knowledge on gender and rights, at times health care providers as the product of the society they live in, further perpetuate stigma while preventing access to SRHR for young people.  In a country like Nepal, where abortion has been legalized for 15 years, stigma continues to be one of the main reasons for unsafe abortions amongst young population.

So what happens when young people are stigmatized for access to safe abortion?

This pushes young people to go for unsafe services, thus risking their lives and health. Morbidity related to unsafe abortion can cause lifelong disability. Even in legal settings, young women can be economically blackmailed by the clandestine providers. These are just a few of the repercussions of abortion stigma.

So can we end stigma?

Yes, definitely – if there is a problem, there has to be a solution! Stigma has its roots in the culture, religion and tradition which have a long history, and might be difficult to uproot at once but definitely not impossible. We should create awareness about gender differences and how it disproportionately favours one group, neglecting the need and rights of others. We should also be able to change our policy and plans and make it more young people friendly. We should sensitize medical providers, media persons and other stakeholders. Most of the work that the Youth Champions and Asia Safe Abortion Partnership are doing in imparting knowledge about safe abortion through a gender lens goes a long way towards this!

What role can youth play?

Youth are not just the future; they are the agents of change in the present. They are the experts in matters related to them, including their autonomy. Youth should be meaningfully engaged in plans and policies related to their own bodies and sexualities. It’s time that sensitized youth create more awareness in the community and work with other stakeholders in upholding their rights and demanding youth-friendly services.

Youth can fight stigma through social media campaigns like the September 28 campaigns, street demonstrations and so much more.

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Power to Rape

Shristi Mainali, ASAP Youth Champion, Nepal


pics

The recent “Me Too” campaign reminded me of an incident which took place a few months back in Birgunj. It was such a refreshing morning; a friend of mine and I were pretty excited to have the opportunity to visit the Gadhimai temple in Kalaiya. We were casually talking about the famous Gadhimai Mela that is held once in every 5 years, and suddenly, the tuk-tuk in which we were travelling back to Birgunj, stopped. Two male passengers got into the vehicle. And as my friend and I were talking, their eyes were fixed on us. With every jolt of the tuk-tuk, their eyesight was engrossed on my breasts. The situation quickly became extremely uncomfortable; neither could I ask them to look away, nor could I put up with their nasty looks. I had an umbrella and a bag in my hand, and I tried every possible way to turn away and cover myself up. But all in vain.

The travel of around an hour was the greatest mental torture I faced recently.

Later, when I reached my hotel room I questioned myself, “What could have I done at that time?”. I felt guilty as I could do nothing but let myself sit through the hour-long mental discomfort.

I had to ask myself… Why didn’t I speak up? Was I scared because I did not belong to that place? Would have I spoken up if the same thing had happened to me in my place of residence? I have been in many such situations in past where the gropers would disgrace me in a crowded place, ranging from the street to the public transportation. There were many instances (in fact almost all) where I did shout and shame such sick-headed men in public. But here, I felt helpless. And to all the questions above I got perplexed answers without any clarity.

Women face so many forms of sexual harassment both in private and public but are always dumbfounded when it comes to reacting in such situations. Many might argue, ‘So what if they looked? They did not get physical anyway. What’s the big deal?’

Okay! Are we supposed to wait and watch until someone grabs us, or tries to enforce his manhood on us? Are we meant to wait till then?

Keeping quiet during the small acts of discomfort is where we make a mistake most of the time, and give the flashers or molesters the “Power to Rape”.

Yes, Power to Rape!

Had it been my place, I could have mustered some courage to speak up to those harassers to stop assaulting me with their eyes. Had they been somewhere else other than their very own place, they would not have probably gathered the guts to gaze at my breasts throughout the journey without any hesitation or fear. This very incident made me realize that rape is all about power and control. It doesn’t mean rapists don’t derive sexual pleasure from the act of rape, what I mean here is they carry out the act not because of any uncontrollable urges of sexual desire, but because the act makes them feel powerful over their victims.

However, our society doesn’t bother to understand this fact, and ultimately the women’s clothes, their speech, actions and behaviors all automatically get blamed. Shrouding women in shame in this manner leaves them even more vulnerable to the games of power that their attackers play. Women should be assured that it was not their fault, or the fault of their dressing sense, or the place they had been which led to the situation. It’s only when we stop shaming women for being a victim, they will gather the courage to come out of the traumatic scenario and speak up. It’s only when we stop thinking about rape through the moral lens of lust and shame that we can properly address the politics of power that uses rape as a tool. It is only then, we can converse about the safety of a woman as an independent person with rights, rather than an object of satisfaction and purity. In addition, we must start being equally outraged by the less extreme acts of hatred or harassment towards women that are no less effective in giving rapists the license to operate and keep victims quiet, shamed and deprived of justice.

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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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