Women in Nepal are vulnerable to several health-related problems due to several socio-economic factors. Maternal mortality ratio in Nepal is still high. One of the significant attributable factors of maternal deaths and injuries is unsafe abortion. In March 2002, the Nepali Parliament passed a breakthrough legislation contrary to its abortion law. Under the new Abortion Policy 2002, the government granted women legal access to abortion, which came into effect in 2003. Women are permitted abortion for up to 12 weeks of gestation on request and under certain medical/legal conditions.

Specifications of Nepal’s 2002 Abortion Law

Pregnancy termination is available under these circumstances:

  • Up to 12 weeks gestation for any indication, by request
  • Up to 18 weeks gestation in the case of rape or incest
  • At any time during pregnancy if mental/physical health or life of the pregnant woman is at risk (approval from a medical practitioner required)
  • At any time during pregnancy if the fetus is deformed and incompatible with life (approval from a medical practitioner required)

Additional considerations:

  • Only providers certified in safe abortion care are eligible to provide induced abortion services;
  • The pregnant woman alone has the right to choose to continue or discontinue pregnancy
  • In the case of minors (< 16 years of age) or mental incompetence, a legal guardian must give consent
  • Pregnancy termination on the basis of sex selection is prohibited

 

The policy change followed an intensive period of advocacy and planning for implementation of safe legal abortion services. The scope and speed of abortion services scale-up in Nepal in an extremely challenging geographic, political and economic environment engaged multiple stakeholders from a variety of sectors in a well-coordinated, collaborative effort. Nepal’s experience serves as a useful model for introduction and rapid development of safe abortion infrastructure following liberalization of abortion policy.

Nepal’s first legal document Muluki Ain was introduced in 1854. In all other cases, the law equated pregnancy termination with homicide until 1963, when the act banned abortion except when the woman’s life was at risk. Back then women were prosecuted and sent to prison under charges of infanticide. Up to one-fifth of women in Nepali prisons before 2002 were convicted on the basis of illegal abortion.

In 1994, the abortion rate in Nepal was estimated at 117 per 100,000 women; all of which were concealed and many were unsafe. This reliance on abortion occurred in the context of high fertility and low contraceptive use. Before 2002, Nepal’s maternal mortality ratio was among the highest in the world with a large proportion of deaths attributed to unsafe abortion along with abortion-related morbidity; one hospital-based study of obstetric complications found that 53.7% of admissions were attributable to clandestine abortion.

In the late 1980s, with support from the United States Agency for International Development (USAID) and technical assistance from the international non-governmental organization (NGO) JHPIEGO, the Ministry of Health and Population (MoHP) began improving the quality and availability of post-abortion care (emergency treatment of complications of unsafe abortion linked to post-abortion contraception and other reproductive health services). Over time, growing awareness of the negative impact of unsafe abortion on women’s health and lives, and of access to safe abortion as fundamental to women’s rights and maternal health goals, fostered multi-sectoral support for reform of Nepal’s restrictive abortion law. Advocacy efforts, led by the MOHP, culminated in 2002 with passage of the Muluki Ain 11th Amendment Bill, a gender equality bill containing language liberalizing access to abortion.

To guide implementation of the law, in February 2002, the MOHP’s Family Health Division (FHD) created the Abortion Task Force (ATF), comprising the Nepal Society of Gynaecology & Obstetricians (NESOG), the Centre for Research on Environment Health and Population Activities (CREHPA), German Technical Assistance (GTZ) and Ipas. Many organizations and individuals on the task force had also been involved in advocacy for legal reform, as well as in Safe Motherhood efforts led by Options and funded primarily by the U.K. Department for International Development (DFID).