1 National Population and Housing Census 2011 (National Report) Government of Nepal, National Planning Commission, Secretariat Central Bureau of Statistics, Kathmandu, Nepal. November 2012.
https://web.archive.org/web/20130418041642/http://cbs.gov.np/wp-content/uploads/2012/11/
National%20Report.pdf
2 Global Health Observatory Data Repository http://apps.who.int/gho/data/view.main.1390 3 Nepal Demographic and Health Survey 2016. Key Findings.
https://nepal.unfpa.org/sites/default/files/pub-pdf/NDHS%202016%20key%20findings.pdf 4 The current state of maternal health in Nepal.
https://www.mhtf.org/2017/12/29/the-current-state-of-maternal-health-in-nepal/ (accessed on 2019, Aug 23) 5 Comprehensive Abortion Care. Integrated Trainers’ Manual – Third Edition 2015.
https://abortion-policies.srhr.org/documents/countries/03-Nepal-Comprehensive-Abortion-Care- Trainers-Manual-2015.pdf
6 Nepal Maternal Mortality and Morbidity Study 2008/09. Summary of Preliminary Findings.
https://options.org.np/sites/default/files/nepal_maternal_mortality_2011_04_22.pdf 7 Abortion and unintended Pregnancy in Nepal.
https://www.guttmacher.org/fact-sheet/abortion-unintended-pregnancy-in-nepal 8 The Right to Safe Motherhood and Reproductive Health Act, 2075 (2018). Chapter 4.
http://www.lawcommission.gov.np/en/archives/20858
9 Comprehensive Abortion Care. Integrated Reference Manual – Third Edition 2015.
https://abortion-policies.srhr.org/documents/countries/02-Nepal-National-Comprehensive-Abortion- Care-Guidelines.pdf
REFERENCES
Specialists (ob gyns) Non-specialists WHO*
HOW
Where
Up to 10 weeks
Listed facilities*****
Listed EmOC facility with an ob gyn or MDGP
specialist
All CAC facilities where the providers are
trained on CAC or SBA Not defined Up to 13 weeks Non-specialists (MBBS)
Nurses (Staff nurse including senior ANMs) Medical abortion (using mifepristone &
misoprostol combination)
Up to 12 weeks
First
Trimester Second
Trimester Post-Abortion Care
**
*Qualification and training criteria apply.
**Upto nine weeks for MA and eight weeks for MVA.
***Need to meet specifications of infrastructure. Includes all types of facilities - government, semi-autonomous, non-governmental and private sector facilities.
Specialists (ob gyns) Non-specialists (MDGP)
ABORTION
POLICY LANDSCAPE
Nepal
Specialists (ob gyns)
Non-specialists According to the 2014 Guttmacher report7 about 323 000 abortions took place in Nepal in the year
2014 and the abortion rate in Nepal is around 42 abortions per 1 000 women aged 15 – 49 years.
Despite the legalization of abortion under a liberal law, the study estimates that 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.
Abortion provisions are included in the Safe Motherhood and Reproductive Health Rights Act, enact- ed in September 2018. Hailed as a landmark progress, the Act states access to SRH services as a reproductive right of women. Safe abortion services and referral upto 12 weeks, post-abortion care and post-abortion family planning and counseling services are included in the National Basic Health Services Package, and the Governmen of Nepal is committed to provide them free of cost in the public sector.
ABORTION LAWS
The current law8 and policy documents5,9, being based on the principles of reproductive rights of the woman, recognize that the consent of the woman and the woman alone (if she is of sound mind and above 18 years of age) is sufficient for the provision of abortion services. Spousal consent is not required.
In the case of a woman who is insane, who is not in a condition to give consent instantly or who has not completed the age of 18 years, the consent of her guardian or curator is required to conduct the abortion. The Act also mentions that in the case of a woman who is below the age of 18 years, safe abortion service shall have to be provided considering her best interests.
CONSENT FOR ABORTION
Figure 1: Conditions and gestation limit for which abortion is permitted in Nepal*
*In accordance with the Safe Motherhood and Reproductive Health Rights Act, determining the sex of the f etus and conducting an abortion as a result of this sex determination is a crime
Spontaneous abortion / miscarriage rate
(as % of all pregnancies)
6.8
623%
358.8%
6Proportion of women who were aware that abortion at a gestational age less than 12 weeks was available for any woman
Proportion of women who knew at least one facility where they could seek abortion services.
Induced abortion rate
(as % of all pregnancies)
7.5%
6BACKGROUND
Nepal is a land-locked country in South Asia, located partly in the Himalayan belt and partly in the Indo-Gangetic plain. According to its 2011 census1, it had a population of about 26.5 million, of which about 13.64 million were girls and women, viz. a sex ratio (males to 100 females) of 94.2.
Key reproductive health indicators have shown steady improvement over the years – MMR has reduced (from 539 in 19964 to 239 in 20163); TFR has reduced (from 4.6 in 1996 to 2.3 in 2016); and CPR has increased (from 48% in 2006 to 53% in 2016). However, this rise has been due to an increased uptake of traditional methods of contraception. In fact, the CPR for modern methods had declined from 44%
in 2006 to 43% in 2011, and has remained at that level in 20163. Abortion related complications are the third largest cause of maternal deaths5 and account for about 7% of the MMR in the country6.
A Guttmacher study7 estimated that about 50% of the pregnancies in Nepal in 2014 were unintended (mistimed or unwanted), which probably is a direct consequence of the high unmet need for family planning
POLICY PROGRESS AND GAPS
Task shifting mechanism to ensure availability of safe abortion services up to the community level through ANMs.
Medical abortion combipack included in the essential drug list to ensure supplies and availability.
ABORTION-RELATED INDICATORS AND SERVICE PROVISION
Conditions permitted till 28 weeks
Condition permitted till 12 weeks
Condition not permitted
Con dition
s per
mitted till 28w eeks
