Safe Motherhood in Nepal

This study reviews the complications following comprehensive abortion procedures at 30 randomly selected registered safe abortion sites (both public and private) in Nepal over a 3-month period. Around 7,000 women were followed up after they had received services to determine whether they had developed complications. The complication rate was 2.0 per 100 procedures, either during the procedure or during the follow up period. The complications were mostly minor, including retained products of conception (1%), offensive discharge (<1%), moderate bleeding (<1%) and suspected sepsis (<1%). Only 2 of the 7,000 cases experienced high severity complications. This low overall complication rate suggests that abortion services are being provided safely.

A case study on the effects of the global gag rule on reproductive health services in Nepal, which conflicts with the Government efforts to implement a democratically reformed abortion law and thus address the toll of suffering caused by unsafe abortions

In 2002 Nepal\'s parliament passed a liberal abortion law, after nearly three decades of reform efforts. This paper reviews the history of the movement for reform and the combination of factors that contributed to its success. These include sustained advocacy for reform; the dissemination of knowledge, information and evidence; adoption of the reform agenda by the public sector and its leadership in involving other stakeholders; the existence of work for safe motherhood as the context in which the initiative could gain support; an active women\'s rights movement and support from international and multilateral organisations; sustained involvement of local NGOs, civil society and professional organisations; the involvement of journalists and the media; the absence of significant opposition; courageous government officials and an enabling democratic political system. The overriding rationale for reforming the abortion law in Nepal has been to ensure safe motherhood and women\'s rights. The first government abortion services officially began in March 2004 at the Maternity Hospital in Kathmandu; services will be expanded gradually to other public and private hospitals and private clinics in the coming years.

In Nepal, the effects of the low social status of women and lack of access to health care and family planning have resulted in a maternal mortality ratio that is among the highest in South Asia. By the mid-1990s, the contribution of unsafe abortions to maternal deaths and morbidity was acknowledged by key individuals in the Ministry of Health and Department of Health Services. Advocacy for abortion law reform over several decades culminated in the passage of a new law on abortion in 2002. The parliamentary process took almost four years from the tabling of the bill. Almost two years elapsed between the passage of the bill and approval of the Procedural Order for implementing it. This paper describes the development of policy and programme strategies for implementing the new law, led by the government in collaboration with NGOs, donors and other stakeholders. During that time, documents required for implementation were prepared, training of service providers was begun and a model service delivery and training site was established in Kathmandu Maternity Hospital. Simple systems to enable rapid expansion of services and a women-friendly approach were devised, promoting universal availability of affordable services provided by physicians and eventually nurses, the latter particularly in remote and rural areas, where 88% of the population live.