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Nepalis take on America to initiate abortion reform

The Nepali Parliament has proposed a radical change in law, which, if approved, will legalise abortion for the first time. The move has the backing of several large nongovernmental groups.

Four months after Nepal's Lower House of Parliament took an historic step by voting to partially legalise abortion, Nepalis are awaiting steps that will finally see off a leading killer of women in this South Asian nation.

The new proposal – part of a larger Bill on women's rights – must be approved by the National Assembly of Parliament and signed by King Gyanendra. If this happens, abortion will be made legal if a woman requests it in the first 12 weeks of pregnancy, or within 18 weeks in cases of rape or incest, and when a woman's life or health is in danger or the foetus is impaired.

Abortion in Nepal is equated with infanticide and punishable by law – even if the pregnancy is a threat to a woman's life or is the result of rape. The result: six women die every day from unsafe abortions. Those who are caught can be punished with life sentences.

The Lower House vote came nearly a year after American President George W Bush reinstated the 1984 Mexico City Policy (also called the Global Gag Rule) that prevents US government-funded non-governmental organisations from campaigning for abortion reform or providing abortion-related services, including counselling and referrals, even if the NGOs use other funds for the work.

But several Nepali organisations have publicly defied Bush. One of these is the Family Planning Association of Nepal (FPAN), the largest family planning NGO in the country, which has received US government funds for nearly 27 years.

"My own government wants FPAN to help decriminalise abortion and make it safer," FPAN director general Dr Nirmal K Bista complained to the US Senate Foreign Relations Committee in July. "But the US government says 'No'."

Urging the committee to overturn the ruling, Bista explained that if FPAN accepted its terms, "I would be prevented from speaking in my own country… about a healthcare crisis I know first-hand."

Nepal has the fourth highest maternal death rate in the world – 539 women in 100,000 of reproductive age die from pregnancy-related complications each year as compared to seven in the United States – and United Nations agencies estimate that 50 per cent of these women die from unsafe abortions.

A recent hospital study in Kathmandu found that 20-60 per cent of all women admitted to obstetric and gynaecological wards suffered from critical post-abortion complications requiring blood transfusions and lengthy hospital stays -a crippling drain on the country's limited health resources and a financial burden to women and their families.

"Decriminalising and legalising abortion will definitely help reduce Nepal's high maternal mortality and morbidity rates," explains Bista.

FPAN's principled decision has cost it approximately $250,000 in US funds and forced a cutback in services such as free contraceptive provision at its three clinics. However, even though victory may be in sight – campaigners hope for the Bill's ratification in early 2002 -women's access to safe abortion services will still be threatened by the Bush dictat.

"The Global Gag Rule will [continue to] have a chilling effect as it will discourage NGOs receiving US funds from assisting the Ministry of Health in Safe Motherhood activities, such as public education and advocacy on the proposed abortion law," says Anand Tamang, director of the Centre for Research on Environment Health and Population Activities (CREHPA).

The centre, which also rejected strings-attached US funding, is part of a network of NGOs formed at the request of the Ministry of Health to advise the government on measures to save women from needless death and disability due to unsafe abortion.

Surveys by CREHPA and others show that the majority of people from all sections of society and 74 per cent of lawmakers are in favour of legalising abortion.

"Once it becomes law," says Dr Laxmi Raj Pathak, director of the government's Family Health Division, "the government's duty… includes making post abortion care accessible to as many women as possible."

Providing emergency health care, particularly in remote mountainous regions, remains a problem. "Liberalising the abortion law is only the first step," warns rights campaigner Dr Aruna Uprety, noting that just 15 per cent of the population has access to hospitals.

While better-off urban women can afford up to $100 for an illegal abortion in a private clinic, young and poor rural women are forced into the hands of quacks whose dangerous treatments -inserting sticks, shards of glass or cow dung into the vagina -can perforate organs and cause haemorrhaging, gangrene and sterility.

Those lucky to escape with their lives risk harsh prison sentences. A 1997 nation-wide prison survey found nearly 100 women, or one in five female prisoners, incarcerated for abortion. A study by the Centre for Reproductive Law and Policy (CRLP) and the Forum for Women, Law and Development (FWLD) found that many such jailed women had no legal representation.

Even if a woman miscarries -a common occurrence in Nepal because of women's poor health and inadequate antenatal care -she may suffer the same fate. During her fifth month of pregnancy, while she was working in the fields to support her four children, 30 year-old Kumari went into premature labour. Village elders accused her of killing her child and reported her to the police. She was charged with infanticide and sentenced to 20 years' imprisonment.

Kumari did not undergo a medical examination. She did not have a lawyer nor was she informed about her right to legal representation. When she pleaded with the judge that she had not killed her baby, he said: "If you didn't, who did?"

"Most women are poor, illiterate, and have no idea of the law," says Sapana Pradhan Malla, FWLD coordinator.

One young woman sentenced under Nepal's abortion law, 16-year-old Min Min Lama, is now free. Sentenced for 20 years at the age of 13 for terminating a pregnancy after she was raped by a relative, the teenager was released in 1999, thanks to a national and international campaign.

"While it is too soon to declare victory," cautions CRLP staff attorney Melissa Upreti, "[the impending vote] is indeed an historic event, given that gender-based discriminatory provisions depriving women of even their most basic rights have existed in formal law in Nepal for almost 150 years."

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Panos London

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02/01/2002

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