Legal abortion is not enough without safe and accessible services, says Dr. Bhola Rijal

Shristi Baral in conversation with gynecologist Dr. Bhola Rijal

KATHMANDU: Abortion is a sensitive issue directly connected to women’s reproductive health. Having accurate information about unwanted pregnancies, the risks of unsafe abortion, related social misconceptions, and legal arrangements is essential. Although abortion has been given legal recognition, making safe services accessible to all women remains challenging. The following is an edited excerpt of an interview conducted by Shristi Baral with gynecologist Dr. Bhola Rijal regarding topics such as misconceptions about abortion, legal arrangements, the need for safe services, and the impact on women’s reproductive health:

There is discussion that abortion cases have been increasing recently. What is abortion?

Before understanding abortion, it is necessary to understand the difference between safe and unsafe abortion. A spontaneous miscarriage and ending a pregnancy through medication or other medical methods are different situations. Abortion can be safe if performed using the correct method, at an appropriate time, and by a skilled health worker. However, an abortion performed without necessary examinations and safety standards is risky.

You have advocated for legal recognition of abortion in Nepal for a long time. What was the reason?

I have closely seen the condition when abortion was not legal in Nepal. Around the fiscal year 1982/83, I publicly raised my voice that abortion should be given legal recognition. At that time, my interview on this subject was also published in ‘The Rising Nepal’.

Gynecologist Dr. Bhola Rijal

While working at the Maternity Hospital, I saw women brought to the hospital in serious condition due to unsafe abortions. The lives of many were even at risk. Their lives had to be saved through treatment. This experience made me realize that it is necessary to give legal recognition to abortion and make safe services available. While receiving training in Bangladesh, I also got the opportunity to work in the fields of abortion-related services and training. After that, I continuously raised my voice in favor of safe abortion in Nepal.

What were the challenges at that time?

At that time, it was not easy to talk openly about this subject. There were people who held the view that giving legal recognition to abortion would lead to its misuse by unmarried young women. Some religious and social groups also protested. I tried to make people understand by participating in various meetings, discussions, and roundtable conferences. Discussions continuously took place regarding women’s rights, safe motherhood, and the need to prevent deaths caused by unsafe abortions. With the help of women’s rights activists, various personalities, and policymakers, this issue moved forward and abortion finally gained legal recognition.

Even after gaining recognition, unsafe abortions are still happening. What is the reason for this?

Making a law is one thing, and implementing it effectively is another. To provide safe abortion services, skilled human resources, suitable health institutions, necessary equipment, medicine, and arrangements for emergency treatment in case of complications are required.

After a law is made, attention must also be paid to the necessary budget, human resources, and management. However, in our health system, the implementation of these matters has not been sufficiently effective. To transform unsafe abortions into safe services, all three aspects, trained health workers, suitable locations to provide services, and necessary materials, must be strong.

Can unmarried women receive abortion services?

The notion that a woman must be married to receive abortion services is not correct. A woman’s reproductive health needs should not be determined solely based on whether she is married or not. A woman’s age, health condition, duration of pregnancy, and conditions specified by law are important. In the case of adolescents, the legal provisions applicable according to age and necessary protection must also be taken care of. Providing safe health services to women is our responsibility.

What should be done to improve the implementation of abortion laws and services?

First of all, necessary budget must be allocated to the health sector. The work of producing skilled human resources and enhancing the capacity of health institutions must also be taken forward simultaneously. Health workers providing abortion services must have received necessary training.

Gynecologist Dr. Bhola Rijal

A safe service is not just the procedure of terminating a pregnancy. There should also be arrangements to examine a woman’s health, determine the duration of pregnancy, treat complications, and refer her to another hospital if necessary.

Up to how many weeks of pregnancy can an abortion be performed?

The duration of pregnancy and legal conditions are important for abortion. The same rule does not apply in all situations. While services can be obtained within the period specified by law under normal conditions, separate legal provisions may apply in special circumstances. As the duration of pregnancy increases, the procedure can become complex. Therefore, consultation should be sought in a timely manner, and services should be obtained only from appropriate health institutions according to the standards set by law.