Safe abortion services, effectiveness of legislation to

control teenage pregnancy

Swornim Bajracharya067/BPH/19

Overview

• Introduction/ Background• Rationale • Situation • Objectives • Findings • Conclusion• Recommendations • References

Introduction

• Abortion is the termination of a pregnancy before the fetus has attained viability, i.e. become capable of independent extra-uterine life.

• Induced abortion is the deliberate termination of a pregnancy before the fetus has attained viability, i.e. become capable of independent extra-uterine life.

• Spontaneous abortion is the spontaneous termination of a pregnancy before the fetus has attained viability, i.e. become capable of independent extra-uterine life. This is often referred to as a miscarriage.

--WHO, 2006

WHO defines unsafe abortion as:

“a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards, or both.”

Teenage pregnancy

• Teenagers (adolescent) is defined as being between 10 -19 years, encompassing the entire continuum of transition from childhood to adulthood.

• Teenage pregnancy can be defined as pregnancy in a woman aged 10–19 years.

• Teenage pregnancy is a rising public health issue being faced by many countries globally.

Abortion legalization• Abortion was legalized in Nepal under the

11th amendment to the Country Code (Muluki Ain) in March 2002, receiving royal assent in September 2002.

• The law enables women’s rights to control over and decide on their unintended pregnancies.

Abortion is legal in Nepal on the following grounds:

1) Up to 12 weeks of gestation for any woman;

2) Up to 18 weeks of gestation if pregnancy results from rape or incest; and

3) At any time during pregnancy, with the advice of a medical practitioner or if the physical or mental health or life of the pregnant woman is at risk or if the fetus is deformed and incompatible with life.

Abortion will be punishable on the following two conditions:

1) Sex selective abortion, and

2) Abortion without the consent of the pregnant woman.

The provision of jail from 3 to 6 months fro the individual responsible and service providers and additional 1 year if sex selective abortion.

Safe abortion services

• Preventing unwanted pregnancies through quality family planning services is a first step towards addressing women's reproductive health needs

• A comprehensive approach needs to be integrated between three services, family planning, safe abortion and post abortion care.

• Ensuring the availability of comprehensive abortion care (CAC) that refers termination of unwanted pregnancies through

• safe technique with effective pain management,• post procedure family planning information and • service to ensure women are able to plan when to

have children and avoid further unwanted pregnancies

• Only trained doctors or health workers can provide safe abortion services at the government accredited health facilities, with the consent of women and based on the criterion spelled in the safe abortion service guideline

Rationale

• Unsafe abortion is one of the vital cause of maternal mortality.

• Teenager’s health is hugely affected by unsafe abortion.

• The knowledge and information about legalization of abortion is very low.

• Awareness regarding hugely helps to reduce teenage pregnancy and reduce complications

Situation

Source: ASAP(Asia Safe Abortion Partnership)

Globally

• WHO estimates that globally nearly 68,000 women die from complications of unsafe abortion each year.( WHO,1998)

• The unsafe abortion rate for Asia is 13 per 1,000 women aged 15-44 years, and the ratio is 14 unsafe abortion to 100 live births (WHO, 2004).

Nepal

• Nepal has one of the highest maternal deaths (539 per 100,00 live births) among SAARC countries. It is estimated that over half of the maternal deaths are due to unsafe abortions.

• Despite the highly restrictive abortion law, every year thousands of induced abortions are performed illegally in the country.

• As the Nepalese youths are being also involved in early-age sexual and reproductive activities, the incidents of unwanted pregnancies are on rise in our country and finally the cases of abortions, whether legal or illegal, are also on rise

• The number of teenagers undergoing abortion in the Valley almost doubled in 2009 as compared to 2008. Some teenagers undergoing abortion were as young as fourteen.

A joint study of annual reports of Maternity Hospital and Family Planning Association of Nepal (FPAN) shows that 581 teenagers underwent abortion in 2008, while the number stood at 1,065 in 2009.

Source: Republica,aug 7 2010

• Everyday at least 65 teenagers seek for abortion services in hospitals. This figure has increased two fold compared to previous years (from 2010). However, the figure may be an underestimate as many pregnant teenagers may not seek abortion care in formal hospital (Nepal Matribhumi Khabar, 2012)

• Additionally, the Health service division under the MoHP revealed that 95,000 abortions were carried out in 2010/11 where 25% of those were in teenagers

Abortion by 14-year-old

Some two years ago, a girl of 14 aborted a fetus at FPAN. She was seduced by a man who was much older than her, and whom, she called elder brother, according to Ashwini Rana, a counselor at FPAN. Upon getting her pregnant, the man fled and was no where to be found. Further details however were not known.

Objectives

• To review unsafe abortion practice after the legalization

• To discuss about the safe abortion services available

• To discuss about the necessity of safe abortion to control teenage pregnancy

Asap-asia.org

Unsafe abortion after legalization era

• Even after a decade of Legalization of abortion in Nepal, unsafe abortion practices are prevalent in the society.

• 66% of the women receiving post abortion care in tertiary hospitals chose unsafe methods for abortion.

• 44% of the women do not have knowledge about the legalization of abortion.

• Recently conducted study in terai and hilly region showed that only 61% people know that abortion is legal and 39% are still unknown about it.(fb page: nepaliphworkernepal,posted on 19th july, 2014)

• The practices from uncertified institutions that go un-reported are usually unsafe.

• MoHP revealed that abortion is high and increasing. There were 95,000 cases reported in 2010/11 where 25% were teenagers but this is only the tip of the iceberg (Parakhi, 2012a). Despite the legalisation of abortion, many women risk their health in unsafe and illegal abortions (Trustlaw, 2012)

CAC services

• The increasing trend in abortion utilization shows that more and more women are seeking safe abortion services.

• In FY 2069/70 alone a total of 195 service providers have been trained on safe abortion services.

• 84,011 women received safe abortion service from 574 listed sites

Source: annual report 2069/70

Safe abortion services

• In public, there are 96 and in private 108 sites are available during 1st trimester

• Similarly in public, 4 in higher referral hospitals and 2 sites in private during 2nd trimester

• Most Govt. managed abortion clinics (CAC centers at government hospitals) charge Rs 1,000 as abortion fee. Few government CAC centers charges Rs 800

• The abortion fee at NGO managed CAC centers range between Rs. 950 to Rs. 1350 In private CAC centers, it ranges from Rs 1500 -Rs. 3000

Source: CREPHA COUNTRY PROFILE

Trends of Adolescent Fertility Rate, Nepal

1996 2001 2006 20110

20

40

60

80

100

120

140127

11098

81

Source: NDHS 2011Note: The target for 2015 is 70 per 1,000 ABR

Legislation control teenage pregnancy

• In 2008 and 2009, Maternity Hospital provided abortion service to 60 and 191 teenagers respectively. On the other side, FPAN helped 521 and 874 teenagers undergo abortions in the respective years.

• "One reason behind the increased rate of abortion is the availability of safe abortion services," Ashwini Rana of FPAN, who has been working as a counselor for the past two decades said.

Conclusion

• Legalization of abortion alone has not made it safe.• Women today still lack adequate access to safe and

legal abortion.• Many of them are unaware about the legalization of

abortion and services being provided.• They need to be aware of the services and legalization • In 2002, abortion was legalized in Nepal and many

public hospitals since then have been providing the service. It has become a safe choice for women to end unwanted pregnancies.

Recommendations

• Many women in Nepal are still not aware that abortion is now legal in Nepal and the stigma attached to it is still widespread. So they should make aware the common people of these issues at the earliest

• Education on Sexual and Reproductive Health should be provided within the family, community and training institutions.

• Education on SRH should be initiated from school level• Family planning services should be made available,

accessible and affordable to all women, men and adolescents of reproductive age;

• Youths should be paid with special attention.• Abortion should not be considered as an ill

method or the murder of an unborn human being

• Laws concerning rape should be made stricter, its enactment ensured and furthermore the punishment should be increased

References • Unsafe Abortion Nepal Country Profile- 2006 MoHP, Nepal,

WHO, CREPHA• Unsafe abortion after legalisation in Nepal: a cross-sectional study

of women presenting to hospitals 2010-2011• National Safe Abortion Policy 2002 , MoHP• Asap-asia.org• Archives.myrepublica.com• Teenage pregnancy in Nepal: consequences, causes and policy

recommendations -2012,Akina Shrestha, Nepal• Annual report 2069/70• Abortion in context of Nepal-2010, Jaya Jung MAHAT• http://abortionnepal.tumblr.com/(2014/7/21)

Thank you