Abortion Care in Nepal, 15 Years after Legalization

Nepal is often heralded as a model of the successful implementation and rapid scale-up of safe abortion services. Prior to 2002, Nepal had very restrictive abortion laws that prosecuted and imprisoned women and their family members for undergoing pregnancy terminations. Up to one-fifth of incarcerated women were convicted for abortion-related crimes.2 Despite the restrictive laws and legal implications, many unsafe abortions were still performed by untrained providers throughout the country.3 Government data from 1998 indicated that 54% of gynecologic and obstetric hospital admissions were due to unsafe abortions.4 Data from one hospital-based study attributed more than half of maternal deaths during the one-year study period to abortion-related complications.5 Nepal legalized abortion in 2002 in response to advocacy efforts that emphasized the high rates of maternal morbidity and mortality attributed to unsafe abortions. First-trimester surgical abortions were made available throughout the country in 2004. Second-trimester abortion training began in 2007, and medical abortions were introduced in 2009. The law permits abortion with the consent of the pregnant woman for any indication up to 12 weeks’ gestation and up to 18 weeks’ gestation in cases of rape and incest. Abortion is legal at any gestational age if a medical practitioner declares that the women’s mental or physical health is at risk or that the fetus is deformed. In cases of women who are younger than 16 or are not mentally competent, consent of the woman’s nearest relative or immediate guardian is required.6