Nepal: Maternal mortality down as law allows abortion
The Rising Nepal
8 August 2009
Maternal mortality rate in the nation has gone down significantly after the endorsement of the safe Abortion Procedural Order and the related policies on legal abortion approved by Nepali Parliament in 2002.
The women belonging to the disadvantaged and poor communities in the rural areas are the usual prey due to lack of awareness and limited health service, the senior's general practitioner, government officials and the domestic and international health concerned institutions claimed at a seminar on ‘Scaling up of Medical Abortion Services in Nepal' here in the capital.
According to them, only 30 per cent women are aware of the legal abortion and this percentage belongs to the privileged groups. The social stigma, health service concentrated at district headquarters and the centre, absence of counselors, lack of contraceptive choices, sustainable subsidized drug supply and conventional technical backup existed in Medical Abortion (MA) were the reason that large portion of rural women have been engrossed with high mortality and morbidity rate, they pointed out.
As per the maternal mortality ratio figure, one-third of all births are mistimed or unwanted, one-fourth of married women of reproductive age have an unmet need for family planning, and the maternal mortality is 281 deaths per 100,000 live births of which one cause is unsafe abortion.
The figures claimed that the maternal mortality rate has been reduced to 281 deaths per 100,000 live births from 539 per 100,000 live births. The Millennium Development Goals (MDGs) has set target to reduce the existing maternal mortality rate by 75 per cent.
With the encouraging reduction in the maternal mortality rate after the safe abortion procedural order 2004, the Government of Nepal (Ministry of Health and Population) developed a strategic guideline to expand safe abortion services with this alternative method. For this, a six month pilot study was implemented in six district-Chitwan, Dhading, Jhapa, Kailali, Tanahu and Surkhet.
Dr. Meera Ojha, presenting the key MA pilot findings and recommendation for scale up, said that the pilot findings conducted in 32 listed services sites revealed that a total of 26,620 women received safe abortion service.
Of the 26,620 women, 1,718 women received safe abortion services using MA. According to the study, 96.44 per cent (1,657 women) of the total women (1,718 women) who received MA were successfully followed up in two weeks and they were all satisfied with the method. Only, 0.6 per cent of the women (10 women) experienced complication; among them two were treated in the referral hospital and eight received treatment at the service site, she said.
"Despite the tremendous achievement in the MA, there is a grave problem arising in the women of the rural areas," she added.
She said that MA should be integrated and scaled up into all safe abortion services and also harnesses the potential of the private sector in making these services more easily accessible, affordable and reliable.
She said that the donor community had stopped the medicine assistance to this purpose. "Now, the government has the responsibility to make this campaign successful to meet the target of the MDGs", she said.
Dr. Govinda Prasad Ojha, Director General, Department of Health Services pointed out that the maternal mortality had substantially decreased but the existing figure of 281 deaths per 100,000 live births is still high.
He said that the government was taking effective move to upgrading the community health service centers to health posts in every village. He said that the institutional effort should be blended in an easy manner and it should provide affordable MA services to the disadvantaged and poor community, which would help reduce maternal mortality as expected.
However, lack of awareness, infrastructure, equipment, qualified medical workers and medicines are the challenges that could hinder the government target to reduce the mortality and morbidity significantly.
Dr. Alexander G. Andjaparidze, WHO representative, said that the progress made by Nepal in just five years was a huge achievement. He said that the WHO had been assisting the health documentation in the developing countries in order to bail out them from the serious health hazards. "However, the major constrains in the developing countries is the implementation part," he added.
He said that Nepal had done well progress in the health sector despite various emerging challenges. "We will continue our supports to Nepal in the coming days," he added.
Andrew C. Boner, country representative, PSI Nepal said that the legalisation of MA in Nepal had significantly reduced the maternal mortality. However, the problem related to unwanted pregnancy is taking a high toll. "Confronting with this reality Nepal still is far from the MDGs target," he added.
He underscored the need to improving the quality of the private medical services and the government responsibility towards it.
The programme was jointly organised by the Ministry of Health and Population Department of Health Services, the PSI Nepal and the IPAS.
