Title: Second trimester abortion in Nepal
1 Second trimester abortion in Nepal--------------
----------
- Dr. Veena Shrivastava
- President Elect
- Nepal Society Of Obstetricians Gynaecologists
- Nepal
Global Safe Abortion Conference , London 23rd
24th October, 2007
2 Objectives
- Highlight current status of second trimester
abortion in Nepal - Share experience of the only training on
comprehensive second trimester abortion services
in Nepal
3Map of Asia
4Map of Nepal
5Legalization of abortion in Nepal
- Abortion became legal in 2002 (restrictive
abortion). - From March 2004 CAC service was started.
- 167 listed sites giving CAC service.
6Abortion Law according to 11th amendment of
Muluki Ain Sept ,2002
- On request- up to 12 weeks
- .
- Rape and incest, - up to 18 weeks
- Anytime with the approval by an authorized
physician - foetus is abnormal - - pregnancy posses the danger
to the life of the pregnant woman or to her
physical or mental health -
7Case History
- Maya had been happily married for six
months, when suddenly her husband disappeared .
She realized that she is pregnant, but did not go
for an abortion hoping that her husband would
come back. After a couple of months she learnt
that he cheated on her and already had a family.
Devastated, she went to a chemist to get
medicines for abortion. The chemist referred her
to the maternity hospital where CAC was available
at an affordable price. -
- The doctors at the maternity hospital found
Maya to be over 20 weeks pregnant and denied to
perform abortion on her. No one cared to
understand the mental trauma she was undergoing.
She had no option .She was ready to commit
suicide rather than have the baby. Eventually a
paramedic referred her to a private clinic who
provided service at higher price. However, she
started having torrential bleeding after the
procedure. Again, she was referred to the
maternity hospital, where she had to undergo
hysterectomy. - If only people had understood her situation....
-
- If service providers were capable to assess
her mental status for the indication of
termination pregnancy, Maya would have been
enjoyed her rights to safe abortion services.
8Post legalization of abortion status in Nepal
- MMR dropped from 539 to- 278/100,000 live
births. -
(NDHS-2006) - No imprisonment of women due to induced abortion.
- Hospital admission for abortion complications
unchanged (CAC PAC understanding
complications NJOG Dr Sudha Dr Indira Dr
Kasturi ). - Report of four deaths due to abortion in news
paper.
9Post legalization status
- 13-22 denied because their pregnancy was beyond
12 weeks (National baseline survey CREHPA-2006). - 61 of patients admitted with complication of
abortion had 2nd trimester induced abortion
(Study on maternal mortality morbidity among
induced septic abortion 2006 ,Dr Achala). -
1
10- Second trimester induced abortion is still a big
health issue in Nepal.
11Second trimester abortion, where are we ?.
- Eighty three first trimester trainings have been
conducted - ( 374 Trained providers ).
- No second trimester abortion training - been
organized. - Providers not very clear about indications of
late abortion. - Clinicians are reluctant to perform second
trimester abortion. - Those who do perform - use old methods.
12- Need for second trimester abortion training was
recognized by the government.
13First mid -trimester abortion TOT
- Training was organized by FHD, MOH with the
support of TCIC on 10 -22 June 2007 in Maternity
Hospital CAC Unit.
14 Data During Mid-Trimester Training
- Total no of mid trimester abortions done during
the training - 23 - Total no of first trimester abortions - 107
15 Demographics of Mid trimester abortion
- Age distribution 14- 45 yrs
- Parity Nulliparous- 17
- Grand multi - 17
- Economic condition- poor (2-4 Per day)
- Education- 70 no education
- Home - 40 from remote
area
16Reasons for abortion
17Duration of time from insertion of Misoprostol
to evacuation
Total No- 19
18Time taken for evacuation
- 15-20 minutes (one case - 30 minutes)
19Complications
- No major complications
- Minor - 3
- High Fever - 1 (1020F) admitted discharged next
day - Bleeding - 2 (1- cervical injury, 1- atony)
-
20Follow up
21- First mid- trimester abortion training was
successful.
22Future Plan
- Five mid trimester abortion trainings will be
organized each year . - All seventeen Zonal Hospitals will have trained
doctors (Gynaecologists/ General practitioners ) -
- The training will follow Value Clarification
workshop. - Necessary instruments and medicines will be made
available to them.
23 Conclusion
- Second trimester abortion services has not been
given priority so far in Nepal and is a major
challenge in ensuring reproductive health rights
of Nepalese women - It also highlights that provision of law without
implementation will not solve the problem - Competency based training in second trimester
abortion is very much feasible to implement and
save womens lives from unsafe abortion
24Acknowledgment
- Marie Stopes International Specially Ms Rodica
Comendent - TCIC Nepal specially Dr Indira Basnet
25Thank you