Research shows that, in 2014, Nepali women had 323,100 abortions in total, 137,000 of which were legal, and 63,200 women were treated for abortion complications. The abortion rate was 42 per 1,000 women aged 15–49, with a ratio of 56 abortions per 100 live births. There are social stigmas prevalent when it comes to abortion and reproductive health of women. Recently Nepal Live Today‘s Ashim Neupane and Rhishav Sapkota interviewed Dr Popular Gentle, Country Director of Ipas Nepal, an organization that has been working in the field of sexual and reproductive health and rights, regarding the same issue. Excerpts:
How would you introduce Ipas Nepal and its work?
Ipas is a global organization that works towards women’s reproductive rights. It aims to ensure safe abortions for all who choose to have them. Abortion is one of the leading causes of maternal mortality in the world and Nepal is no exception.
We do not claim sole responsibility for the improvement in reproductive health and rights in Nepal, but Ipas Nepal, the Nepal chapter of Ipas, has been providing technical assistance to the Ministry of Health and Population (MoHP) to initiate and expand safe abortion service in the country since its legalization in 2002.
Do you think we’re at a satisfactory level when it comes to access to safe abortion facilities for women?
Even though abortion has been legalized and right to safe motherhood and reproductive health has been incorporated as a basic right for women in Nepal’s Constitution in 2015, we are still not at a satisfactory level. The inclusion of such a right in the constitution was a significant step forward, but political will to continue with implementation may be waning. This is because providing access to safe abortion and contraception to all women who want it has been envisioned in our policies as a gradual process.
For example, when resources are allocated to listed abortion centers in the country, existing footfall of women seeking such services are accounted for, whereas many women are unaware that abortion is legal and never step foot in the listed centers. This prevents a large number of women from getting access to safe abortion services.
What does a woman have to do to get a safe abortion in Nepal?
Both the private and public sectors operate safe abortion clinics. It is necessary to ensure that the center is government-certified. Abortion services are provided free of charge in government centers, and it is the responsibility of the center to protect the privacy of service seekers. They cannot, for example, inquire about the age of the women who visit these clinics for abortions.
‘We don’t see many policies from top to bottom in governance hierarchies that take gender as a mainstream approach. When gender is a secondary issue in policymaking, the results are directly visible in the types of more tangible programs that will be prioritized and endorsed’
Which intersection of the demographic of women is the hardest to reach when it comes to spreading awareness about safe motherhood and reproductive health?
There are numerous factors to consider here. First, the information and education that the women have received has a significant impact on whether they are aware of these aspects of their health and the facilities that are available to them. There are also geographical pockets that are difficult to access, which are further intersected by the prevalence of marginalized communities in these areas. The problem of a lack of proper communication with women in Terai and other remote areas is exacerbated by the existing patriarchal structure. Women in the far western and western hills face similar dilemmas. But then there are pockets that are difficult to reach in Kathmandu as well.
What has been your approach to mobilizing the community in the process of raising awareness about safe motherhood and reproductive health issues?
We felt the need to mobilize people in the community itself for greater reach, so we trained nearly 107 community leaders from marginalized communities who were willing to volunteer without monetary compensation. They have been working tirelessly and enthusiastically for the past year and a half and have been able to reach and positively impact nearly 15,000 people across the country.
What are the recent focus areas of your organization at the moment?
We’ve been looking into the relationship between climate change and reproductive health. This is a causation hypothesis that is rarely investigated. During our preliminary research, we discovered that there is a link between the two.
We are also conducting extensive research on how to optimize the government’s service delivery mechanism in the federal system, where the direct on-the-ground responsibility for reproductive health and safe motherhood rests with the local government. In our experience, elected officials in local governments have a strong desire to address these issues but lack the necessary expertise. In these cases, we provide technical assistance to these local governments in order to maximize their capacity for service delivery. Strengthening the service delivery mechanisms of local governments is especially important because, as privatization in the health sector increases, the economically disadvantaged will be the most affected by the government’s ineffectiveness.
The government’s planning session will begin around mid-December, and if we are not quick, deliberate, and prepared to raise these issues, they risk being overlooked.
How has the Covid-19 pandemic affected your organization’s work, and what steps have you taken to mitigate those effects?
During the pandemic, we provided technical support to the government to develop an Interim Guideline for Reproductive, Maternal, Newborn and Child Health (RMNCH), and the guidelines envisioned the facility of medical abortion at home. When combined with virtual consultation and implemented, a woman who opts for abortion will be able to consult a medical professional from the comfort of her own home and will be able to take medication to successfully complete the abortion process. We created a prototype simulation and tested it, yielding excellent results. If we can implement this system throughout Nepal, we will be able to overcome geographical and social stigmatization barriers.
What are the social barriers that come in the way of women wanting to opt for abortion?
The first is women’s lack of agency in making decisions about their sexual lives, contraception use, and family matters. According to research we’ve done on the subject, the most discouraging factors for women seeking abortions are their own intimate partners, followed by family members and society. The fear of being shunned by society if one’s privacy is violated is another major reason why women are unable to obtain abortions.
Is there any policy gap when it comes to addressing these issues?
We don’t see many policies from top to bottom in governance hierarchies that take gender as a mainstream approach. When gender is a secondary issue in policymaking, the results are directly visible in the types of more tangible programs, that will be prioritized and endorsed, all of which slows down the government’s larger attempt to address the health issues that women face in this country.
What is the scope of your organization’s presence in Nepal?
We currently work in 20 districts across Province 1, Gandaki Province, Lumbini Province, and Sudur Pashchim Province. Our working approach is to create technical assistance mechanisms for the government as well as raise awareness about reproductive health and rights, with the goal of eventually handing them over to the community. This method has allowed us to impact 45 districts.
We provide technical assistance and don’t want to duplicate with the work of the government because we aren’t a parallel institution. Our goal is to strengthen the government’s service delivery mechanism and raise awareness about safe reproductive health and rights, particularly safe abortion and contraception. If the community becomes sufficiently aware, the government will be more accountable to address its needs.