PERSPECTIVE OF WOMEN OF BHAKTAPUR DISTRICT

TOWARDS INDUCED ABORTION

A Dissertation Proposal






Submitted by:
Nischal Dhamala



Submitted to:
Department of Humanities and Social Sciences
Tri-Chandra College
Tribhuvan University
Kathmandu, Nepal



Under the supervision of


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1. Prelude
The world is heading towards the first quarter of the 21
st
century and more than 50 percent of
the world population comprises of women Of the worlds 1.3 billion poor people, it is
estimated that nearly 70 per cent are women. Between 75 and 80 per cent of the worlds 27
million refugees are women. A lot of countries are there where women are treated as
subordinate and second class citizen, though the equal rights are preserved in the constitution.

Nepal is a country of great geographic, cultural, ethnic and religious diversity. Across the
diversity, the majority of communities in Nepal are patriarchal. A womens life is strongly
influenced by her father, husband and son. Such patriarchal practices are further reinforced
by the legal system. The event of marriage determines the way of her life. A womans power
to accept or reject marriage partner is evidently an index of the degree of freedom she
exercises in the management of her own life, and thus also of her status. The status of women
is determined by the patriarchal social system, values, and womens right preserved and
protected by the state, and state policy for the development of women. Women ever since
their birth or even before, have to face various challenges for her survival and well-being.
Among the several factors that are considered sensitive towards womens life and death,
pregnancy and abortion is one of the very crucial issues.

There are innumerous factors that lead towards maternal death during the pregnancy in the
country. Women not just die due to complication during labor and delivery but also due to
other diseases that are aggravated by pregnancy. In case of present contemporary society,
many women die in an attempt to end their unwanted pregnancy due to lack of adequate and
appropriate services.

In October 2000, at the United Nations millennium summit all countries agreed on the global
imperative to reduce poverty and inequalities. The need to improve maternal health was
identified as one of the key millennium development goal, with a target reducing levels of
maternal mortality by 3 quarters between 1990 and 2015. In global context, despite the
increased use of contraceptives, over the past three decades an estimated 42 million abortions
occur annually (approximately 115,000 daily), 83% of which abortions occur in developing
countries and 17% occur in countries. Approximately, 13% of maternal deaths are due to
complications of unsafe abortion.
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Hence, the international conference in population and development (ICPV) in Cairo in 1994
the fourth world conference on women (FWCW) in Beijing in 1995 both affirmed the human
rights of women in the area of reproductive and sexual health. The Cairo conference agreed
that Reproductive rights embrace certain human rights that are already recognized in
national laws, international human rights, documents and other consensus documents. These
rights rest on the recognition of the basic rights of all couples and individuals to decide freely
and responsibly the number, spacing and timing of their children and to have the information
and means to do so, and the right to obtain the highest standard of sexual and reproductive
health United nation s 1995. (Safe abortion: Technical and Policy Guidance for Health
Systems). The 5th Asia-Pacific Conference on Reproductive and Sexual Health & Rights
Conference APCRSHR) took place in Beijing, China from 17th to 20th October 2009. The
theme of this conference was Working for Universal Reproductive and Sexual Health and
Rights: Building on the ICPD PoA and the MDGs. The conference followed on from
successful conferences in Manila, Bangkok, Kuala Lumpur and Hyderabad. The Conference
provided a common platform for all stakeholders to exchange experiences and discuss
strategies in the field of reproductive health in Asian and Pacific countries.

1.1 Abortion
Abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a
fetus or embryo, resulting in or caused by its death. An abortion can occur spontaneously due
to complications during pregnancy or can be induced, in humans and other species. In the
context of human pregnancies, an abortion induced to preserve the health of the gravida
(pregnant female) is termed a therapeutic abortion, while an abortion induced for any other
reason is termed an elective abortion. The term abortion most commonly refers to the induced
abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.
1.1.1 Types of Normal Abortion
a. Spontaneous abortion or miscarriages
Threatened abortion
Inevitable abortion
Complete abortion
Incomplete abortion
Missed abortion
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1.2 Induced Abortion
Induced abortion is the intentional termination of a pregnancy before the fetus can live
independently. An abortion may be elective (based on a woman's personal choice) or
therapeutic (to preserve the health or save the life of a pregnant woman).
(http://www.medterms.com/script/main/art.asp?articlekey=17775)

A pregnancy can be intentionally aborted in many ways. The manner selected depends
chiefly upon the gestational age of the embryo or fetus, which increases in size as it ages.
Specific procedures may also be selected due to legality, regional availability, and doctor-
patient preference. Reasons for procuring induced abortions are typically characterized as
either therapeutic or elective.

An abortion is medically referred to as therapeutic when it is performed to:
save the life of the pregnant woman
preserve the woman's physical or mental health
terminate pregnancy that would result in a child born with a congenital disorder
that would be fatal or associated with significant morbidity or selectively reduce the
number of fetuses to lessen health risks associated with multiple pregnancy.
An abortion is referred to as elective when it is performed at the request of the woman "for
reasons other than maternal health or fetal disease."
(http://en.wikipedia.org/wiki/Abortion#Induced_abortion)

1.3 Problem Definition
1.3.1 Abortion in Nepal

Nepal is among the handful of countries in the world that consistently prosecuted
and imprisoned women for having abortions. The law and the criminal justice
system ignored the circumstances surrounding a womans pregnancy and abortion.
Law enforcement officials arbitrarily classified many abortion cases as
infanticide, or the murder of a child following birth a crime that carried heavy
criminal penalties.

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Hence, more than half of the women were imprisoned on such charges as of January
2001 had received a 20-year sentence. Medical practitioners and unskilled abortion
providers were rarely, if ever, indicted and the women targeted lacked even
elementary schooling and come from rural and low-income areas.

Nepal decriminalized abortion in 2002 with an amendment to its laws, which at the
time were responsible for incarcerating at least one-fifth of its female prisoner
population. Many of these women were convicted of infanticide, which carries the
same sentence as murder. Unsafe abortions were estimated to cause as much as 50
per cent of maternal deaths and unsafe abortion complications accounted for almost
60 per cent of hospital admissions of women.

The amendment to the civil law meant that women can now have an abortion on
demand up to 12 weeks into a pregnancy, 18 weeks into a pregnancy arising from
rape or incest, and any time if the pregnancy will adversely affect her physical or
mental health. In Nepal, women seek clandestine abortions under conditions that
endanger their lives. About 50% of all maternal deaths in the country are attributed
to unsafe abortion, contrasted with a global rate of 13% of maternal deaths due to
unsafe abortion. A 1998 Nepalese government study on maternal mortality and
morbidity reports a total of 4,478 maternal deaths per year, or one death every two
hours.

This figure places Nepal among the countries with the highest maternal mortality
rates in South Asia and the world. It has been reported that complications of unsafe
abortion are the leading reason for hospital admissions (54%).Thousands of
preventable deaths of Nepali women can be linked to Nepals criminalization of
abortion. Because most abortions are conducted clandestinely, it is likely that the
actual number of abortion-related deaths is much higher.

Changes in Nepals abortion law and its reproductive health law in general have
been incremental. The basis for the repeal of the anti-abortion law in 2002 was the
enactment of anti-discrimination legislation. In 2007, Nepals interim constitution
recognized reproductive rights as fundamental human rights and this provided
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further grounding for abortion rights. In 2008 the Supreme Court upheld a womans
right to abortion by dismissing a case that challenged the abortion law. The
petitioner in that case had charged that the law discriminates against men because it
allows a woman to terminate a pregnancy without the consent of a spouse. The
CEDAW (Convention on the Elimination of All Forms of Discrimination Against
Women) committee has recognized that requiring spousal consent for abortion
would violate Article 15 of CEDAW which requires states to accord women
equality with men before the law. Reproductive rights advocates convinced the
Court that adding a spousal consent requirement would violate womens human
rights under international law and Nepals constitution.

1.4 Objective
To know the status of reproductive health awareness amidst the women of Bhaktapur
District
To know the level of awareness regarding prenatal and postnatal death
To know the status of Crude Birth Rate, Crude Death Rate, Maternal Mortality Rate,
Infant Mortality Rate in the communities of Bhaktapur.
To disseminate basic information related to reproductive health, safe motherhood and
safe abortion practices.

1.5 Literature review
Human Rights Committee - The United Nations treat body that monitors state (compliance
with the civil and political rights covenant):"The right to life has been too often narrowly
interpreted. The expression inherent right to life cannot be properly understood in a
restrictive manner and the protection of this right requires that states adopt positive measures.

Reform of Nepal's abortion ban and release of women wrongfully imprisoned under the
abortion law are needed as immediate steps. In addition, further legislation action is required
to ensure that all women can access safe and legal abortion services. Finally, law reform
should be accompanied by a holistic set of initiatives to raise women's status in Nepal. Justice
demands that action be taken to end the needless suffering and loss of Nepali women. (CRLP,
FWLD, 2002)
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Caeytoux, (1993) in his book entitled Women: A global perspective states Many estimate
that the incidence of induced abortion is increasing world wide. Reasons for this increase are
attributed to a variety of changing trends world wide, including a desire for smaller families,
shifts from rural to urban residence, and the increase in non-marital sexual activity.

Eleventh amendment of the Civil code legalized abortion in 2000. To implement the service
allowed by the law, surgical abortion was started in September 2002. Seventy-two districts
have CAC service where abortion for pregnancy up to 12 weeks is provided. However,
second trimester service was limited to Prasuti Griha, was provided abortion for pregnancies
between 13 to 18 weeks
(The Kathmandu Post, 19 June, 2008)

As of June 2009, according to MOHP (Ministry of Health and Population) data, more than 3,
31,000 women opted for abortion since the inception of the services
(The Kathmandu Post, 21st March, 2010, Pg no.4)

According to a report made public by an NGO, Kripa, some pregnant women are losing their
lives as they are performing abortion in their own houses without evening consulting trained
doctors or visiting hospitals. According to the report, the largest numbers of women
performing unsafe abortions are in Achham. Vice-chairman of Doti chapter of Nepal Family
Planning Association Laba Shrestha also admitted that the condition in Accham. As Women
are performing abortion using domestic means in their own houses, it is unsafe and risky, Dr
Kiran Pandaya at the Doti District Hospital, said.
(The Himalayan Times, 16 June 2008, Pg no.5.)

1.6 The Estimated Schedule
Task Name Duration Start Finish
Topic Selection And Proposal Submission 10 days Sun 8/15/10 Thu 8/26/10
Study, Analysis and Field Visit 20 days Fri 8/20/10 Thu 9/16/10
Documentation 20 days Wed 8/25/10 Tue 9/21/10
Review and Debugging 5 days Wed 9/22/10 Tue 9/28/10
Final Presentation To be scheduled later





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Bibliography and References
[1] Royston, E., and Armstrong, S. (1989): Preventing maternal deaths. World Health
Organization, Geneva.

[2] Thomas W. Hilgers, Robert P N Shearin 1973: Induced Abortion: a documented
report

[3] Coeytaux, F.M., A.H.leonard and C.M.Bloomer.1993.Abortion.In:M.Koblinsky ,
J.Timyanky and J.Gay(eds), women : A global perspectives. Boulder.co:west view
press, pp.133 -46.

[4] Mahila ko Garbha patan sambhandhi adhikar:Kanun ko Prabhavkari Karyanayanko
Lagi sahayogi Pustika. Forum for Women, Law and Development FWLD, PPFA-I,
2064.

[5] The Himalayan Times, 16 June 2008, Pg no.5.

[6] The Kathmandu Post, 19 June, 2008

[7] http://en.wikipedia.org/wiki/Abortion

[8] http://www.medterms.com/script/main/art.asp?articlekey=2091

[9] http://www.iisd.ca/cairo.html

[10] http://www.5apcrshr.org/file/LWJ.pdf