Prior to its amendment in 2002, the abortion law in Nepal was highly restrictive: abortion was permitted only to save a woman’s life. Moreover, unsafe abortion was common, and deaths from abortion related complications accounted for more than half of maternal deaths that occurred in major hospitals. In 2002, the Country Code of Nepal (Muluki Ain) was amended to grant all women the right to terminate a pregnancy at up to 12 weeks gestation on demand, at up to 18 weeks gestation if the pregnancy resulted from rape or incest, and at any gestational age with a doctor’s recommendation if the pregnancy poses a danger to the woman’s life or her physical or mental health or if there is a risk of fatal abnormality or impairment. In addition, the revised law prohibits sex selective abortions and abortions done without the consent of the woman.
During the past decade, the Ministry of Health has developed strategies for implementing the law and expanding access to safe and legal services. These strategies include training clinicians to perform abortions, providing them with necessary equipment, and certifying providers and health facilities. All health facilities that have official approval to provide abortions are expected to perform first trimester abortions. A few lower level facilities such as health posts are approved only to provide medical abortion up to nine weeks gestation. To provide abortions after the first trimester, facilities need separate approval and are required to have staff members trained and certified to provide such abortions. Abortion legalisation has led to a decrease in the number of women presenting severe abortion complications, and it has contributed to a decline in the country’s maternal mortality ratio which fell from 580 maternal deaths per 100,000 live births in 1995 to 190 deaths per 100,000 live births in 2013.
In 2014, the Center for Research on Environment Health and Population Activities (CREHPA) and the Guttmacher Institute conducted a study to generate the first national and regional estimates of abortion incidence in Nepal. This study adopted a modified version of the established Abortion Incidence Complications Methodology which uses indirect estimation techniques to measure the number of abortions occurring each year, the abortion rate and the abortion ratio which also consists of a survey of a nationally representative sample of facilities that provide safe abortion or post-abortion services, and experts on abortion in Nepal.
According to the study many women in Nepal continue to face barriers to obtaining safe and legal procedures. Obstacles include lack of awareness of the legal status of abortion, lack of services, lack of transport to approved facilities, gender norms that hinder women’s decision making autonomy, the often-prohibitive cost of the procedure, and fear of abortion related stigma.