Nepal Country Program

While a 2006 peace accord offered hope for future stability, continued recent political disputes and disruptions have plagued Nepal's transition from monarchy to republic. Civil war, political instability, persistent poverty, and poor government infrastructure have all negatively affected the quality of life and health of the people in Nepal — who have a life expectancy at birth of just 62 years. 

Nepal's diverse population includes more than 100 different ethnic and caste groups, as well as significant numbers of Bhutanese and Tibetan refugees. The vast majority of the population lives in rural hills or plains areas — many of which are still unreachable by road — in households of more than five people, relying primarily on agriculture and traditional sources of energy like firewood. Women in Nepal tend to be less educated and less economically active than men, with just a 60 percent literacy rate as compared to 81 percent among men in Nepal. 

Nepal's health care indicators are poor and the public health care system fails to provide for the health needs of most Nepalis. Nearly half of the population is infected with tuberculosis, and HIV has become a concentrated epidemic among certain vulnerable populations. In 2004/5, there were fewer than 1,300 government-paid doctors and in 2006 there were fewer than 90 hospitals for a population of nearly 28 million. As an alternative, private health clinics have sprung up although most Nepalis lack insurance or funds to pay for such health care. 

Nepal has one of the highest maternal death rates in the world. Women in Nepal face distinct health risks due to pregnancy and childbirth and have a one in 24 lifetime chance of dying from maternity-related causes. 

Contraceptive use among Nepali women is low, putting women at risk for a high incidence of unintended pregnancy. Whether or not a woman chooses to follow through with her pregnancy, she faces grave health risks: just 11 percent of births are attended by skilled birth attendants, and even though abortion was partially legalized in 2002, many women still cannot afford or do not know how to access the services now available to them. Thus there is a great need for affordable and accessible reproductive health care — especially safe post-abortion and emergency obstetric care for impoverished and rural women.

PPFA in Nepal

When 28 year-old Shushila suspected that she was pregnant, the first place she went was not a health clinic but rather a pharmacy in her bustling neighborhood in Kathmandu. When Shushila found out she was, in fact, pregnant, she felt dread not joy. With five children already at home to support with her and her husband's small income, she could not imagine how they would support another child.

Shushila went to her local pharmacist who talked her through her options: have the baby or have an abortion. Shushila was desperate to avoid bringing another child into her already struggling household, but feared that she might become one of the many women she had heard about who died after having an abortion. The pharmacist explained that it was now possible to go to a clinic that the government had certified as safe, and that the chances of her being harmed were very low. The pharmacist also told her that if she could not pay for it, the clinic would provide the procedure for free, and gave her a list of safe clinics in the area with a map that illustrated how to get there.

Shushila's story is common in Nepal. Prior to the 2002 partial legalization of abortion, unsafe abortion was one of the leading causes of death and disability among pregnant women in Nepal, where more women died of maternity-related causes than in almost any other country in the world. However, many people in Nepal today are not yet aware that abortion is legal and can be obtained safely, and some still go to unsafe underground providers to have an abortion.

Planned Parenthood Federation of America (PPFA) has been working to reduce unsafe abortion in Nepal since early 2002, when it began collaborating with Nepali nongovernmental organizations (NGOs) to advocate for the legalization of abortion. In late 2002, these efforts were rewarded when abortion was partially legalized.

In 2005, PPFA launched the Network for Addressing Women's Reproductive Rights in Nepal (NAWRN), which works to raise awareness about the new abortion law, increase the availability of safe abortion services, and ensure that women like Shushila are referred to providers that have been deemed safe. The four organizations that comprise the Network train medical providers and pharmacists, educate community members and law enforcement personnel about the law, monitor the implementation of the existing abortion law, and advocate for further improvements to reproductive laws.