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Second trimester abortion in Nepal

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Map of Asia. 6/11/09. 4. Map of Nepal. 6/11/09. 5. Legalization of abortion in Nepal ... posses the danger to the life of the pregnant woman or to her physical ... – PowerPoint PPT presentation

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Title: Second trimester abortion in Nepal


1
Second trimester abortion in Nepal--------------
----------
  • Dr. Veena Shrivastava
  • President Elect
  • Nepal Society Of Obstetricians Gynaecologists
  • Nepal

Global Safe Abortion Conference , London 23rd
24th October, 2007
2
Objectives
  • Highlight current status of second trimester
    abortion in Nepal
  • Share experience of the only training on
    comprehensive second trimester abortion services
    in Nepal

3

Map of Asia
4
Map of Nepal
5
Legalization of abortion in Nepal
  • Abortion became legal in 2002 (restrictive
    abortion).
  • From March 2004 CAC service was started.
  • 167 listed sites giving CAC service.

6
Abortion Law according to 11th amendment of
Muluki Ain Sept ,2002
  • On request- up to 12 weeks
  • .
  • Rape and incest, - up to 18 weeks
  • Anytime with the approval by an authorized
    physician - foetus is abnormal
  • - pregnancy posses the danger
    to the life of the pregnant woman or to her
    physical or mental health

7
Case History
  • Maya had been happily married for six
    months, when suddenly her husband disappeared .
    She realized that she is pregnant, but did not go
    for an abortion hoping that her husband would
    come back. After a couple of months she learnt
    that he cheated on her and already had a family.
    Devastated, she went to a chemist to get
    medicines for abortion. The chemist referred her
    to the maternity hospital where CAC was available
    at an affordable price.
  •  
  • The doctors at the maternity hospital found
    Maya to be over 20 weeks pregnant and denied to
    perform abortion on her. No one cared to
    understand the mental trauma she was undergoing.
    She had no option .She was ready to commit
    suicide rather than have the baby. Eventually a
    paramedic referred her to a private clinic who
    provided service at higher price. However, she
    started having torrential bleeding after the
    procedure. Again, she was referred to the
    maternity hospital, where she had to undergo
    hysterectomy.
  • If only people had understood her situation....
  •  
  • If service providers were capable to assess
    her mental status for the indication of
    termination pregnancy, Maya would have been
    enjoyed her rights to safe abortion services.

8
Post legalization of abortion status in Nepal
  • MMR dropped from 539 to- 278/100,000 live
    births.

  • (NDHS-2006)
  • No imprisonment of women due to induced abortion.
  • Hospital admission for abortion complications
    unchanged (CAC PAC understanding
    complications NJOG Dr Sudha Dr Indira Dr
    Kasturi ).
  • Report of four deaths due to abortion in news
    paper.

9
Post legalization status
  • 13-22 denied because their pregnancy was beyond
    12 weeks (National baseline survey CREHPA-2006).
  • 61 of patients admitted with complication of
    abortion had 2nd trimester induced abortion
    (Study on maternal mortality morbidity among
    induced septic abortion 2006 ,Dr Achala).

1
10
  • Second trimester induced abortion is still a big
    health issue in Nepal.

11
Second trimester abortion, where are we ?.
  • Eighty three first trimester trainings have been
    conducted
  • ( 374 Trained providers ).
  • No second trimester abortion training - been
    organized.
  • Providers not very clear about indications of
    late abortion.
  • Clinicians are reluctant to perform second
    trimester abortion.
  • Those who do perform - use old methods.

12
  • Need for second trimester abortion training was
    recognized by the government.

13
First mid -trimester abortion TOT
  • Training was organized by FHD, MOH with the
    support of TCIC on 10 -22 June 2007 in Maternity
    Hospital CAC Unit.

14

Data During Mid-Trimester Training
  • Total no of mid trimester abortions done during
    the training - 23
  • Total no of first trimester abortions - 107

15
Demographics of Mid trimester abortion
  • Age distribution 14- 45 yrs
  • Parity Nulliparous- 17
  • Grand multi - 17
  • Economic condition- poor (2-4 Per day)
  • Education- 70 no education
  • Home - 40 from remote
    area

16
Reasons for abortion
17
Duration of time from insertion of Misoprostol
to evacuation
Total No- 19
18
Time taken for evacuation
  • 15-20 minutes (one case - 30 minutes)

19
Complications
  • No major complications
  • Minor - 3
  • High Fever - 1 (1020F) admitted discharged next
    day
  • Bleeding - 2 (1- cervical injury, 1- atony)

20
Follow up
  • No problem

21
  • First mid- trimester abortion training was
    successful.

22
Future Plan
  • Five mid trimester abortion trainings will be
    organized each year .
  • All seventeen Zonal Hospitals will have trained
    doctors (Gynaecologists/ General practitioners )
  • The training will follow Value Clarification
    workshop.
  • Necessary instruments and medicines will be made
    available to them.

23
Conclusion
  • Second trimester abortion services has not been
    given priority so far in Nepal and is a major
    challenge in ensuring reproductive health rights
    of Nepalese women
  • It also highlights that provision of law without
    implementation will not solve the problem
  • Competency based training in second trimester
    abortion is very much feasible to implement and
    save womens lives from unsafe abortion

24
Acknowledgment
  • Marie Stopes International Specially Ms Rodica
    Comendent
  • TCIC Nepal specially Dr Indira Basnet

25

Thank you
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