Despite Legalization, Clandestine Abortion Remains Common, Dangerous in Nepal

By Sunny Shrestha

KATHMANDU, NEPAL -- Patali Thapa Magar, 28, is roasting corn on a metal pan while sitting under a Peepal tree at a crossroads in Badegaun, a village about 15 kilometers away from Kathmandu. She holds a load of corncobs in a sack on her back. Every few minutes, she fans the amber in the metal pan to make fire. She has a dark complexion, eyes with dark circle underneath. Her face looks fatigued and pale. Her hair is full of the dust and dirt that clouds the road every time a vehicle passes. Sweat runs from her neck as she waits for a customer to buy her roasted corn.

Today is Thapa Magar's first day back at work selling corn. For the last four days, she has been a patient at the Patan Hospital in Lalitpur, a district adjoined to Kathmandu.

She checked into the hospital after she experienced continuous vaginal bleeding for days. After doctors in the hospital told her that her uterus was infected, she admitted trying to induce an abortion herself. She says she took an herbal pill, without informing anyone, including her husband. Magar's self-induced abortion left her with a prolapsed uterus, a disorder that causes the uterus to descend down the vaginal canal.

According to a report from a local NGO, Centre of Research on Environment, Population and Health Activities, CREPHA, 50 percent of women in Nepal who come to hospitals with reproductive problems are experiencing side effects from unsafe, clandestine, or self-induced abortions. Of every 100 pregnancies, 60 percent are unwanted here. Among these unwanted pregnancies, 37 percent opt for abortion and only 17 percent of those cases have access to safe abortion. Among those who resort to unsafe abortion, 20 to 40 percent die and most of them suffer from reproductive health complications.

Abortion was legalized in Nepal in 2002. The amendment of the civil law allows abortion up to 12 weeks with a woman's consent, up to 18 weeks if the pregnancy is due to rape or incest, and anytime if the physical or mental health of the woman is at risk, or the fetus is deformed. Sex-selective abortion remains a crime, punishable with six months to three years in prison.

According to CREPHA, since abortion was legalized approximately 160,000 women have had legal abortions in government approved facilities. But various studies show many more women have not been able to access the safe abortion services. The survey report of United Nations Population Fund, UNFPA, ranks Nepal as the country worst affected by unsafe abortions, with 539 maternal deaths in every 100,000 births. Fifty percent of all maternal deaths here are the result of unsafe abortion. According to CREPHA, the most common methods of clandestine abortions are intake of oral herbal preparations, overdose of modern oral medicines, insertion of foreign objects into the vagina, and vaginal ointments.

Magar comes from a farming family in Tharuppa a village near Sindhupalchowk, about 100 kilometers away from Kathmandu. She was married at age 15 to a local farmer, Sambhar Thapa Magar, in 1994. She bore her first daughter within a year of the marriage. She was a mother of five by the time she was 25 years old.

She says her family's income from the farm was not enough to sustain the growing family. "Though it was insufficient, we were somehow surviving with what we had," she said. But the family's problems were increasing as the ongoing armed conflict between Maoists and government intensified in their village. When they found it too dangerous to stay in their village, they, like hundreds of thousands of other, fled Kathmandu in 2005.

Life in Kathmandu was not easy for the family. Magar recalls spending her days and nights in the city streets. She says, "We came here with 4000 rupees (about $57 USD) and it was obviously not enough to manage food and shelter to the family of eight." During that time she says her family had no alternative but to starve. Her husband finally found a job as a daily wage potter and then they rented a room in the Badegaun neighborhood. The whole family, including her mother-in-law, share a one room flat.

But still, her husband's earnings alone were not enough to feed eight people. So to support the family, she started to sell roasted corn on the street. The family's combined income is still not enough to manage two meals a day. She says, "Some days I earn about 200 rupees (about $3 USD) while there are days when I don’t make any money.”

So when Magar realized she was pregnant again, she says she knew she could not provide an adequate life for a sixth child. She says she saw no option other than an abortion. She says, "I thought when I cannot give proper life to the child, what's the use of giving birth to it. And so I aborted."

But despite the availability of legal abortion at Maternity Hospital in Kathmandu, Magar could not afford the legal procedure. Instead she bought a black pill from a sudeni, a person who pretends to have knowledge about reproductive problems. She paid 100 rupees, about $1.50 USD. She says she took the pill but nothing happened. So she took another one and after few hours she experienced an excess pain and stream of blood started to flow. She says, "I don’t know what exactly the medicine was but it was very bitter and I fainted few hours after I took it."

Magar comes from a village where few women are literate and do not have access to information about family planning and birth control. She has never used contraceptives. She did not know she could have abortion in hospitals. She says she thought hospitals only performed critical operations and charge hefty amounts. "I thought why to waste time and money if I can do the same thing in 100 rupees," she says. The price of legal abortion here, according to government mandate, is 1,000 rupees, about $14 USD, but studies show the hospital expenses can range from 800 to 2000 rupees, up to $28 USD.

Magar's mother-in-law, found her in grave condition a few hours after she took the second pill. She took Magar to Patan Hospital. According to Durga Shrestha, a nurse on duty at the time, Magar was unconscious when she was brought to the hospital. She had fever of 102 degrees and had lost a lot of blood. She received a saline IV, and a blood transfusion. Within six hours, Shrestha says she regained consciousness.

Magar said, the doctors then informed her that as a result of the drugs she took to abort, she would now suffer from uterine prolpase. Doctors advised her undergo an operation to restore her uterus, which costs about 10,000 rupees, about$143 USD. Magar told doctors she couldn't afford the procedure, so she now uses a removable ring to prevent her uterus from descending. Regretting her decision to opt for unsafe abortion, she says, "I would not have had to suffer if I had aborted in the hospital."

"When women are getting medicines for about 100 rupees, why would they spend 1000 rupees at hospitals?” asked Prabhakar Shrestha, a training and advocacy officer at CREPHA. He expressed his concern on the lack of awareness among women about the effects of these medicines.

Yamuna Bhattarai, a local attorney working at the Supreme Court of Nepal says, although the government has legalized abortion, it has not been able to make it accessible and create awareness among the people, both men and women, about its legalization. A survey jointly conducted by the government and CREPHA showed only 49 percent of people from urban areas and 20 percent of people from rural area are aware of safe, legal abortion options. Various reports show many women in Nepal still seek for clandestine and unsafe abortions due to ignorance, ingrained fears, shame and lack of availability of services.

Dr. Kasturi Malla, director of CAC, Comprehensive Abortion Care service, a government project for safe abortion at Prashuti Griha, Kathmandu, agrees. She says, among the 75 districts in Nepal, the government has provided safe abortion services in 70 districts. "Rural women are deprived from safe abortion services, as abortion facilities are centered in urban areas," she said.

Many people still resort to various clandestine procedures in fear of social reprisals. Hindu mythology forbids abortion. Shrestha, of CREPHA says, "A woman who aborts her own child is considered a sinner in our Hindu religion and the society looks down upon her." So many women here still use dangerous domestic methods to abort. "Even today women resort to risky domestic methods of abortion like intake of grinded glass pieces, putting heavy objects on the abdomen, and using cow dung in their vagina," says Meera Dhungana, an advocate at the Forum for Women, Law, and Development, FWLD, a local NGO.

In 2006, FWLD filed a writ with the Supreme Court asking for free abortion services for poor and uneducated women throughout the country. No ruling has been made.

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