Abortion Rules in Nepal
U.S. foreign policy continues to influence the introduction of safe abortion services in Nepal. The Helms Amendment, passed in 1973, is a U.S. law that restricts the use of foreign aid for abortion «as a method of family planning.» 61 As a result of this legislation, funding flows from the United States Agency for International Development (USAID) prevent the integration of abortion services into reproductive health care. Many state and nonprofit clinics that receive USAID funding cannot offer abortions, and women seeking services at these clinics must be referred to parent centers. The distance and cost of transportation to these higher-level centers often prevent women from accessing abortion services.62 «When the service is used in the right place after consulting an expert in the field, it is safer. We have heard many people say that someone has taken medication for abortion and therefore died or is now bleeding heavily. Does this person in the pharmacy have enough idea about what drugs to use in the current month of pregnancy? No. So nowhere is this comparable to consulting in hospitals or clinics with experts. CC IDI 4, Roghini, 32 The government then replaced the ATF with the Technical Committee for the Implementation of Comprehensive Abortion Care (TCIC), a coordinating body within the Family Health Division.
Government members include the National Health Training Centre, the Logistics Management Division and the National Health Information, Education and Communication Centre; Civil society participants include the Nepal Health Sector Support Programme (a project funded by DFID), Marie Stopes International, the Family Planning Association of Nepal (FPAN), the Forum for Women`s Law and Development, the National Federation for Safe Motherhood, PSI, CREPHA and Ipas. The Procedural Ordinance also established the Advisory Committee on Safe Abortion (SAAC) with members of several ministries, expert councils, NGOs and advocacy organizations to oversee the TCIC and provide policy guidance and high-level program decisions [13]. SaAC consults closely with the National Association of Gynecology, which makes recommendations to policy makers and keeps partners informed of progress in safe abortion care [14]. Footman K, Keenan K, Reiss K, Reichwein B, Biswas P, Church K. Medical abortion by pharmacies and drug vendors in low- and middle-income countries: a systematic review. Stud Fam Plan. 2018;49:57–70. The significant contribution of unsafe abortion to maternal mortality and morbidity was a crucial factor that led to the liberalization of Nepal`s restrictive abortion law in 2002.
Careful and comprehensive planning by Nepal`s Ministry of Health and Population, led by a number of multi-sectoral actors, has enabled the country to introduce and expand safe abortion services in a remarkably short period of time. This article examines the factors that have contributed to the rapid and successful implementation of legal abortion in this mountainous republic, including deliberate attention to key areas of policy, health system capacity, equipment and care, and information dissemination. Important elements of this successful model of expanding safe legal abortion are: the pre-existence of post-abortion care services, thanks to which health care providers already knew the most important clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public and private sector actors; rely on public health evidence to formulate guidelines on abortion screening, which has led to the adoption of medical abortion and the authorization of mid-level care providers as key strategies for decentralization of care; and the integration of abortion care into the existing safe motherhood and the wider health system. Although it remains difficult to ensure that all Nepalese women can exercise their legal right to preterm abortion, the national safe abortion programme has already achieved positive results. Nepal`s experience in scaling up high-quality abortion care in a short period of time provides important lessons for other countries seeking to reduce maternal mortality and morbidity through unsafe abortions and achieve the Millennium Development Goals. The participant further explains that her positive experiences at the MSC for her previous incomplete abortion influenced her decision-making when she had a second unplanned pregnancy. Effective and comprehensive training of service providers in the area of safe abortion, which began long before energy consumption, has been the cornerstone of rapid expansion. As part of the preliminary planning, the TCIC training sub-group, with the support of Ipas, developed reference and training manuals for safe abortions, as well as a curriculum initially focused on competency-based training on MVA [20].
The program includes instructions on technical abortion procedures, counseling, post-abortion contraception, and counseling to improve the functionality of the facility. This qualitative research is a significant contribution to Nepal`s rare evidence base for the provision of PA by pharmacies and provides a unique and in-depth analysis of women`s post-abortion experiences.