Dr. Aruna Uprety
Nepal is one of the few countries in the world where abortion is illegal. Unsafe, illegal abortion is a major cause of maternal death in Nepal. 'The medical complications of improperly performed illegal abortions are now reaching epidemic proportions in many parts of the world, and represent a leading cause of death of women among childbearing age. From one to two hundred thousand women die each year in developing countries" (12). In Nepal, about 4000 women die each year from illegal abortions. Abortion is not only illegal in our country - it also comes under the definition of "homicide" so that women go to jail in case abortion is proved.
In this paper I will discuss the legal issues regarding abortion in Nepal. I will look at how this law reflects the status of women in our society through its disregard for women's right to make their own reproductive choices. I will look at how women have been affected by the laws that criminalizes abortion. I will discuss women's activities to legalise abortion and some of the obstacles facing this process. I will discuss if this will solve the problems associated with women's health issues. Finally, I will propose what should be done to ensure all women have access to safe abortions.
The abortion issue has never been perceived as a health issue for the people who are in government and people who make policy. Even feminists and activists in Nepal had not raised abortion as a woman's health issue. Although some concerns have been raised by the medical community from time to time during the last twenty years, it was only after ICED and the Beijing conference that this issue began to gain momentum among women's activists in Nepal .
Unsafe Abortions: A Global Epedemic
Millions of women around the world risk their lives and health to end an unwanted pregnancy. Every day, 55,000 unsafe abortions take place, 95% of them in developing countries, which lead to the deaths of more than two hundred women daily. World-wide, the percentage of maternal deaths due to unsafe abortions is 13%, but in Nepal this figure rises to 50 percent.
From the medical point of view, abortion is the termination of pregnancy and is "legal under some circumstances in nearly all countries of the world: 96 per cent of countries recognise a threat to a mother's life as legal basis for stopping pregnancy". (The Status of World Population, 1997: 22). Nepal is among the those 4 per cent of countries where abortion is illegal even if pregnancy is a threat to the mother's health or life. That is why no hospitals in Nepal perform abortions even as a medical procedure and for this reason women are forced to seek other methods.
Historically, women have performed abortions in villages in Nepal to regulate their fertility. Many village women know some kind of traditional medicine to abort the foetus in the first 2-3 three months of pregnancy. Many village women seek the help of old women to get rid of pregnancy or go to the "village doctor", who may be male or female. Most of the time, pregnancies are terminated in the villages in a very brutal manner. A stick with mud or cow dung and even sometimes poison grass is inserted inside the vagina to induce the contraction of the uterus and cause the foetus to be expelled. Sometimes the abdomen of the pregnant woman is massaged with the hand or with the feet so that the foetus is expelled. One can easily imagine the condition and suffering of those women who have to suffer such a "procedure".
How the abortion law affects women
Nepali laws are especially harsh to women who try to abort their foetuses. In addition to imprisonment the sentence may also include the confiscation of all the woman's property. This is a provision which makes woman particularly vulnerable to false charges from greedy in-laws or other relatives. Because of these laws an estimated two thirds of the women in Nepalese jails are convicted of garbhapat (destruction of life), which is a term applied to abortion, infanticide and attempted infanticide through abandonment.
Sapana Malla, a young lawyer, clearly states what Nepalese law says about abortion and infanticide. Abortion and infanticide is a crime against the state, dealt with under the homicide chapter of Muluki Ain, the Civil code of Nepal. In the case of abortion, penalty for the termination of a 6 month pregnancy is 2 years imprisonment and for pregnancy above 6 months it is 3 years imprisonment. The punishment for infanticide is life imprisonment and confiscation of property' (Kathmandu Post ,1996; 4 ) The legal definition of abortion that links it to homicide is seen in a new light: "Bizarrely, if a woman kills her rapist within one hour of the assault, she receives legal immunity - but she goes to jail if she terminates a pregnancy resulting from the same attack."(Goodwin J., 1996: 18).
Ironically, not a single man has been punished for abortion in Nepalese legal history. Society has forgotten the fact that men are equally responsible for the pregnancy of women. Male sexuality is never have been challenged or even questioned by the society, religion or culture and that very 'non-challenge' is reflected in the law and practice. The religious or cultural rights discourse give men more means and avenues of satisfying desires (Imam A., 1997: page 4). Additionally, while doing so, they are not held responsible for any of the acts. The whole burden of responsibility of pregnancy and abortion falls on women.
Three Case Studies
Thousands of Nepali women suffer every year from dangerous back-street abortions. According to one study done by the Maternity Hospital of Kathmandu, from May 15, 1995 to August 31, 1996, 1,961 cases of abortion complications were registered. According to the history given to the doctors by the patients, only six percent of those were induced abortions but the condition in which they were brought strongly suggests more than 50 % was induced. One gynaecologist working in the hospital said, "Most of those cases which have come to the hospital with abortion related complications, most of them done by quacks. Many come to us in a very bad condition." When asked if she reported the cases to the police, the doctor replied, "We should have, but we did not do it. We don't report it to the police because sick women would have been arrested and that would add insult to injury". (Uprety, A.,1996).
Dr. Renu Rajbhandari once told the authour personally, "6 years ago, I was working in Bharatpur Hospital. One woman was raped by a village man while her husband was away and she got pregnant. She went to a quack and something was put inside her vagina. After two days the foetus was expelled. She dug a hole and put the foetus inside it. Three days after the abortion she developed a fever, started bleeding and came to the hospital while I was on duty. By this time, a neighbour had already complained to the local police that she had an illegal abortion. The police came to the hospital and brought the woman to me and asked me to write a report stating whether she had undergone abortion or not. I talked to the woman and found out the whole story. In order to save her from the police and to save her family life, I gave the report that there had been no abortion and she had very bad infection which required hospitalisation. Of course it was not true medically but I do not feel guilty about it, because if I had not written this report the police would have taken her and her life would have been shattered."
A 20 year-old woman with two girls, aged 3 and 1 in Butwal, a small city in the southern part of Nepal, became pregnant. She was harassed by her in-laws that again she would have a daughter. Due to this harassment and her fear of having another daughter, when she was 5 months pregnant she went to a private gynaecologist. The doctor told her that it was dangerous to have an abortion after 4 months. She was desperate to abort the foetus so she went to a woman who was notorious for performing abortions. This woman put something inside her vagina and the following day, after painful contractions, she aborted the foetus. Bleeding began and lasted for three days and thereafter she was taken to the hospital. Unfortunately, because of septicaemia and severe anaemia, the doctors could not save her. The hospital record stated the cause of death as septicaemia caused by induced illicit abortion. Before she died she told her husband about the abortion, but the family was unable to take any action, as they did not have any witnesses. (Uprety A. 1994.)
In June 1996, 'Equality Now' published the case of Lok maya Adhikari, a thirty-eight year old Nepali farmer imprisoned for one year for having an abortion. Married at the age of 15 and widowed at 32, Lok Maya had been left with five children (two sons and three daughters), the youngest of who was 6 years old. During her imprisonment, her children were sent to live with their uncle. The alleged father of the pregnancy, Bhim Prasad Poudel was also arrested, but he denied responsibility for the pregnancy and the abortion- he was the one who brought Lok Maya to a quack for the abortion - but he was found not guilty.
These case studies raise a lot of issues concerning women's positionality within society and the law. In the first case the woman could not tell the police that she was raped as a lot of stigma is attached to the victim. She would have been ostrasized by the society through no fault of her own. In the second case, the woman had to play with her life because of the fear that another child would be a girl, an unwanted baby. In the third case the woman had to go the jail and the person who was responsible for her abortion was set free.
The Human Cost of Illegal Abortions.
'"When an aeroplane crash kills 500 people it makes international headlines for days. The number of women world-wide who die from illegal abortions amounts to one to two such airline crashes very single day and this makes no news anywhere," David Grieves Med told the 1996 National Abortion Federations conferences (Goodwill, 1996: 15). In Nepal maternal death is one of the highest in the world 1500/100000: half of these are caused by illegally induced, back-street abortions.
But women's lives are not the only cost of unsafe abortions. "Between 10 and 50% of all women who undergo unsafe abortions need medical care for complications. The most frequent complications are: incomplete abortions, sepsis, haemorrhage and abdominal injuries, such as puncturing or tearing of the uterus. Long-term health problems caused by unsafe abortion include: chronic pelvic pain, pelvic inflammatory disease, tubal blockage and secondary infertility. Other possible consequences of unsafe abortion are ectopic pregnancy and an increased risk of spontaneous abortion or premature delivery in subsequent pregnancies. Such problems can limit women's productivity inside and outside the home, constrain their ability to care for children and adversely affect their sexual and reproductive lives." (WHO, Internet 1998 23 )
It should also be remembered that there is a tremendous impact on the public health system by illegal abortions and the resulting abortion related complications. The treatment of such complications often requires several days of hospitalisation, staff time, as well as blood transfusions, antibiotics, pain control medicines and other drugs. The provision of this care depletes funds and medical supplies needed for other types of treatment. As much as 50% of hospital budgets in some developing countries are used to treat complications of unsafe abortion." ( WHO internet, 1998 )
The Nepali Movement to Legalize Abortion
One prominent lawyer describes the situation as follows: "I know that in Solukhumbu District (in eastern Nepal) five out of nine women in prison have been prosecuted for/ are serving sentences related to infanticide. One specific problem related to women in prison charged with infanticide is that there is no medical investigation system in Nepal to determine if a woman was really pregnant or not, whether she had a normal delivery, abortion or forced delivery. For this reason, many women are in prison. Secondly, men are in the most cases outside judicial action.
Feminists and activists in Nepal are working toward legalising abortion from the perspective of health and justice for women who are forcibly jailed for abortion. A bill has been drafted and put through parliament. The women's movements are trying to raise this issue in connection with Beijing Conference which was signed by our government. The Fourth World Conference on women recommended that countries "consider reviewing laws containing punitive measures against women who have undergone illegal abortion." (As cited in .Packer C 1996 ) .The bill's recommendations include legalising abortions carried out by registered physicians in the first 12 weeks of pregnancy and thereafter in special cases like rape, incest, life-threatening situations and where the foetus is diagnosed as being severely handicapped (The Silent Pandemic, 1996: page 3).
The proposal for reforms is based on three realities. First, it responds "to the limits of public tolerance and public opinions in Nepal. Second, it responds to the increased awareness of women's rights and the growing concern about the victimisation of women in abortion matters. Third, it accepts modern evidence that legal abortion is significantly safer than its frequent social alternative. The bill contains these major characteristics: Abortion at an early stage of pregnancy will be legalised. Medical doctors will perform the operation. Services will be more assessable to women early, thereby reducing the duration of pregnancy at the time of abortion. Proper information will be given to women". (Real lives, 1997: 10).
Despite the fact that suggests many reforms, much work is still needed. The proposed bill does not look at abortion as a 'reproductive right' issue and does not consider male responsibility. There has been a great deal of discussion regarding this bill, and in February 1997, another bill was introduced which addressed a number of issues relating to women's rights including property inheritance, rape and a proposed amendment to the abortion law. Unfortunately, the parliament was dissolved in 1996 as result of a political crisis, before legislative action was taken on this bill and only now is the bill under discussion again. 'According to a survey done by Family Planning Association of Nepal, 74% of members of parliament are in favour of legalising abortion, as are 94% of gynaecologists'. (Kathmandu Post, 1998 ; 8).
The idea of legalizing is not without obstacles.There are some Hindu religious groups that want to continue to make it illegal. Though they are not a very strong force, they have had an impact. At the same time some members of Parliament are not keen to raise the issue of abortion as they do not think that it is an issue which should be dealt in the discussion. Nevertheless, women's voices, which equate legalizing abortion with women's political empowerment, have already made some changes.
Nepal Medical Association of Nepal has forwarded a program in which it has clearly suggested to the doctors conditions under which abortion can be performed in hospitals. Though in the lawbooks it is illegal to perform an abortion, in some parts of our country doctors in hospitals do perform abortion if mothers health is in risk, or the fetus is severely damaged. It is an open secret that the government is aware of. But it is not done in every hospital and not on the request of the mother.
We cannot hope that the legalization of abortion in Nepal will automatically guarantee access to safe abortion for all segments of the population. In a developing country like Nepal, merely the fact that abortion law is liberal does not and cannot gurantee that women have access to legal abortion facilities. There are too many constraints, including the lack of human resources such as doctors and nurses in many parts of Nepal, lack of confidence of women and financial obstacles. Activists and medical professionals should be aware that "legalising abortion is thus only the first step in making safe abortion a real option." (Hartmann B. 1987; 63).
In countries like India, where abortion is legal, incidence of illegal abortion is still very high. "In India at least 10 times as many illegal abortions are carried out as legal ones and ar least 80 per cent of women admitted ot hospitals with complications have had abortions performed by unqualified people"( Gupta j. ,1996 ;216) . So we have to work to make sure that people have equal access to safe abortions. "properly performed, abortion is a woman's safety net and one of the most important reproductive rights of all".(12)
The government will have more responsibility to ensure that abortion is available to all who need it after it is legal. In order to reduce the current heavy toll of abortion-related maternal death and morbidity, governments, international agencies, women's groups and non-governmental organisations (NGOs) must take steps: ensure universal access to family planning; increase the availability of safe abortion services to the extent allowed by law; improve the quality and accessibility of post-abortion care; educate their communities about reproductive health and unsafe abortion; and work for changes in policies to safeguard women's reproductive health. A high priority should be given to the prevention of unwanted pregnancy through comprehensive client-oriented reproductive health services.
Non-judgmental attitudes, confidential counselling and quality family planning information and services should be universally accessible to all women, including emergency contraception where feasible and appropriate. Quality Services should be safe and available to the full extent allowed by law, particularly in rural and impoverished areas. Service providers must be carefully trained to offer high quality services and compassionate counselling. The providers must be well informed about the legal status of abortion and protocols for providing services so that eligible women can access them quickly and without unnecessary delay or bureaucratic procedures. The available services should be publicised within the community and links should be strengthened with women's groups, health centres and related organisations thus ensuring that women who need services are informed about where and when to seek care.
As things stand, discrimination of women from equal access to health care leads to illegal and unsafe abortions. Criminalization is associated with the lower status of women and with women's subordinate position in the family and in society. Hence it is very important that abortion rights should go together with women's access to and control over social resources. At the local level and national level, policies and programmes must ensure that women enjoy a harmonious and disease free sexual life. Representatives from different political parties should regard women's issues as a part of the main stream agenda, not as an issue that can be sidelined. There should be programs to disengage and influence policies that enable women to manage their own fertility safely and effectively, and by choice, not through coercion.
I would emphasize that abortion not be used as a method of family planning. We should make accessible better and safe contraceptive services for all people to reduce the need for abortion. To ensure complete reproductive health, policies and programmes must be framed within and implemented as part of broader women's development strategies that will redress the equal distribution of economic resources among and between men and women.
(Dr. Aruna Uprety works as a medical pratitioner in Kathmandu, Nepal.)
...tara still abortion garnu paap jastop manchan sahar ma ta testo sochchan bhaney gau ghar ko ta k bhanney hai ......
----USE CONDOM HAVE SAFE SEX----