Law related to Abortion :
Nepal became model for change globally when abortion was legalized under the 11th Amendment to the Civil Code in March 2002. The bill became law when the Nepal Government affixed the Royal Seal in September 2002. However, there was long delay of 15 months before the procedural order, which authorizes the implementation of legal services, was approved by the cabinet on December 25, 2003.
Short summary of conditions within the law :
According to the new law, only listed (trained) doctors or health workers can provide safe abortion services at listed (approved) health facilities, under the following conditions:
- Within the first 12 weeks of pregnancy for any woman on her request. The permission of husband or guardian is not required for women above 16 years of age
- Within the first 18 weeks of pregnancy in cases of rape and incest
- At any time if the pregnancy poses danger to the life or physical or mental health of the pregnant woman or the foetus is seriously deformed and it is recommended by a doctor.
(Government policy enabling for the law, enabling beyond the law in practice etc such as population control policy, pro- natalist policy, anti sex selection policy, two child family norm)
In 2004, a Safe abortion policy was developed in order to ensure the availability of safe and legal services which states that pregnancy termination shall not be performed based on sex selection. It will be punishable if abortion is performed without the consent of the pregnant women. There is no pro-natalist policy or norms of the government on the number of child. However, the policy states that abortion should not be used as a method of family planning.
Providers trained, willing, enabling Altogether 481 doctors and 21 nurses are already trained in safe abortion services and the request for training especially from private sector is increasing.
Reproductive Health Perspective :
Signatory to ICPD, CEDAW: Yes/ No, any conditions.
Abortion Statistics :
No stats are available.
Total – 212,396
1st TM -212,396
2nd TM – No records
Safe – 212,396
Unsafe -Information on induced abortion (both safe and unsafe) prior to legalization is very limited. However, few available studies revealed that despite the illegal status of abortions was fairly widespread in the country. The post legalization trend in unsafe abortion for the country is different to measure in light of the lack of population-based surveys on abortion after the legal reform. One of the main sources of data of this kind would be number of clients visiting post- abortion care (PAC) services due to complications induced abortion (CREHPA, 2008) married women, unmarried women- 3% (among women aged 15-49) 2006 DHS (safe + unsafe)
adolescents – 5.4% of all women receiving safe abortion from approved abortion clinics
Septic abortions – It was seen that the total number of complicated septic induced abortion among PAC clients has reduced significantly in recent years.
Public sector :
Abortion services available
1st Trimester- Yes in 96 sites
2nd Trimester- Yes in 4 higher referral hospitals only
Medical Abortion being piloted in six districts.
Cost; – Most Govt. managed abortion clinics (CAC centers at government hospitals) charge Rs 1,000 as abortion fee. Few government CAC centers charges Rs 800
Private sector :
Abortion services available.
1st Trimester – Yes in 108 sites
2nd Trimester – Yes in 2 sites
Cost – The abortion fee at NGO managed CAC centers range between Rs. 950 to Rs. 1350 In private CAC centers, it ranges from Rs. 1500 -Rs. 3000
Methods used :
D&C, EVA, MVA, MMA with Mife, Miso, MMA with Miso alone, MMA with Methotrexate Miso.
D&C, EVA, MVA are available. Mostly MVA is used in certified (listed) sites
2nd Trimester with D&E, Mife and Miso.
Provider level allowed for surgical and medical abortion :
(Ob Gyn, MBBS, Nurses, Other)
Ob/Gyn and MBBS trained in 1st trimester – Up to 12 weeks of gestations
Nurses (trained in 1st trimester) – Up to 8 weeks gestation under the supervision of the medical officer.
Ob/gyn and MBBS trained in 2nd trimester – Up to 18 weeks gestation
Abortion related morbidity mortality statistics :
Demographic and Health Survey, Nepal 2006 show a steady decline in the Maternal Mortality Ratio (MMR) from 539 in 1996 to 281 in 2006.
Legalization of abortion and provision of safe and legal abortion service may be one of the factors that may have contributed to this decline.
Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment) :
MVA syringe available through local distributor-ATLAS trading concern.
Manufacture/ import of Mifepristone, Misoprostol :
The drugs (Misoprostol and Mifepristone) have been approved and its availability has been assured through the drug department system.
Facility and provider certification norms in brief :
Facility has to have a trained provider and also fulfill the minimum requirement based on the checklist
The provider has to be a registered member of the Nepal Medical Council in the case of doctors and at the nursing councils for the nurses. They have to perform 25 cases individually after the training in order to be the certified (listed) abortion provider
Information available in national service delivery standards :
No records are available.
Informal / illegal providers – if present who are they :
Untrained health care providers, traditional birth attendants, pharmacists, Quakes.
Population urban/ rural – Demography of the country, with an analysis of availability of abortion services ratio to population :
Attached below. Demographic profile from DHS Nepal 2006.
Role of government :
Supportive, enabling, creating barriers, provides adequate funding to run training and service delivery programmes.
The Family Health Division (FHD) under the Department of Health Services (DoHS), Ministry of Health and Population (MoHP) has taken the leading role in formulation the policies, strategies and procedural order, setting norms and standards to implement the abortion law in the country. TCIC works in close collaboration with the government
Role of religion/ religious leaders :
Enabling, supportive, neutral, restrictive.
Local Ob Gyn societies :
Supportive, conscientious objectors.
Nepal Society of Obstetricians and Gynecologists (NESOG) is involved in various trainings and studies on Safe Abortion Services (SAS) At the national level NESOG has been involved in the advocacy of policy makers in evidence based decision making
Current status and potential of research :
Research activities is done by partner organization – CREHPA (Center for Research on Environment Health and Population Activities) a private, not-for-profit consultancy and research organization.
Awareness amongst community members :
Involvement in community educational activities to create public awareness on women’s rights and protecting women’s reproductive health
Design innovative program to reach women directly
Role of member organization/ individual :
Technical Committee for the Implementation of Comprehensive Abortion Care (TCIC) was established in late 2002, following the passing of the bill, in March 2002, that legalised abortion in Nepal. As a multi-partner forum, with membership drawn from various government divisions and ministries, non-government organisations and professional bodies, the role of TCIC is to advise and support the government in implementing the reformed abortion law. This has included drafting manuals, establishing and managing the training programme and public sector services, setting standards and monitoring procedures for both public and private services, and initiating information and behaviour change activities, including development of printed materials and radio/TV spots. The TCIC secretariat, which is responsible for carrying out these activities, is housed in the Department of Health Services (DoHS) building, ensuring regular and close collaboration. Two multi-partner working groups provide technical advice, one for information dissemination and the other for clinical services and training. An Advisory Board, chaired by the Director General of the DoHS is responsible for major strategic decisions and recommendations