Abortions are common all around the world, among women of different ages, races, countries, and religions. Data shows that one out of every three women will have an abortion at some point in her life. Despite this, women continue to suffer in silence due to a strong stigma in conservative societies like ours. Women suffer unintended pregnancies for a variety of reasons, according to global and national evidence, including inadequate access to family planning information and services. In such cases, abortion is practiced. Abortion is the removal or evacuation of an embryo or fetus from a pregnant woman. It can happen spontaneously, also referred to as miscarriage, or as the result of a deliberate intervention. Around 73 million induced abortions take place worldwide each year. Six out of 10 (61%) of all unintended pregnancies, and 3 out of 10 (29%) of all pregnancies, end in induced abortion. Women with unwanted pregnancy of 9 to 12 weeks are eligible to seek abortion services.
MSI Reproductive Choices in Nepal (MSN) is a Nepalese branch of MSI Reproductive Choices, a global NGO dedicated to protecting women’s and couples’ basic right to chose the number and spacing of their children. Marie Stopes Nepal (MSN) has partnered with Sunualo Parivar Nepal (SPN), a local Nepali NGO, since its inception in 1994 to guarantee that Nepali women and couples have access to a comprehensive variety of inexpensive, voluntary modern contraceptive options, allowing them to choose the most appropriate technique for their requirements.
“We estimate that more than 10% of total demand for family planning in 2020 in Nepal was met by MSN. As a key player in the Nepali public health system for over 25 years, MSN has a strong track record increasing access to information and services, implementing and scaling-up innovations to ensure the greatest health impact and outcomes,” Dr. Raman Shrestha informs.
“We place a strong focus on increasing access to adolescents, those living in extreme poverty, and marginalized communities who have no effective access to public Sexual and Reproductive Health (SRH)services, considering our 2030 strategy of ‘Leaving No One Behind.’” MSN’s programs are increasingly tailored to address the changing requirements of young people as well as their long-term goals. All members of the MSN team have been educated to treat teenagers and adolescents with respect and without prejudice, including those with disabilities, and to question any preconceptions about contraception for adolescents. In 2020, 7% of client visits will come from those under the age of 20, with 25% of those between the ages of 20 and 24.
World Health Organization says that an abortion is dangerous if the individual doing it lacks the essential expertise, or if it is performed in a setting that does not satisfy minimum medical standards. This may include practices such as ingesting traditional remedies or toxic substances; incorrect drug administration; or inflicting repeated blunt trauma to the abdomen.
Though abortion has been legal since 2002, 58% of abortions are in unsafe or illegal (i.e. not CAC listed) facilities, many women and girls resort to risky abortion procedures, regardless of their safety or legal implications. Low awareness of the law also leads to the same—only 41% women are aware that abortions are legal, and 48% know where to get a safe abortion service (DHS 2016). Severe bleeding, infection, and harm to the vaginal tract or internal organs are all risks associated with improper abortions.
In addition to infertility and persistent pain, unsafe abortion can have long-term health implications. Every year, at least 22,800 people die as a result of unsafe abortion complications. “We’ve increased our efforts to assist women receive safe abortion treatment and identify ways to support their safe abortion and post-abortion care.” MSN now offers surgical (MVA) and medical (MA) abortions through its clinics, as well as MA medications to pharmacies and health facilities via its commercial sales channel. PAC is a strategy for lowering the number of people who die or are injured as a result of unsafe or incomplete abortions. Through its static health center and referrals to licensed government clinics/hospitals in other areas, MSN is working hard to eliminate unsafe abortion and expand access to post-abortion care services. MSN’s SA/PAC services provide a full range of services, including follow-up and contraception. MSN provided 23,727 safe abortions and post-abortion care in 2020. MSN and its business partners also supplied 97,603 MA combi-packs to pharmacies and healthcare facilities.
MSN also provides a full range of contraceptive methods, including short-term contraception, long-acting reversible contraception (LARCs), and permanent methods. In 2020, MSN provided 11,376 permanent methods of contraception, 42,136 LARCs, and over 1.1 million short-term contraceptives. MSN currently has 30 static centers across seven provinces that provide quality family planning (FP) services, safe abortion services, both medical and surgical and a full range of other SRH services, including cervical cancer screenings and USG and laboratory tests (in five premier centers).
“MSN uses community mobilizers, outreach, and Marie Stopes ladies to sensitize the community, raise awareness, and generate demand for MSN’s SRH services. MSN has a network of approximately 300 community mobilizers working at outreach sites and around the centers,” says Dr. Shrestha. They have been trained in mobilization and provision of SRH information using various strategies, including community talks and small group meetings, and are equipped with sensitization tools, such as information leaflets and FP job aids.
“Our nationwide toll-free helpline, Meri Saathi, is dedicated to iteration with adolescent and youth participation.” Their data shows that adolescents made about 16% of the total 56,000 calls in 2020.
Contact center staff are intensively trained to provide a very high level of customer service and advice on a range of SRH topics, as well as providing referrals to MSN’s service delivery points. They are also trained on how to talk to women through the self-administration of MA, and have adapted scripts to local context, based on MSI global guidance and standards. The contact center also serves as a safety net in cases of post-procedure complication, with clients able to phone for advice at any point before and after a service is delivered.