1. World Population Prospects 2019. United Nations Population Division. https://population.un.org/wpp/Download Standard/Population/
2. Annual Health Bulletin 2018. Ministry of Health. Royal Government of Bhutan. http://www.health.gov.bt/wp-c tent/uploads/ftps/annual-health-bulletins/Annual%20Health%20Bulletin-2018
3. National Statistics Bureau. Bhutan. http://www.nsb.gov.bt/publication/publications.php?id=1
4. Standard Guidelines for the Health Workers on Management of Complication of Abortion. Ministry of Health, Royal Government of Bhutan. https://abortion-policies.srhr.org/documents/countries/03-Bh
tan-Standard-Guidelines-on-Management-of-Complications-of-Abortion-Ministry-of-Health.pdf 5. Regulations. Medical and Health Council. Royal Government of Bhutan.
http://www.bmhc.gov.bt/wp-content/loads/2012/06/MHCRegulationsFINAL.pdf
6. Penal Code of Bhutan https://abortion-policies.srhr.org/documents/countries/01-Bhutan-PENAL-CODE-2004.pdf 7. National Health Promotion Strategic Plan (2015-2023). Ministry of Health. Royal Government of Bhutan
https://www.aidsdatahub.org/sites/default/files/publication/Bhutan_National_Health_Promotion_
Strategic_Plan_2015-2023_2016.pdf 8. National Essential Medicines List. 2018
http://www.health.gov.bt/wp-content/uploads/afd-files/2019/02/National-Essential-Medicines-List-2018.pdf
REFERENCES
ABORTION
POLICY LANDSCAPE
Bhutan
The Standard Guidelines for Management of Complication of Abortion clarifies that if a woman seeks care for illegal abortion, she needs to be treated with respect, and in an unbiased manner;
as the woman post-illegal abortion may not even have familial or social support.
Only facilities with general practitioners and specialists can offer treatment of complications of abortions, while lower-level facilities can offer stabilization and referral services.
PROVISION OF POST-ABORTION CARE
According to the Section 146 of the Penal Code of Bhutan, 20046, the penalty for the woman or the provider for the offence of illegal abortion, is counted as a misdemeanor with punishment of
maximum term of imprisonment less than three years and minimum term of one year for the
convicted defendant. In addition, the Medical and Health Council Regulations classify abortion as a serious professional misconduct that can lead to suspension of registration.6
PENALTIES
Section 146 of the Bhutan Penal Code legalizes abortion under three conditions – to save the woman’s life; in cases of rape and incest; and in cases where the mother is of unsound mental condition. Further, abortions in Bhutan are guided by the Standard Guideline for the Health Workers on Management of Complications of Abortion4, that lays down additional conditions for medical termination of pregnancy – to preserve the woman’s health, and in cases of fetal
impairment, defines gestational limits and describes methods to be used.
ABORTION LAWS AND POLICIES
While there is no mention of consent requirements for abortions in the Penal Code or the Standard Guidelines for Management of Complication of Abortion, the Medical and Health Council
Regulations5 state that it is compulsory to obtain spousal consent.
CONSENT
For induced abortion, the guidelines mention pharmacological induction with mifepristone and prostaglandin; vacuum aspiration; and dilatation and curettage.
METHODS OF ABORTION4
Figure 1: Conditions and gestation limit for which abortion is permitted in Bhutan
86/100 000 live births2 30.8″%3
15.3″%3 1.93 65.63 11.7%3
Maternal mortality ratio
Percentage women married before 18 years
Percentage women with first child before 18 years
Total fertility rate
Contraceptive prevalence rate (all methods)
Unmet need for family planning
BACKGROUND
Bhutan, officially known as the Kingdom of Bhutan is a landlocked country located in the eastern Himalayas and bordering India and the People’s Republic of China. Among the South-East Asian countries, it has the second lowest population 0.763 million and is ninth in terms of size followed by Timor-Leste. The female population is 0.358 million,1 i.e. 47% of the total population, and the sex ratio is 110 males per 100 females.
Intensive programme efforts have resulted in decline in MMR to 86/100 000 live births in 20172. In the years 2001 – 2002, out of 35 investigated maternal deaths in the country, 2 deaths were
because of abortion complications. Abortion complications are one of the most common obstetric morbidity causes with a case fatality rate of 1.4%4.
POLICY PROGRESS AND GAPS 1
The Standard Guidelines for Management of Complication of Abortion clearly acknowledge the lack of family and social support for women undergoing abortions and urges providers/facilities to treat women seeking treatment of complication of abortion with the same respect as they would treat any other client.
3
Misoprostol is part of the essential drug list.82
Abortion care is mentioned as an intervention, especially for adolescents, in the National Health Promotion Strategic Plan.74
The policy documents do not uniformly describe abortion and medical termination of pregnancy. While the documents say that abortion is illegal and termination of pregnancy is permitted under certain conditions, the Penal Code clearly legalizes abortion under certain circumstances. The terminology is also probably a reason why methods of abortion are not described in detail – they are mentioned as treatment of abortion complications.
*As mentioned in the Standard Guidelines for Health Workers for Management of Complication of Abortion
Conditions permitted till 180 days
C o n d
it io ns n
ot e tt pe i r m d
Conditions permitted till 180 days
