by Ojasbi Bhattarai, YUWA, Nepal
Is it enough just to create an unrestricted legal framework?
A locality lacking in safe abortion services fosters a negative climate. An locale with a ratio of too few service providers (supply) to consumers (demand) indicates a shortage of needed abortion services. Unintended or forced pregnancies might increase the rate of unsafe abortions due to social and economic barriers. Unprotected coitus might lead to unwanted births of children whose nurture and nourishment might not be supported by the family’s economic condition. A woman’s status in a community often defines her access to safe abortion services. Viable pregnancies which might pose serious harm to the health of the woman if delivered are left unattended due to social taboos and stigma surrounding abortion. Ectopic and non-viable pregnancies are left undiscovered when antenatal care and safe abortion services are not within reach, either due to geographical, infrastructural or socio-cultural barriers resulting in reproductive complications. All the aforementioned scenarios depict barriers to accessing reproductive health services. Even in the presence of a constitutionally protected framework of rights supporting access to these services, actually accessing them may be a problem due to various barriers. What good is a right when people can’t access the services it is intended to protect!
The combination of reproductive rights and social justice, that is, reproductive justice, aims to confront the economic, social and political inequalities that obstruct women’s access to reproductive health care and services. The term “reproductive justice” has its origin in black women’s movement groups, and is about making services not just available but accessible as well. With its integrated components – including access to safe abortion services, contraceptives, comprehensive sexuality education and a life free from sexual violence, and with a priority focus on the right of women to bodily autonomy, to have children or not to have children, and to parent children in a wholesome environment, reproductive justice emphasises rights, access, equity and participation as four pillars in rendering services.
With the aim of decreasing maternal mortality and morbidity, Nepal legalised abortion in 2002. The Supreme Court of Nepal in 2009 stated: “Reproductive rights are considered to be an inseparable part of women’s human rights and within that the right to abortion is seen to hold an important place.” Not only did the Supreme Court declare there is a right to abortion but stated that access to safe abortion is a human right as well. “Safe abortion” here basically implies two conditions: skilful provision (conforming to high medical standards) and an environment conforming to skilful conduct.
But even after this reform, plus access to safe abortion and the provision of guidelines and standards on abortion, a 2018 study (Prevalence and factors associated with abortion and unsafe abortion in Nepal: a nationwide cross-sectional study, BMC Pregnancy and Childbirth, 2018) showed that of the 21% of women of reproductive age who had had an abortion in the previous five years, 16% were unsafe. Associated causes were illiteracy, economic problems, social stigma, misleading information, needing third party authorisation, gaps in reaching safe abortion services, timeline of abortion, teenage pregnancy, socio-cultural factors, and more. These barriers were despite abortion being a right.
The latest law reform, the Right to Safe Motherhood and Reproductive Health Right Act, 2018 has increased the upper time limit for abortion from 18 weeks to 28 weeks in cases of rape, incest, the mother suffering from HIV or another incurable disease, and other pregnancy related complications, while in the case of unintended pregnancies; the upper time limit is 12 weeks. The effect on access to safe abortion remains to be seen.
A reproductive justice approach to providing abortion services, such as facilitation of comprehensive sexuality education (CSE) both within the school setting and in the community setting – either through a curriculum-based approach or an outreach, pedagogy-based approach, can help to normalise abortion and reduce stigma related to it. Not only does CSE help to normalise abortion, it also helps to enhance the social status of girls and women and promote the value of gender equality, such that women and girls can take decisions about their own body by themselves. Free abortion services in public health facilities has been a breakthrough for access to safe abortion in Nepal. This has reduced the usual financial burden on poor and marginalised people to access safe abortion services. Still, however, challenges remain. Female community health volunteers (FCHVs) play a major role in Nepal in rendering reproductive justice. Mobilization of FCHVs to find those who need an abortion, refer them to a health facility in cases of surgery, and provision of information, education and communication (IEC) materials on abortion can help people reach services. Likewise, the establishment of adolescent-friendly health services that assure confidentiality, consent and symmetrical information dissemination as a primary protocol can help to manage unintended teenage pregnancies. Above all, the public must have access to information on their rights regarding abortion to ensure access to it.
Abortion is a necessary service. Priority must also be given to promotion and use of contraception. Family planning services must have substantial coverage in order to reduce the need for termination of pregnancy. Nonetheless, a few rights placed in a constitution may bring no reform in people’s knowledge, attitudes and practice related to abortion. Availability of information on abortion-related rights and services provided by the nation may not always affect knowledge attitudes and practice either. Access to services brings about reproductive justice. Reproductive justice must be the anticipated goal. Access is the key!
+++
12 shades of purple
by Aastha Subedi, YUWA, Nepal
A child is growing inside me.
It feels blue today; it felt the same yesterday, and I don’t know the end to this. The gigantic maze of blueness is where I reside. They say there is light at the end of the tunnel, but I am not sure whether I will make it to the end. I feel stuck in a moment from the past, and what holds together the past and me is too strong to free either of us. I might inhabit that complicated moment forever.
I have committed a heinous crime in my own eyes. To myself, I am a culprit. Though unplanned and unintended, I am guilty of what has happened. Nine years have passed since that day and I should have let it go. The days are just days, they pass, but it is the nights that hunt you and make it hard to let go. Days bring people to be met, sights to be seen, talks to be talked, and there is very little alone time with myself. At night, everyone is asleep and I am with myself only, surrounded by the silence.
Although not everyone may agree, I am not an ordinary person. The fact is that I have killed. How do you forgive something so horrendous? No matter how many times I try to conceal the truth, the reality is always exposed, and the time that I spend with myself is ghastly, I am afraid of my thoughts and my mind.
People think that I am oblivious of the crime I have committed. Little do they know that I am not as ignorant as they think. I have built an empire inside my head, a corpus of mess and labyrinths, and though it seems complicated, the answers are all in there. I don’t know the authenticity of the answers yet, but I have a very stubborn heart and I believe those answers are an undeniable reality.
***
Nine years ago, as I was halfway across the room, I was astounded by what was said, and I froze. I heard my grandmother say: “So, the child must be aborted. You can’t give birth to another girl child; we need a son.”
“Mother, it will be the fourth abortion, I don’t think I will be able to do it.” My mother was agitated. She looked helpless. Dismay became diffused throughout the room, reaching every corner. “We want a grandson.” “But mother…” My mother was hushed by my father. Silence. You could hear a pin drop.
I didn’t want the dismay to devour me, so I left the room. I didn’t understand what was in those words or gestures, that they gave birth to such apprehension, but I decided to ask my mother later. My mother has taught me many words that sounded strange when uttered for the first time, but I knew she would explain what that word ‘abortion’ meant.
After their conversation was over, my mother went to her room and my grandparents to theirs. Father wasn’t there, he must have gone out for a walk, so I went to my mother. Her eyes looked swollen; she spoke and her words were heavy. The weight of them has been crushing me, slowly, a little more each day. Nine years have passed, yet the heaviness increases as each day goes by.
My mother told me that ‘abortion’ was to terminate a pregnancy, and that she had already had three abortions against her will. She said they had made her weak over the years, but there was nothing she could do about it. “But mummy,” I said. “You can leave them, and we can go somewhere far away.”
But my mother said that leaving the family wasn’t an option for her. Society would never accept her, and it would be difficult to raise me on her own. My mother said a lot of things; she looked pale and helpless.
I asked: “Mother, are we so odious that they don’t want anyone who resembles us ever in their lives again?” Twelve shades of purple appeared in her face. I stared at her with teary eyes. Our eyes met.
Those eyes haunt me even today.
Now it is I who has committed a crime. Had I not been born, the pain in the eyes of my mother may have been prevented, the murders averted, and life wouldn’t have been a mass of blueness, of guilt and fear, of non-acceptance, of anxiety and sleepless nights, of helplessness.
I have committed the crime of being a daughter. I have hurt my mother and myself. Though unintended, I am a culprit. How do you forgive yourself for something that atrocious?
I place my hand on my belly to feel the fetus inside me. I wish the nights too would be easy for the child growing inside of me. I wish this child will never feel lost in the labyrinths that are slowly engulfing me. I want a daughter so much, but I wish for this child to be a son so that I will never have to look at my 11-year-old daughter with haunted eyes, eyes that would haunt her for the rest of her life. I don’t want to commit another crime.