Abortion Inside Out | Feature

Abortion is defined in the Oxford English Dictionary as " the induced termination of pregnancy." It has been a very controversial topic and few people see the need to talk about it openly. As Dr Bhola Rijal, Senior Gynaecologist in Om Hospital, says " I was one of the first people to talk about legalising abortion in 1982 in an interview with the Rising Nepal". This interview caused a hue and cry against him with people accusing him of promoting infanticide, sexual relations and talking against prostitution laws.

Today abortion has been legalised in Nepal for the past three years but still the lack of knowledge and information remains rampant. I did not know abortion had been legalised in Nepal, and being a journalist who had worked here for the past 7 months, if I did not know then imagine the number of youth who are still unaware of this legal development. As can be seen from the WAVE survey from outside Kathmandu, 20.14% of the youth are indulging in sexual activity and only 34% of them are pro-abortion with 53.4% of them aware of its legal status. It is time we informed all of them of its legalities and more importantly of preventive methods.

The battle for abortion rights for women was long and well fought. The absence of abortion laws had resulted in 50% of maternal deaths in Nepal. Not only were mothers not given the right to abort an unwanted foetus but it was also considered a crime amounting to infanticide for which a lot of women were, and still are, convicted as criminals. For many of them, this meant suspension of the lives of their entire families. As can be seen from the case of Shanta Shrestha cited by Yvonne Singh in her article 'Abortion nightmare in Kathmandu' for BBC who had a miscarriage but was arrested by authorities on charges of having an abortion and was sentenced to 20 years in prison. During this time she was unable to take proper care of her five year old son and had to put him in a hostel. So deeply traumatised was she by her experience in jail that till the printing of the article she was unable to find her son as she says "This incident took away precious time with my son. I would give anything to see him again and make sure that he is okay". These earlier laws of abortion were in place irrespective of the circumstances of impregnation including rape and incest.

In comparison to the rest of the world, the Nepali abortion law is very democratic and liberal. This came about only after a lot of effort from activists and organisations such as Dr. Aruna Upreti, a women's health activist who played a vital role in bringing about the present abortion laws. She tells us "Earlier there was a law which stated that a woman could only have an abortion with the consent of her husband, this was not only patriarchal but impractical. What does a woman do if her husband works abroad or if she is a widow and had been raped?" She adds, "We even had to face some Hindu religious groups who were against legalising abortion but compared to other countries this opposition was minimum."

The legalisation of abortion has also brought about a new need for knowledge and information not only among the youth of the country but also the general public. As Dr Rijal tells us, " Sorry to say, but it has been legalised on paper only. It has been over three years that legalisation took place but this has not been implemented and I don't know where the government is lacking and why this service is not made widely available for the poor and those who are in need. It doesn't take three years to implement the legalised procedures, this only proves how inefficient the government is". Dr Upreti, replicates the sentiment when she says, "When abortion was legalised all my fellow activists and journalists turned and asked me how long I thought it would take to implement it, I said at least 50 years". According to CREHPA (Centre for Research on Environment, Health and Population Activities) 42% of the urban population is aware of abortion laws. It is still sceptical as to exactly how much of the rural population which makes up more than 50 percent of Nepal's population are aware of these laws. According to the same survey only 26 government hospitals and 13 non- governmental hospitals and clinics had received government approval for providing Comprehensive Abortion Care (CAC) services.

Another factor that seems to pose a problem towards acquiring complete knowledge on abortion seems to be the social stigma attached to it. As Dr Rijal says 'What I feel strongly is that there are two groups of people dying from maternal deaths. One group out of poverty, because they cannot afford the services. And the other out of ignorance because they can afford the services but the means are not available and our social customs are so bad that they have to resort to primitive methods to avoid social stigma".

These primitive methods include inserting a stick with cow dung or even poisonous grass into the vagina to induce contractions of the uterus to cause it to expel the foetus or massaging the abdomen with the hands or the feet to induce the expulsion of the foetus. These practices are still at large in Nepal and more often than not doctors have to deal with more complicated problems that arise out of unsafe abortive practices. As Dr Upreti explains " A lot of people end up going to quacks to perform abortions and only come to registered clinics when the abortion goes wrong. This is not only extremely unsafe but can also result in lifelong infertility".

Though the problem of implementing abortion laws would seem to affect only married women, this is not the case. A lot of young girls face problems of unwanted pregnancies be it due to rape, failure of contraceptives or just a plain lapse of information and formal sex education. A senior gynaecologist has even told us that, girls as young as 14-15 come to her clinic for abortions or with signs of an abortion gone wrong. Though there has been no formal survey done in teenage pregnancies it is understood to be on the rise. CREHPA and other organisations have instigated various youth oriented programs. The youth branch of the Family Planning Association of Nepal (FPAN) soon plans to document the cases of abortion in the youth but as Ramesh Upreti, of the youth Program of FPAN tells us "Due to procedural delays, abortion has been in practice for a very short period only and it will take some time before we can gather conclusive information or statistics". FPAN also has a free youth counselling hotline, 5554092, from 2 to 4PM. Another reason behind the lack of information on teenage pregnancies could be as Dr Upreti says "In Nepal it has been the norm for girls to be married off at the age of 14-15, so teenage pregnancies were never a big deal but now in urban areas the trend is changing and we should give it importance but in the villages it is still not considered an issue".

Another grave concern of most people before abortion laws were passed was that it might encourage sexual activities, abortion and even prostitution. These fears seem to be baseless. In the survey conducted by CREHPA 61% of the people said that they believe abortion would rise. Though this may look like a bad omen, one must realise that till date abortions had not been recorded and now that it is being recorded, it is natural to see a rise. It is an improvement to see a growing number of people performing safe and legal abortions. The tendency of increase of sexual activity cannot be related to abortion. Abortion is not a joke, it involves a complete invasion of the body, which no one would allow without desperate measures. Dr Rijal explains "You cannot check the physiological phenomenon of either the girls or the boys by trying to keep them apart. Sex education is the factor that needs to be addressed". Dr Upreti adds, "The youth seem to have misguided opinions on love. Love does not mean sex. In Nepal we need to be more open with our children, we have to make them comfortable with their bodies. Parents shouldn't be hesitant talking to their children about sex, contraceptives and the changes taking place in their bodies. In fact it is imperative that parents talk to their children about these issues."

The overall consensus seems to be that sex education and awareness on all issues relating to sex and sexuality need to be addressed urgently with the youth. People need to come out and address these issues. Not only talk about them but also be able to be comfortable answering questions about them. The need to talk is felt the most in our society. It is time that the youth growing up today understand and realise that abortion is legal and available to those who are in desperate situations irrespective of any social or cultural barriers.

The Gist of The Law

• It is absolutely mandatory that the woman undergoing abortion has given her consent. Without the consent of the woman nothing can be done legally.
• Abortion is legal for any pregnant woman within 12 weeks of the onset of pregnancy
• Abortion is legal upto 18 weeks for women who have been a victim of rape or incest.
• Abortion is legal if at any point of the pregnancy there is a threat to the health of the mother, the foetus or if the foetus is found to be deformed. In all the above cases it has to be certified by two medical doctors.
• The law protects the privacy of the woman undergoing abortion and their right to make their own reproductive choices without the consent of any man.

A Case study

An incident I can tell you about is when one of my journalist friends called me up and said there was something important she wanted to talk to me about. When she came, she was very shy but I knew instinctively it had to do with abortion and pregnancy. My friend then hesitantly said that one of her nieces in Delhi was having a problem and I immediately asked " is she pregnant?" and my friend said "yes". So I asked my friend how old her niece was and was told she was 22 and couldn't marry the boy. I told my friend that in Delhi abortion had been legal for almost 25-28 years and there were so many places where her niece could go and get an abortion. To this my friend replied that her niece was unaware of a single one of these clinics. I was really surprised that a young girl of 22 studying in one of the good universities in Delhi had to call her aunt in Nepal to find to about abortion. Anyway I called up one of the clinics here to find their branch in Indian and I gave the number to my friend who passed it on to her niece. Three days later we came to know that she had gone to the clinic and safely aborted the foetus.

It shows that if this girl did not have access to this sort of information she would've probably gone to a quack and her life would have be jeopardised.

In India after 25-28 years of legalisation, there are still so many cases of abortion related deaths because of the lack of information and because young girls don't know where to go and if she goes to the hospitals she has to face many questions and hassles, so she ends up going to a quack or someone who doesn't know how to do it properly and does it illegally. This was an eye opener for me, that just being in a good institution in a big city doesn't mean that you will have information.

That's why I think it is very important that young people be told about reproductive health issues, abortion issues and sexually transmitted diseases and also know where to go for these information and services.

Dr. ARUNA UPRETI, Women's Health Activist.
(As told to Aarti Basnyat)