Youth and Safe Abortion Services
“There is only one good, knowledge and one evil, ignorance.” – Socrates
It was the summer of 2009. I was posted for my gynecologist outpatient department (OPD) posting during my undergrad days in nursing. It was a public hospital so the OPD was quiet full of senior residents, junior residents, nursing students like us who came for observation and clients from both rural and urban areas.
A male junior doctor was overviewing the case of Ms. Sita, a young rural, unmarried women in her 20’s who came to the OPD with her father. Her chief complaints were amenorrhea (cessation of menstruation) and vomiting for 3 months. After a quick history and baseline investigation, we determined that she was pregnant. The junior doctor tried explaining to the client about her pregnancy and her reaction drew the attention of other staff members. A senior female resident then quickly took that lady behind a private curtain and enquired about her sexual history. The young woman immediately broke down. She said her partner had pursued her for sexual relations and had told her that no physical relations before marriage would turn into pregnancy. She had no idea of contraception or pregnancy. The guy hadn’t contacted her after that day.
Looking at her naive explanation, I almost broke. I realized she was just an example of many more young women who land up in such situations out of ignorance. Had she known about sex, sexuality and contraception she wouldn’t have had to face such brunt consequences. The resident counseled her and her father regarding the availability of safe abortion services and contraception.
Luckily, Nepal legalized abortion in September 2002, a historic achievement for the reproductive health and rights of Nepalese women. The government began providing comprehensive abortion care (CAC) services in March 2004 and at present the services of medical abortion and comprehensive abortion services are running in an integrated way in all 75 districts up to the primary health center level. Had this young woman come a few years ago, she would have been behind bars for attempting abortion or been an unmarried mother and shun from society as a result.
Studies show that even after a decade of legalization of abortion in Nepal, many people still lack adequate knowledge regarding legal aspects of abortion, safe abortion services and complications of unsafe abortion. Only 38% of women are aware that abortion is legal in Nepal. In addition, their knowledge of the specific circumstances under which abortion is legal is poor.
Similarly, the most vulnerable group (women aged 15 – 45 years) are still unaware of the availability and accessibility of safe abortion services and current laws. A study conducted among women who’ve had an abortion showed that only 68% of the respondents knew about legalization of abortion (Sharma, 2008). Adolescent girls face higher risks of unintended pregnancies and unsafe abortion with devastating consequences for their health. As a result of early marriage, high fertility, lack of access and ability to use contraceptive, many forms of sexual exploitations, social, cultural and legal barriers young females are more prone to unwanted pregnancies and eventually may seek or use dangerous methods to terminate, leading to abortion complications (CREPHA, 2003). Like in case of Ms. Sita, had she known she was pregnant, she might have opted for other unsafe ways to terminate her pregnancy. It was her fate that she landed in that hospital.
If not provided with accurate and factual information regarding their sexual and reproductive health and rights, many young women can land up in situations like Ms. Sita. Hence, it is important to empower young women and men to have sexual and reproductive choices to avoid unwanted sexual contact, to make informed decisions about childbearing and to face fewer risks in the course of pregnancy and childbirth. In 2009, the government of Nepal’s Ministry of health and population, as a part of their Adolescent Sexual and reproductive health program and strategy, issued books on comprehensive sexuality education (CSE). The program was coordinated with schools through peer education programs. But unfortunately this was not been implemented in all the 75 districts of Nepal. If Ms. Sita had been a recipient of this program, she wouldn’t have landed in such situation.
Evidence worldwide shows that CSE reduces the incidences of unsafe abortion and empowers youth. I hope that some day Nepal’s comprehensive sexuality education program meets international standards. I hope it reaches every nook and corner of the country empowering more young women in days to come.
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