Maternal Mortality is the result of a plethora of factors – the inadequacy of information, nutrition and healthcare, complications during pregnancy or delivery of the child, and even due to unsafe abortions. The World Health Organisation has estimated that each year, as many as around 358,000 women die because of complications during pregnancy or childbirth and many more encounter serious problems.
Among the many causes that augmented Maternal Mortality in Nepal, the direct cause was haemorrhage, while other major causes included within its fold abortion-related complications. Traditionally steeped in the notion that pregnancy is natural, Nepal, quite like many other countries in Asia, provides a social climate where regular medical check-ups are not considered necessary unless there are complications. In addition, the law restricted abortions and women seeking such services could be and were imprisoned. In 2002, when the law was finally amended, things didn’t change much because safe and accessible abortion procedures were still out of reach for many due to the costs involved. With the intervention of the Supreme Court of Nepal in Lakshmi Dhikta’s case, things changed for the better and access to safe and legal abortions was made an obligation for the government to guarantee and ensure.
With that, the statistical drop in the MMR was an impressive observation. In 1996, the MMR stood at 539 maternal deaths per 100,000 live births, and this became 281 by 2006, representing a decline of 48 percent over a period of ten years. The commendable quantum shift brought Nepal an award from the United Nations to laud its contribution towards the achievement of MDG 5 (Improve maternal health by reducing maternal mortality rates). This reduction coincides considerably with the reform in the laws concerning abortion, and in the changed enforcement of the laws after Lakshmi Dhikta.
How did this happen? Unsafe abortions can have a lasting impact on a woman’s health as well as life. The use of toxic mixtures, invasive techniques that might perforate and injure internal organs, and even inducing abortions from untrained ‘providers’ can pose a threat to the life of the woman or girl. When the pregnancy is unwanted, and access to abortions is restricted, the woman is forced to opt for unsafe means, as we can see in this film From Unwanted Pregnancy to Safe Abortions.
Nepal’s decriminalisation of abortion paved the way to get rid of this major factor contributing to high maternal mortality rates. A rather welcome move, Nepal is a front-runner of sorts in being an example to the world in reducing maternal mortality. Many countries across the world could do well to understand that it is not only a change in the law that is necessary – and that advocacy is a never-ending process because there needs to be a continued effort to ensure that there is access to safe and affordable methods of abortion, sufficient training, and even a budgeted approach vis-à-vis the public sector towards providing safe abortion services. The key factor to be remembered is that the reduction in maternal mortality isn’t just about the public health angle – but most importantly one that concerns social justice and human rights.