National Abortion Policy of Nepal 2002

Introduction

Nepal has one of the highest maternal mortality rates in the world, and unsafe abortion has been identified as one of the leading causes. Recognizing the serious health risks caused by unsafe abortion, the Government of Nepal made an important decision to legalize abortion in 2002. This was a major step toward reducing preventable deaths among mothers and supporting women’s rights to make decisions about their own health.

The National Safe Abortion Policy was formulated in alignment with this legal reform, aiming to ensure that all women have access to safe, affordable, and accessible abortion services. However, to translate legal provisions into practice, there remains an urgent need to expand the availability of skilled service providers, adequate infrastructure, essential equipment, and drugs across the country.

The policy seeks to provide a rights-based framework for abortion services and is designed to support the implementation of comprehensive abortion care in a respectful, confidential, and non-discriminatory manner.

Legal History of Abortion in Nepal

Before the 11th Amendment, the National Code (Muluki Ain) of 1959, which was the main legal law of Nepal, strictly prohibited abortion. It was treated as a serious crime against life, and there were no exceptions, not even if the pregnancy risked the woman’s life. Women who had an abortion were punished with jail time as follows.

• 1 year for abortion up to 12 weeks of pregnancy
• 3 years for abortion up to 25 weeks
• 5 years for abortion beyond 25 weeks

11th Amendment to the Muluki Ain (2002)

On 14th March 2002, the Parliament of Nepal approvedthe 11th Amendment Bill, and it was officially enacted on 27th September 2002. This amendment liberalized abortion under certain conditions and added two important clauses: Clause 28A and Clause 28B.

Clause 28A:

• If a woman is coerced or negatively influenced into having an abortion, the person(s) responsible, including service providers, can be imprisoned for 3 to 6 months.
• If the abortion is done for sex selection purposes, both the person seeking the abortion and the service provider can face an additional 1-year jail sentence.

Clause 28B:

This clause nullifies Clause 28A if a qualified and authorized health worker carries out the abortion following proper procedures set by the Government of Nepal. Abortion is allowed under the following conditions:

• Up to 12 weeks of pregnancy, with the consent of the pregnant woman.
• Up to 18 weeks of pregnancy, if the pregnancy is a result of rape or incest, with the consent of the woman.
• At any stage of pregnancy, if continuing the pregnancy poses a risk to the woman’s life, physical or mental health, or if the fetus is severely deformed, based on the advice of a medical practitioner and the consent of the pregnant woman.

Policy Statement on Abortion

As per the legal provisions in the Muluki Ain and the Procedural Process for Safe Pregnancy Termination Services 2060 B.S., the Ministry of Health is committed to providing safe, legal, and accessible abortion services. The following guidelines will be followed:

Comprehensive Abortion Care (CAC) Services

1. Abortion services (CAC) will be safe, easily accessible, and affordable for all women, without discrimination.
2. Only trained and certified health workers listed under the Safe Pregnancy Termination Order will be allowed to provide these services.
3. Women will be informed about and given a choice of safe abortion methods available.
4. The process to register and approve health institutions and service providers for CAC services will be kept simple and efficient.
5. A strong referral system will be developed between CAC centers and advanced hospitals for managing complications and providing higher-level care.
6. CAC services will be expanded through government health facilities, semi-autonomous bodies, NGOs, and the private sector to reach more women.
7. Service providers who offer abortion services legally and in good faith will be protected by the law.
8. Abortion will not be promoted or used as a method of family planning.
9. Abortion will not be performed for the purpose of choosing the baby’s sex.
10. High-quality abortion care will be ensured by skilled providers who follow standard medical guidelines and ethical practices.
11. Abortion services will be integrated into the existing reproductive health and hospital systems. These services will be introduced in phases, aiming to provide them at Primary Health Care Centers.
12. Standard clinical guidelines will be used for service delivery and training. Providers will receive regular training to maintain their skills. Counseling, including family planning counseling, will be a part of every abortion service.
13. Traditional or unsafe abortion providers will be encouraged to refer women to trained and certified health workers.
14. All service providers and institutions must clearly display and follow a transparent fee structure for abortion services.
15. All abortion service sites and referral centers must work together and coordinate to provide quality care.

Additional

• All health workers involved in CAC services must maintain client privacy and confidentiality at all times.
• Community awareness programs will be conducted to educate the public about the availability and legality of safe abortion services.
• Monitoring and evaluation systems will be strengthened to ensure the quality and safety of abortion services.

Human Resource Development for CAC Services

1. The necessary human resources for providing Comprehensive Abortion Care (CAC) services will be identified. These individuals will receive orientation and skill-based training focused on competency.
2. All human resource development needs related to CAC services will be fulfilled to ensure quality service delivery.
3. CAC curriculum will be included in both pre-service and in-service training programs for different levels of health service providers.
4. Information about preventing unsafe abortion will be added to the sexual and reproductive health curriculum in secondary schools.
5. Public, private, and NGO institutions will be developed as CAC training centers. These sites will be regularly monitored and evaluated by the government to ensure standards are met.

Rights of women

1. Women have the right to either continue or end an unwanted pregnancy within the legal guidelines.
2. Informed consent is required for pregnancy termination. If the woman is under 16 or mentally unable to consent, her nearest relative must provide consent.
3. The woman must be informed about the risks, benefits, and alternatives to pregnancy termination. She should also receive counselling on other reproductive health needs, including family planning.
4. The health institution and service provider must keep all personal information confidential. Documents and records will not be shared, except in the following cases:

• For legal investigations or court hearings.
• For research purposes, without identifying the woman.
• To the woman herself.

Role of non-governmental and private sectors

1. Comprehensive Abortion Care (CAC) services will be available through private, non-governmental, and semi-governmental sectors.
2. Private, semi-governmental and non-governmental sectors are encouraged to provide CAC services in underserved areas and to marginalized populations.
3. The private and non-governmental sectors will be supported in providing information on abortion, including training, research, and IEC (Information, Education, and Communication) /advocacy.
4. A networking mechanism will be established with the private and non-governmental sectors to enhance various aspects of CAC services.

Advocacy, IEC and Social Mobilization

1. Advocacy, IEC and Social Mobilization on the prevention of unwanted pregnancies and danger of unsafe abortion shall be promoted.
2. Advocacy to address stigmatization and misconceptions associated with safe pregnancy termination shall be promoted.
3. Advocacy to promote a woman’s right to CAC shall be promoted.
4. Advocacy, IEC and social mobilization measure will be launched to increase awareness and influence the development of positive perceptions and values on safe pregnancy termination. Appropriate positive messages will be used to counter the social stigma and others taboos on safe pregnancy termination through community leaders.
5. All available media will be used to raise public awareness on the new abortion policy, unwanted pregnancy and safe abortion, emergency contraception and unsafe abortion. Information on CAC services and referral procedures will be shared in local languages.

Coordination, Planning, Monitoring, Supervision, and Follow-Up

1. The Ministry of Health is responsible for coordinating CAC training and services in Nepal.
2. The Ministry of Health will plan, monitor, supervise, and follow up on CAC services at all public sector levels.
3. The Ministry of Health will support the planning and implementation of CAC services in the private sector.
4. Effective coordination, supervision, monitoring, and evaluation of CAC services will be set up from the central to the local level.
5. The Family Health Division of the Department of Health Services will be the main point for all abortion-related activities.
6. Both external and internal resources will be mobilized to ensure that pregnancy termination services are safe, available, and accessible.
7. The District Health Management Team will receive training on managing CAC services.
8. Information about CAC will be added to the existing Health Management Information System (HMIS).
9. Monitoring, evaluation, and quality assurance tools will be used.

Research

Abortion-related research will be conducted, and the findings will be used to improve policies and programs.

Institutional Arrangements

Institutional arrangements for CAC services, including planning, follow-up, and networking, will be developed and strengthened in line with the Safe Abortion Policy and Procedural Process.

References:

1. Ipas. (n;.d.). Where we work: Nepal. Ipas. https://www.ipas.org/where-we-work/asia/nepal/
2. Lal, B. K., Pandav, R. S., Hyder, M. K. A., et al. (2023). Policy change to improve access to safe abortion care in federal Nepal. International Journal of Gynecology & Obstetrics, 151(1), 9-15. https://doi.org/10.1002/ijgo.14729
3. Ministry of Health and Population. (2002). National Safe Abortion Policy 2002. Government of Nepal. https://fwd.gov.np/wp-content/uploads/2021/03/National-Safe-Abortion-Policy-2002.pdf
4. United Nations Population Fund (UNFPA). (2018). The Right to Safe Motherhood and Reproductive Health Act 2075. UNFPA. https://nepal.unfpa.org/sites/default/files/pub-pdf/The%20Right%20to%20Safe%20Motherhood%20and%20Reproductive%20Health%20Act%202075.pdf