Initiations in safe abortion at home

After the coronavirus outbreak made it difficult for common people to access health centers, the local governments have started providing door-to-door services related to reproduction and family planning.


Kathamandu, Oct 25 :  19-year-old Diksha Sharma (name changed) from ArjunChaupari, Syangja got pregnant after having intimate contact with a young guy within her blood relation. This unmarried teen wanted to terminate early pregnancy and decided to seek the district hospital or Pokhara. It was in last Chaitra when the lockdown was imposed to control coronavirus infection and it was not quite possible for her to reach any hospital. Then the duo consulted ChinmayaGurung, the vice president of the rural municipality. 
“I was in the plan to help Sharma get an abortion and take action against the guy”, Gurung said, “But local police wanted to arrest the guy first and then help the girl terminate baby, so girl’s family was asked to file a complaint against the guy.” When the guy got arrested, the incident came to public eyes. Then Gurung suggested the girl’s family not to have an abortion as she wanted to save the lives of both mother and baby. It became difficult to deal with public incitement of hatred and the girl was sent to Maiti Nepal, Kathmandu with the help of the municipality. Gurung also said Sharma has now given birth to the baby. 

The village witnessed another similar incident where a woman (whose husband was abroad) got pregnant after having a relationship with her own brother-in-law Chandra Sharma (name changed). To cover up the mistake they both went to district headquarters Syangja for abortion but couldn’t terminate the pregnancy. The news of their relationship spread in the village like a wildfire and they were boycotted by the public. ChinmayaGurung arranged a vehicle and sent them to Pokhara when they sought help. Unfortunately, Chandra’s mother passed away right after he left the village and he couldn’t return home for the last rituals. 

Gurung says, both the incidents got complicated due to lockdown amidst the Corona pandemic. 

Common people are facing trouble due to health centers and transportations shutting down after the Corona outbreak. Local government bodies are doing their best to help needed people during this time. 


Bhirkot municipality office recently helped a woman who faced an unwanted pregnancy. According to ChhyaramKhanal, chief of the municipality, the woman was sent to Butwal for abortion after chief district officer RambahadurKurungbang helped with a vehicle arrangement.


in the midst of unavailability of public transport and risk of Corona exposure in hospitals and health centers, several rural municipalities in coordination with non-government organizations have started providing abortion and maternity counseling services at homes. ArjunChaupari village municipality and Bhirkot municipality are two such communities. In collaboration with Ipas Nepal, ArjunChaupari has been providing abortion services in the village itself. The village municipality has allocated 5 lakh rupees for this service. 38 trained female health workers and auxiliary nurse midwives (ANMs) are working in the front end. 


Country Director of Ipas Nepal Dr. Popular Gentle says, self-managed medication abortion and telemedicine service are practiced globally and the Nepal government has now stepped into it targeting the Corona effect. Home-based abortion service has definitely eased women’s lives. 


In Baishakh, the Ministry of Health and Population introduced Interim Guidance for Reproductive, Maternal, Newborn and Child Health Services in COVID-19 Pandemic. The guidance has facilitated the way people approached medical solutions. Women also can receive information about safe abortion, availability of services, alternatives, details about required medicines, symptoms about complications, etc. from the primary health centers, and health posts through telephone. 


The government has now allowed distributors to store and distribute the medicines of abortion that are approved by the Department of Drug Administration. Listed pharmacies and trained pharmacists did not have permission earlier. 


Bhirkot municipality has trained and mobilized 55 volunteers. Chief of the municipality ChhyaramKhanal said each of the volunteers is given an android phone and they coordinate with respective focal health personnel through a video call. Health workers regularly guide them while they are in the field. Door to door service is gradually extended across the country. 


ANM Ranjita Sharma Acharya from Purbakhola village municipality health post, Palpa said, they have been receiving requests for abortion services. She provided required assistance to five women who sought an abortion in the last three months. “Two of them came through female health workers while I went to provide home service to one, Ranjita said “A lot of women consult us regarding abortion services through telephone as well.” Women do not like to disclose when it comes to abortion and there’s quite a difficulty in maintaining privacy in village areas.


ANM DevikaBhattarai from Sakhejung Health Post, Ilam municipality ward number 1 received a phone call on 31st Shrawan. It was with a request from a woman who wanted to abort her unwanted pregnancy but couldn’t reach health post as local transportations were affected due to the Covid pandemic. Finally, Bhattarai provided her home abortion service. 

Devika also resolved a similar issue of a 20-year-old from Ilam Municipality ward number 1 who couldn’t go to a hospital or clinic for abortion due to Covid outbreak. Devika says, “Women first consult through phone, we usually call them to the health post. If they are not feasible to come, we provide home service.”


Despite the government’s initiative towards safe abortion after the Corona outbreak, a lot of women seem unaware of the same. According to the Ministry of Health and Population, Rolpa, Palpa. Achham, Tehrathum, Doti, Dadeldhura are the districts where service providers are actively working. 


According to Dr. BhimsinghTinkari (Head of Family Welfare Division, the Ministry of Health and Population), the implementation of the interim guidance was brought to avoid the Coronavirus effect in other health services. The government’s step towards safe maternity, family planning, reproductive health, vaccine, and other pregnancy-related services is being appreciated amidst the pandemic crisis. Vaccination against measles, rubella, distribution of vitamin A capsules, etc. have also been done successfully. Maternity and abortion services are also being provided more conveniently than earlier. Tinkari says, “We can not block other health services just because Covid has hit us hard. Covid is just a component.” He further added, “If not 100%, we are at least doing more than nothing.”

Unfortunately, during the first one and half months of lockdown, 45 pregnant women lost their lives due to deprivation of maternity health service. Death cases due to the inability to reach the hospital on time in need and the interruption of maternity services due to various reasons drew the government’s attention. Tinkari said the services have been made smooth by making guidelines in collaboration with the partner organizations of the Ministry of Health. Tinkari added, “the Ministry is also studying the effects of Covid in reproductive health and family planning, we will soon release the report.”

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