Translating Research into Policy Advocacy in Nepal

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Translating Research into Policy Advocacy in Nepal
Public Education and Advocacy Against Unsafe
Abortion
Anand Tamang CREHPA
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ISSUES CONCERNING ABORTIONS

• Nepal has one of the highest maternal mortality
  (539 per 100,000 live births).
• Over half of the maternal deaths are due to
  unsafe abortions.
• Induced abortion is a criminal act in any
  circumstances, even in case of rape or incest.
• Both women and service providers are punishable
  by imprisonment

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ISSUES CONCERNING ABORTIONS (Contd)

• Despite legal restrictions, every year thousands
  of induced abortions are performed illegally.
• Nepal is the probably the only country in the
  world where women are incarcerated for abortion
• Prevention and Management of complications of
  abortions is one of the eight components of
  National RH Strategy 1998 of Ministry of
  Health/Nepal

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RESEARCH ON ABORTIONS
Between 1991-2000, a number of abortion related
research conducted and their results disseminated
by CREHPA

• 1. Determinants of Abortion and Subsequent
  Reproductive Behavior Among Women of Three Urban
  Districts of Nepal 1991-94 (Tamang, et al , IIDS)
  
• 2. Opinion Polls on Abortion Rights for Women.
  1996
• 3. Induced Abortions and Subsequent Reproductive
  Behavior among Women in Urban Areas of Nepal,
  Nov. 1996 (Published paper)

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RESEARCH ON ABORTIONS (Contd..)

• 4. Factors Behind Womens Imprisonment in Nepal
  with Special Reference to Women Imprisoned for
  Abortion, Sept. 1997-98
• 5. A Study on Implications of Restrictive
  Abortion Law on Women's Social Status and Health
  1998 (Published Paper and Advocacy Paper in
  Nepali)
• 6. Knowledge and Perception of Rural Married
  Women on Abortions in Seven districts of Nepal.
  1999
• 7. Perceptions on Safe Unsafe abortions among
  frontline health providers and village opinion
  leaders in Eastern Development Region of Nepal.
  1999

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RESEARCH ON ABORTIONS (Contd..)

• 8. Management of abortion related complication in
  hospitals of Nepal A Situation Analysis. 2000
• 9. Unwanted Pregnancy, Sex Determination Tests
  and Abortion Seeking Behavior in Private Clinics
  of Nepal. 2000
• 10. Extent of Contraceptive Failure, Unwanted
  Pregnancy and Induced Abortions Among Married
  Couples in Kathmandu Valley. 2000 (Analysis on
  Progress)
• 11. Role of Private Pharmacist in Preventing
  Pregnancy related Complication Including Unsafe
  Abortions. 2000 (Analysis on Progress)

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KEY ISSUES EMERGED FROM RESEARCH

• The large majority of the women are unaware of
  the legal status of abortion
• The 1997 nationwide prison survey reveals that 80
  women (20) as against 14 men were imprisoned
  for charges of abortion or infanticide (CREHPA,
  2000).
• 20 and 60 of all obs gyne admissions in six
  major hospitals are abortion complication cases.

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KEY ISSUES EMERGED FROM RESEARCH (Contd)

• Women with abortion complications occupy hospital
  beds for about 3 days to over 7 days and spend on
  an average Rs. 3,918 for treatment.
• Most women resorting to unsafe abortion
  procedures were unaware about the possible health
  risks of the act.
• Majority of the government hospitals lack
  sufficient manpower, equipment, space, beds,
  etc., to deal with abortion related
  complications.

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FELT NEEDS

• Advocacy for Legalizing abortion
• Education about health implications of Unsafe
  abortions
• Enhancement of providers' skills and services at
  government hospitals to deal with abortion
  complications
• Discouragement of abortion services by
  Unqualified persons
• Periodic updates of abortion data

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STRATEGIES DESIGN NETWORKING

• Planning and strategies development workshop
  organized in October 1998 to initiate PUBLIC
  EDUCATION AND ADVOCACY PROGRAM (PEAP)
• Purpose

• To develop appropriate advocacy messages and
  slogan
• To develop logo for PEAP
• To develop non-threatening messages
• To identify the medium for disseminating advocacy
  messages
• Networking with Ministry of Health (MOH)

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STRATEGIES DESIGN NETWORKING (Contd)

• To identify and analyze strengths and weakness of
  district level NGOs and explore the ways and
  means of empowering them under PEAP
• To plan appropriate supervision and monitoring
  mechanism for PEAP
• To prepare suitable strategies for reopening
  policy dialogue with law makers at district and
  central levels

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THE FRAMEWORK
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ACTION Slogans Text Messages Developed
Appropriate non threatening advocacy messages
and slogans developed in Nepali

• "Do not rely on unqualified Persons
• Do not resort to unsafe abortions"
• "Unsafe abortions can claim women's lives
• Abortion is not a method of family planning"
• "Unsafe Abortion may put women's lives at risk".
• "Healthy life of mother and child,
• Use methods of family planning,
• Avoid Unsafe Abortions"

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ACTION Medium of Communication Dissemination
Identified
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ADVOCACY STRATEGIES Media Coverage
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Target Audience for PEAP
Education - Women Groups - Social Workers -
Community Health Providers - Pharmacists -
Community Leaders - School Teachers / High School
Students
Advocacy - Parliamentarians - Political Parties -
Policy Makers/ Administrators - Lawyers - Women
Associations - Journalists - NGO/INGOs
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ACTION MOH Involved From the Start

• Technical advisory committee with representatives
  from NHEICC/MOH formed for IEC development
• Formal launching of the posters and brochures by
  representatives from NHEICC/MOH

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ACTION OUTCOMES OF PEAP-I

• More District level NGOs identified and trained
• District level advocacy workshop held by partner
  NGOs
• Village level PEAP activities launched by partner
  NGOs
• Demand created for replication of the program
• Formation of Network SMHEAN (Safe Maternal
  Health Education and Advocacy Network)

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• INFLUENCING POLICY

• Acceptance and ownership of the IEC materials
  (Posters) on abortions by MOH
• Inclusion of PEAP related strategies in
  government's 15 years health plan
• District Health office (MOH) demand orientation
  training for TBAs against unsafe abortions
• Formation of seven member committee (with the
  inclusion of CREHPA) by MOH for advocacy towards
  legalization of abortion (submission of a
  separate abortion bill by MOH)

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LESSONS

• Research is key to influence Opinion Policy.
• Since abortion is highly divisive issue,
  sensitization should start from the top.
• Wide range of Approaches needed.
• Cost-effective yet expensive
• Concerned Policy Makers' involvement required
  from planning stage
• Credibility of the organization
• Creativity Continuity Necessary

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Thank You University of Southampton John Snow
International, UK