Professional Documents
Culture Documents
Appraisal of Abortion
related Laws and Act
of Nepal
Sagar Parajuli
MPH Third Semester 2023
School of Health & Allied Sciences
Pokhara University
Presentation Outlines
• Introduction; Abortion
• Status Quo: Abortion in Nepal, including global status
• Review of Abortion related laws and act of Nepal
Muluki Ain (The National Code)
National Abortion Policy and Strategy 2003
The Safe Motherhood and Reproductive Health Act 2018
• Critical Appraisal of Abortion related laws and act of Nepal
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Introduction to Abortion or Termination of Pregnancy (ToP)
08/19/2023 Alves, C., & Rapp, A. (2023). Spontaneous Abortion. StatPearls. http://www.ncbi.nlm.nih.gov/books/NBK560521/ 4
Methods of Abortion
In Nepal
Medical Abortion: Upto 9 weeks with women’s consent
MVA: Upto 12 weeks with
D & E: Beyond 12 weeks on recommendation of two subject experts
In case of rape and incest on recommendation of 1 subject experts
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Status Quo: Global and National Status
• Six out of 10 (61%) of all intended pregnancies and 3 out of 10 (29%) of all
pregnancies end in induced abortion
• Nearly 1 out of 2 abortions are unsafe
• About 45% of all global abortions are unsafe, of which 97% take place in
developing countries. (Global Estimates from 2010-2014)
• More than half of unsafe abortions occur in Asia, mostly in south and central Asia.
• Unsafe abortion is a leading cause of maternal deaths and morbidities
• Each year, 4.7–13.2% of maternal deaths attributed to unsafe abortion
• 25 percent of the world’s women live in countries where abortion is still restricted
to saving a woman’s life.
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Status Quo: Global Status
- In developed regions, it is
estimated that 30 women die for
every 100 000 unsafe abortions.
- In developing regions, that
number rises to 220 deaths per
100 000 unsafe abortions
• Comprehensive abortion care
listed in essential health care by
WHO in 2020.
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Status Quo: Global Status
Laws on Abortion
throughout the
globe
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Status Quo: National Status
• Miscarriages and induced abortions: 9% have had a miscarriage and 10% have had
an induced abortion (NDHS 2022)
• Total abortion rate in Nepal is 0.3 abortions per woman.
• Ethnicity: Lowest in the Muslim (3%) and Madhesi (4%), highest in
Brahmin/Chhetri (13%)
• Residence: Higher in urban
• Ecological region: Mountain-13.2%, Hill-12.3%, Terai-7.6%
• Province: Gandaki Province-16.9% (Highest), Madhesh-4.3% (Lowest)
• Abortion reported as the third leading cause of maternal death in 2011 study and
after abortion legalization contributed to decline in MMR in Nepal from 580 in
1995 to 190 per 100,000 in 2013. 9
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Status Quo: National Status
Availability of Abortion Service Abortion Service by type
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The Muluki Ain (National Code-Penal and Criminal)
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The Muluki Ain (National Code)
The 11th amendment added two additional clauses to the Muluki Ain:
• Clause 28A: If the pregnant woman is negatively influenced or coerced for
abortion, there is provision for jail punishment of 3 to 6 months for the
individuals responsible and service providers. If sex selective abortion is
intended or performed, there is the provision for jail punishment of an
additional 1 year for both parties.
• Clause 28B: The clause provides for nullification of Clause 28A if the
qualified and authorized health workers accomplish pregnancy termination
with fulfillment of the abortion procedural process set by Government of
Nepal.
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The Muluki Ain (National Code)
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National Safe Abortion Policy and Strategy 2003
Developed based on The National’s Code (Muluki Ain) and Procedural Process for Safe
Pregnancy Termination Services, 2060 BS
Planning,
Advocacy, IEC
monitoring, Institutional
and Social Research
supervision and arrangements
Mobilization
follow up
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National Safe Abortion Policy and Strategy 2003
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National Safe Abortion Policy and Strategy 2003
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National Safe Abortion Policy and Strategy 2003
2. Forced Abortion Prohibited: No one shall carry out abortion by enticing, coercing
or threatening or alluring a pregnant woman.
4. Safe abortion services: Provision of SAS for a pregnant woman on her consent by
licensed health service provider (meeting standards and qualifications) but in case of
women less than 18 year and women not in condition to provide consent, guardian or
curator can give consent considering her best interest as per guideline.
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The Safe Motherhood and Reproductive Health Act, 2018
5. Confidentiality to be maintained:
• A listed health institution and health service provider shall maintain the
confidentiality, of information and documents, relating to reproductive health
counseling and services provided
• Information can be made available to concerned authorities on demand by
investigation authority or court for hearing of any lawsuit, required to quote
without revealing identity of the related woman for the purpose of study,
research or monitoring relating to safe abortion
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Critical Appraisal of Abortion related laws and act of Nepal
The Constitution of 2015 and the 2018 SMRHR Act guarantee the right to an
abortion as a fundamental right for every woman.
The MOHP developed and updated regulations, strategies and directives for
implementing the abortion law and for expanding access to safe and legal
abortion services.
Training on SAS including CAC, as of 2021, about 4,500 clinician, 1,833
auxiliary nurse midwives, 743 nurses, 1,853 medical doctors, and 92
obstetrician gynecologists and general practitioners trained
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Critical Appraisal of Abortion related laws and act of Nepal
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Critical Appraisal of Abortion related laws and act of Nepal
Lack of Provincial and local level acts, regulations and directives for SAS:
Four provinces with Public Health Services Act; Madhesh Pradesh, Bagmati,
Karnali and Sudurpaschim Province only, Policy guidance gap in effective
delivery of SAS at provincial and local level
Stigma, discrimination and lack of awareness: Unaware of legal provisions,
service and service center, cost preventing from accessing services
NDHS 2016
Aware of legal provisions 41%
- Know location to get service 48%
Aware of abortion service up to 12 weeks 23%
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Critical Appraisal of Abortion related laws and act of Nepal
Limited service providers and health facilities: About 58% were performed
by unapproved providers or at uncertified facilities.*
NFHS 2015
Surgical Abortion 45%
Medical Abortion 26%
Postabortion care 36%
Lack of effective implementation of free abortion services policy: Issue in
purchase of registered and listed MA drugs and ignorant of reimbursement
policy from local government, lack of regulation on privates
Reference *Puri M et al., Abortion incidence and unwanted pregnancy in Nepal, International Perspectives on Sexual and Reproductive Health, 2016, 42(4):197–209.
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Critical Appraisal of Abortion related laws and act of Nepal
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Global Influences on Safe Abortion Policies and Programs
Roe v Wade and Global Gag Rule (GGR) Impact: Funding and program
limitation resulting into disruption of reproductive health services
including safe abortion services in Nepal
- Family Planning Association Nepal (FPAN), a member of IPPF In 2019
received only $ 1.5 million in funding (operational cost of $9 million)
- Affected MS Ladies Program of Marie Stopes Nepal in 11 districts
- Radio talk shows Khuldulee.com (Partly funded by USAID) barred from
using the word ‘abortion’
References: The right to bodily autonomy—The Record. (n.d.). Retrieved July 26, 2023 fromhttps://www.recordnepal.com/the-right-to-bodily-autonomy
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Way Forward
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References
1. Alves C, Rapp A. Spontaneous Abortion [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing;
2023 [cited 2023 Jul 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560521/
2. Abortion Law: Global Comparisons [Internet]. Counc. Foreign Relat. [cited 2023 Jul 26];Available from:
https://www.cfr.org/article/abortion-law-global-comparisons
3. Nearly half of the pregnancies in Nepal are unintended, UN agency says [Internet]. [cited 2023 Jul 24];Available
from: http://kathmandupost.com/health/2022/03/31/nearly-half-of-the-pregnancies-in-nepal-are-unintended-un-
agency-says
4. Requirement of a separate law in Abortion in Nepal [Internet]. Forum Women Law Dev. - FWLD [cited 2023 Jul
24];Available from: https://fwld.org/publications/requirement-separate-law-abortion-nepal/
5. The right to bodily autonomy - The Record [Internet]. [cited 2023 Jul 26];Available from:
https://www.recordnepal.com/the-right-to-bodily-autonomy
6. Addressing Gaps in Safe Abortion Services in Nepal [Internet]. Guttmacher Inst.2022 [cited 2023 Jul
25];Available from: https://www.guttmacher.org/article/2022/06/addressing-gaps-safe-abortion-services-nepal
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References
7. Countries - GAPD - The Global Abortion Policies Database [Internet]. [cited 2023 Jul 26];Available from:
https://abortion-policies.srhr.org/countries/
8. Civil-code.pdf [Internet]. [cited 2023 Jul 25];Available from:
https://www.moljpa.gov.np/en/wp-content/uploads/2018/12/Civil-code.pdf
9. Legal-categories-of-lawful-abortion.pdf [Internet]. [cited 2023 Jul 26];Available from: https://abortion-
policies.srhr.org/documents/reference/Legal-categories-of-lawful-abortion.pdf
10. Muluki-ain-general-code-2020.pdf [Internet]. [cited 2023 Jul 25];Available from:
https://www.lawcommission.gov.np/en/wp-content/uploads/2018/10/muluki-ain-general-code-2020.pdf
11. National-Safe-Abortion-Policy-2002.pdf [Internet]. [cited 2023 Jul 24];Available from: https://fwd.gov.np/wp-
content/uploads/2021/03/National-Safe-Abortion-Policy-2002.pdf
12. Regulatory-and-policy-environment-of-abortion.pdf [Internet]. [cited 2023 Jul 26];Available from: https://abortion-
policies.srhr.org/documents/reference/Regulatory-and-policy-environment-of-abortion.pdf
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Safe and legal
abortion is
not a women’ right
but human right.
Thank you ! “Abortion is often navigated through unending debate between ‘pro-life’
and ‘pro-choice’. Supporting safe abortion is supporting the choices of
women and respecting bodily autonomy.”
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