After Legalization of Abortion: The Continued Relevance of PAC in Nepal

Dr. Indira Basnett Country Director Ipas Nepal PAC Consortium annual meeting Nov 19th 2014

Before Abortion Legalization In Nepal Every day Shanti Shrestha thanks God that she is free. "I thought I was

going to rot in jail," she says. "I never thought that I would be released."

Many women were sent to prison. After legalization, many

were released, but a few are still there…

Legalization Process in Nepal

2002: Abortion legalized

Before 2002:

Abortion strictly illegal and culturally

unacceptable. High abortion-related MMM.

PAC performed with VA or sharp

curettage

2004:

Safe and legal abortion as well as

PAC services at Kathmandu

Maternity Hospital

Background of PAC in Nepal

• Prior to 1995: incomplete abortion treated with

sharp curettage in theater

• 1995: MVA for PAC introduced, but only by

physicians

• By 2004: PAC fully integrated into EmOC;

midlevel providers trained in MVA for PAC

Effect of Abortion Legalization (2001-2010)

Trends of abortion complications presenting at four tertiary care hospitals, Henderson et al 2013

Trend of abortion complication as percentage of

facility-based (Hospital & PHCC) obstetric

morbidity**

41 38 36 36 35 35

30 28 28

44

24 26

05

101520253035404550

Pe

rc

en

t

Year

**Based on EOC monitoring reports from 3 districts in 1997/98 and 1998/99; 13 districts in 1999/00 to 2005/06; 19 districts in 2006/07; 22 districts in 2007/08 and 26 districts in 2008/09.

Post Abortion Care (2008-2013)

7000

8000

9000

10000

11000

12000

13000

FY08 FY09 FY10 FY11 FY12

PAC Cases

PAC Cases

Serious Adverse Events (SAE) Cases

19%

81%

Place of Initial Abortion Service (n=53)

Same Health Facility

Outside of HealthFacility

Abortion-Related Stigma in the Community

Young Women and Abortion-Related Stigma

Stigma around PAC

Stigma Reduction: Successes

• Women seeking PAC or induced

abortion do not have to register their names

• Follow-up care is not mandatory

• Ipas sites receive whole-site orientation for all staff, including abortion values clarification

• Police report not required in cases of rape or incest

Stigma Reduction: Successes with Young Women

One-third are young service users (<24 years)

Stigma Reduction: Future Work

• Values clarification to be integrated

with provider and peer leader training

packages

• Implementation of an educational

program focusing on contraceptive use,

targeting husbands and mothers-in-law

Conclusion

THANK YOU

The photographs used in this publication are for illustrative purposes only; they do not imply any particular attitudes, behaviors, or actions on the part of the any person who appears in the photographs.