Abortion in Nepal

Although two decades have passed since the legalization of abortion, a significant part of the population remains unaware of their right to safe abortion. In addition to that, despite having liberal laws regarding abortion, the societal attitude towards a woman’s autonomy is quite conservative. Premarital sex is a taboo subject, which adds to the pervasive stigma surrounding abortion.

As a result, many people may feel isolated and ashamed in seeking abortion services. This disconnect between progressive legislation and societal attitudes highlights the need for comprehensive efforts to address cultural barriers and further promote people’s reproductive rights and autonomy.

Law and Policy: 4/5

Nepal has a very liberal legal framework for abortion. The constitution and laws protect SRHR, promote equality, and offer support for marginalized groups, although they could be more comprehensive.

Accessibility: 3/5

Access to abortion services is moderate. While services are free at public health facilities, geographical barriers and costs associated with transportation limit access, especially in rural areas.

Provider Training: 4/5

Providers are well-trained in WHO-recommended methods. Training programs are available, but there are still issues with supply and some facilities not providing services.

Public Opinion: 2/5

Abortion in Nepal is somewhat accepted but still faces significant stigma and negative attitudes, particularly due to conservative societal norms.

Support Services: 4/5

Accurate information and non-directive counseling are available, with good linkage to additional care, though there are minor gaps.

Data: 4/5

Adequate and fairly detailed data on abortion is available and accessible, with updates within the past 10 years, though some gaps exist.

International Standards: 4/5

Nepal has a high rate of ratification of relevant human rights documents, showing significant commitment to international standards.

Adherence to Health Standards in Abortion Care: 4/5

Abortion care practices in Nepal generally align with WHO guidelines on safety, effectiveness, accessibility, and user-centered care, with occasional minor deviations.

The Constitution of Nepal and the Safe Motherhood and Reproductive Health Act 2018 (SMRH) guarantee the right to abortion as a fundamental right for all individuals. Under Article 38, “Rights of Women,” the Constitution provides that every person shall have the right to safe parenthood and reproductive health; the SMRH Act further elaborates this by allowing individuals to obtain an abortion for any reason up to 12 weeks gestation or up to 28 weeks in case of rape or incest. Abortion is also permitted up to 28 weeks gestation if a licensed medical practitioner identifies a risk to the person’s physical or mental health or if the fetus is “likely to become non-viable.” The Act criminalizes abortions done under force, coercion, or threat and sex-selective abortions.

Despite having some of the most liberal abortion-related legislation, Nepal has been facing issues in their implementation; this is because the country has two legal frameworks that simultaneously deal with abortion. Because it is a specific legislation, the SMRH Act prevails over the Criminal Code. However, the Act refers to the provisions of the Criminal Code for punishment in abortion-related cases. 

The SMRH Act defines abortion as the “act of fetus coming out or taking it out of the womb before the fetus becomes capable of being born naturally.” The term “act of fetus coming out” refers to a pregnancy ending naturally or spontaneously, also known as a miscarriage. Including miscarriage while defining an abortion, especially when the law punishes individuals for carrying out abortions under certain circumstances, is very controversial.

Addressing abortion through the lens of criminal law violates the ability of individuals in Nepal to enjoy their constitutionally guaranteed fundamental rights. A study by the Guttmacher Institute found that less than half (42%) of all abortions were provided legally in government-approved facilities; individuals themselves provided the remaining (58%) through covert procedures by untrained providers or self-induced.

According to the Nepal Demographic and Health Survey 2022, 10% of women aged 15-49 have undergone an induced abortion, translating to a total abortion rate of 0.3 abortions per woman. Despite the legal framework supporting safe abortion services, significant cultural and social barriers still impact access to these services. In 2021, approximately 90,000 women and girls accessed safe abortion services through accredited facilities [18].

The distribution of abortion services varies across regions, with higher rates observed in the Central region compared to others [1]. This disparity highlights both the progress made since the legalization of abortion in 2002 and the ongoing challenges related to societal attitudes and access to healthcare services.

Conservative and patriarchal beliefs still govern a big chunk of the Nepali population. The cultural barriers posed by these beliefs, the fear of social stigma, and the lack of autonomy prevent many people from seeking safe abortion services.

A study showed that several young women do not seek abortion after unintended conception because of objections from their partner, family influence, societal pressures, and poverty [4].

The age-specific abortion rate is highest among women aged 25-29 (15 abortions per 1,000 women), followed by women aged 20-24 (12 abortions per 1,000 women) and women aged 30-34 (11 abortions per 1,000 women). The survey also found that the rate of induced abortions increased with pregnancy order, from 2% for the first pregnancy rising to 29% for the fifth (or higher) pregnancy. 

A study found that access issues were exacerbated by the socioeconomic differences between married and unmarried people seeking abortion services. Such access issues may be attributed to the stigma surrounding premarital sex that often results in social ostracization or disapproval from family and community members. 

The same study also found that most people who use safe abortion services come from relatively well-off families in terms of finances. Several participants in the survey reported being discouraged from utilizing safe abortion services because of the price attached to it. The financial burden may influences many abortion seekers to procure unsafe abortion measures.  

The geographical makeup of Nepal also acts as a hurdle because the concentration of most health services in the Terai belt, the lowland area in southern Nepal, and the Central regions cause trouble for abortion seekers in mountain and hill areas. A significant portion of the population in Nepal resides in urban regions with access to in clinic and medical abortion services. However, access to abortion services is an issue in rural areas. Abortion seekers may feel forced to use risky abortion techniques in these places, which could have detrimental effects on their health. [7]

The government has been providing free abortion services at public health facilities in combination with free family planning services since 2016 to help overcome the economic burden of accessing safe abortion services [8]. As of 2021, about 4,500 clinicians – 1,822 auxiliary nurse midwives, 743 nurses, 1,853 doctors, and 92 obstetrician-gynecologists and general practitioners – have been trained.

According to government policy, auxiliary nurse midwives are allowed to provide medical abortion care only up to 10 weeks gestation; staff nurses are allowed to perform both manual vacuum aspiration (MVA) and medical abortion (MA) up to 10 weeks gestation, while doctors are allowed to perform MVA up to 12 weeks. Obstetricians, gynecologists, and general practitioners are the only ones allowed to perform abortions at 13-28 weeks gestation. In addition, 34 public sector and private sector hospitals obtained accreditation to perform second-trimester abortions, and overall, 1,516 facilities received certification for providing safe abortion services in 2021 [9].

Abortion with pills

Medical abortion is a safe and easy way of ending early pregnancy. Government policy permits staff nurses and auxiliary nurse midwives to provide medical abortion care up to 10 weeks gestation [9]. Medical abortion access is solely permitted via government-accredited safe abortion services, but both registered and unregistered abortion pills are easily accessible for purchase throughout the country [10].

Mifepristone + Misoprostol 

This two-stage dose of medication is a low-risk method of ending a pregnancy. Many abortion seekers prefer medical abortion because it is safe, dependable, and non-invasive.

Manual Vacuum Aspiration

MVA is an in clinic procedure that trained staff nurses and doctors are permitted to perform in Nepal [9].

The government and health system provide information on safe abortion services; however, it is primarily organizations like the Guttmacher Institute, Marie Stopes International, the Center for Research on Environment Health and Population Activities, and the United Nations Population Fund, etc. that research and provide critical data regarding abortion in Nepal.

Abortion

The data  provides insight into related topics and searches that users look up alongside “abortion.” The related searches and topics indicate a strong association between abortion and broader health concerns, highlighting the need for safe and accessible abortion information and pills. The questions  “What is total sanitation?” and “What is safe abortion?” indicate a concern for cleanliness and safety in the context of abortion procedures. This is significant as it highlights a public interest in understanding safe practices and environments for abortion, also it could indicates some worries resulted of abortion stigma. While, the topics  “Abortion treatment pregnancy” and “Abortion pills Daraz” show a focus on the availability and methods of abortion. The mention of Daraz, an online shopping platform, suggests a trend toward seeking abortion pills through e-commerce channels, reflecting a possible need of private and safe abortion methods.

*Daraz is an online shopping platform.

Overview of Search Trends (June 2023 – May 2024)

The data provides monthly search volumes for the term “abortion” from June 2023 to May 2024.  The search volume for “abortion” shows fluctuations over the year. The highest search volume occurred in March 2024 (421), while the lowest was recorded in September 2023 (207). : There seems to be a slight increase in searches around the end of the year (December 2023), possibly due to the higher number of pregnancies and health-related searches during this period. Also, the spike in March 2024 could indicate a significant event or heightened awareness related to abortion during that month. This could be due to new legislation, public health campaigns, or a widely publicized news story.

Abortion with Pills

The data provides insight into related topics and searches that users look up alongside “abortion pill.”  The related searches and topics emphasize the public’s need for accessible, detailed information about abortion pills, their costs, and usage instructions.   Searches like “21 Day Abortion Pill,” “Abortion pill name and price in India,” “Abortion pill name and price,” and “Misoprostol price” indicate a strong interest in the accessibility, cost, and specific details of abortion pills. This highlights a need for clear and accessible information regarding abortion pills. 

Overview of Search Trends (June 2023 – May 2024)

The data provides monthly search volumes for the term “abortion pill” from June 2023 to May 2024. The search volume for “abortion pill” shows significant fluctuations over the year with periods of no recorded searches interspersed with notable spikes. The highest search volumes occurred in January 2024 and May 2024, both at 155. This may indicate significant interest or events related to the abortion pill during these months.

Misoprostol 

The data provides insight into related topics and searches that users look up alongside “Misoprostol.”  The related searches and topics emphasize the public’s need for accessible information about Misoprostol, its cost, and detailed usage instructions.  Topics like “signs and symptoms,” “uterus,” “cervical dilatation,” and “peptic” suggest a medical context, highlighting concerns related to the use of Misoprostol, its effects, and its applications. “Marie Stopes” also indicates an interest to access abortion services.   Searches like “Misoprostol pharmacy price,” “Abortion pill cost,” and “Mifepristone and misoprostol pills price” indicate strong interest in the cost and accessibility of Mifepristone and Misoprostol. “Misoprostol 200 mg uses” and “Misoprostol mechanism of action” show a demand for clear information on how to use abortion pills for safe abortions at home. 

Overview of Search Trends (June 2023 – May 2024)

The data provides monthly search volumes for the term “Misoprostol” from June 2023 to May 2024. The search volume for “Misoprostol” shows irregular fluctuations over the year with periods of zero recorded searches and intermittent spikes. The highest search volumes were in January 2024 and May 2024, both at 155. This indicates substantial interest or events related to Misoprostol during these months.  The spikes in January and May 2024 suggest increased public interest or specific events leading to heightened searches for Misoprostol. These may correlate with policy changes, public health campaigns, or media coverage.

The indices measuring the Nepali context showcase that the Global Gender Gap Index is at 0.692 (0 being gap and 1 being no gap), the Contraceptive Prevalence Rate is 53%, the Maternal Mortality Rate was found to be 151 per 100,000 live births, 16% of total abortions were found to be unsafe, but most unsafe abortions go unreported.

Unsafe abortion still stands as the third leading cause of all pregnancy-related maternal deaths in Nepal [3]. 

Abortion Access and Barriers

In a recent research, it was discovered that 44% of all abortion seekers were denied care despite being legally eligible for abortion [9]. People with lower socioeconomic status—including younger, less educated, and less wealthy individuals—were more likely to delay seeking an abortion, to be turned away, and to carry on with their pregnancy after being refused medical care. Although abortion services are “free,” most people are either unaware of these services or they are inaccessible. This, combined with  privacy concerns and low cost, results in a lot of abortion seekers turning to medical abortion pills easily sold over the counter at pharmacies.

Lack of awareness plays a significant role in the barriers faced by abortion seekers. A study done with 527 women presenting to hospitals with complications from induced abortions found that only 44% were aware that abortion was legal in Nepal, 68% of respondents induced abortion through medication, whereas 32% used an in-clinic method [5].

Despite an increase in the number of service providers trained in safe abortion services and being assigned to government-accredited facilities, these services are predominantly available only in urban and semi-urban areas. Additionally, a 2014 nationwide study found that only 38% of public facilities authorized to offer safe abortion services did so[13].

Nepal has formulated laws and policies that provide safe and easily accessible abortion services to the people; however, these laws are rarely implemented properly. A 2021 study found that staff at many public health facilities are unaware of reimbursement policies and have stopped providing medical abortion services due to a “lack of medical abortion drug supply.” Because fees for abortion services at private facilities are unregulated, they tend to be higher than elsewhere [14].  

Nepal has formulated laws and policies to provide safe and accessible abortion services; however, these laws are rarely implemented properly. A 2021 study found that staff at many public health facilities are unaware of reimbursement policies and have stopped providing medical abortion services due to a lack of medical abortion drug supply. Fees for abortion services at private facilities are unregulated and tend to be higher than elsewhere.

Multiple factors pose a hurdle to accessing sexual and reproductive healthcare services; these factors include the low status of women, especially in highly patriarchal societies, poverty, fear of isolation, socio-economic and sociocultural impacts of the caste system, etc. Even with the free services provided by the government in public settings, impoverished women – especially those living in rural and isolated areas – remain unable to access these services due to the high costs of transportation, accommodation, medication, and additional medical fees [6].

For ease of access, abortion seekers must be informed about the cost of abortion services and the availability of other care options, especially since public health centers provide these services for free. Research indicates that many women cannot obtain safe and authorized abortion services because they are unaware of the relevant laws, service locations, costs, and availability [12].

Unsafe abortion rates 

Taking the first steps to ensure sexual and reproductive health rights in 2002, Nepal amended its Penal Code to legalize abortion on specific grounds [15]. Before this amendment, Nepal’s maternal mortality ratio was 580 maternal deaths per 100,000 live births in 1995, but the legalization of abortion caused a drastic decline to 190 per 100,000 in 2013 [16]. Individuals having to resort to unsafe methods of abortion because they were highly restricted before this amendment was a significant factor contributing to high maternal mortality rates.

According to the WHO, in the first 12 weeks of pregnancy, abortion can be safely self-managed by the pregnant person outside a healthcare facility. [17] However, a study found that pharmacies in Nepal sold registered and unregistered medical abortion tablets along with drugs of unknown chemical composition. Because abortion pills are easily accessible, people seeking abortion go to pharmacies, use the pills without the right information, experience incomplete abortions or complications, and need to seek medical care.

Many individuals seek safe abortion only after undergoing incomplete abortions or complications through unsafe measures because of the lack of information [7]. Addressing these gaps is essential to ensure the safety and efficacy of self managed abortions in Nepal and reducing the incidence of avoidable complications associated with inadequate knowledge and support.

Sex-selective abortion 

Although it is strictly banned by law, sex-selective abortion is still a very prevalent issue in Nepal. It showcases people’s preference for sons, mostly from religious beliefs. A 2011 study revealed that 12 districts had significantly skewed birth sex ratios (110–127 males per 100 females). Before the 2011 population census, an estimated 22,540 girl births went missing during five years. Geographically, sex-selective abortion is concentrated, primarily in the Lumbini Province and the Bagmati Province; only 11 of Nepal’s 77 districts account for 53% of the country’s “missing girls” cases [18].

How did the pandemic influence abortion in Nepal

The COVID-19 pandemic significantly impacted sexual and reproductive health rights globally and in Nepal. Marie Stopes Nepal closed all 36 clinics at the beginning of the lockdown. However, they reopened 29 clinics at varying points before the authorities lifted the lockdown restrictions. There was a meaningful reduction in the number of weekly abortion care visits per clinic once clinics reopened as expected because of the lockdown restrictions. However, there was also a change in the sociodemographic status of clients seeking abortion care. There was a significant increase in the number of clients with tertiary or higher education and a considerable reduction in clients below the age of 20 [19]. This data highlights how the pandemic might have impacted the sexual and reproductive rights of marginalized communities.

Compared to the previous year, the amount of people seeking safe abortion services decreased by 34.4% during the lockdown [20].

Even though the healthcare system does have certain data, it is NGOs that provide the most critical information. However, in order to have a wider picture of the situation of abortion in Peru, investigation should also approach the following questions:

*This page presents abortion data only for women and girls since the information available is usually not separated by gender. However, AbortionData.org acknowledges this limitation.

[1] Abortion and unintended pregnancy in Nepal. (2022, August 24). Guttmacher Institute. https://www.guttmacher.org/fact-sheet/abortion-unintended-pregnancy-in-nepal

[2] Annual Report- 2076/77 (2019/20) – Department of Health Services. (2021, July 6). http://dohs.gov.np/annual-report-2076-77-2019-20/

[3] Warriner, I., Wang, D., Huong, N. M., Thapa, K., Tamang, A., Shah, I., Baird, D. T., & Meirik, O. (2011). Can midlevel health-care providers administer early medical abortion as safely and effectively as doctors? A randomised controlled equivalence trial in Nepal. The Lancet, 377(9772), 1155–1161. https://doi.org/10.1016/s0140-6736(10)62229-5

[4] Puri, M., Ingham, R., & Matthews, Z. (2007). Factors Affecting Abortion Decisions among Young Couples in Nepal. Journal of Adolescent Health, 40(6), 535–542. https://doi.org/10.1016/j.jadohealth.2007.01.010

[5] Rocca, C. H., Puri, M., Dulal, B. P., Bajracharya, L., Blum, M., & Henderson, J. (2013). Unsafe abortion after legalisation in Nepal: a cross‐sectional study of women presenting to hospitals. BJOG: An International Journal of Obstetrics and Gynaecology, 120(9), 1075–1084. https://doi.org/10.1111/1471-0528.12242

[6] Atreya, A., Adhikari, K., Nepal, S., Bhusal, M., Menezes, R. G., Shrestha, D. B., & Shrestha, D. (2024). Striving toward safe abortion services in Nepal: A review of barriers and facilitators. Health science reports, 7(2), e1877. https://doi.org/10.1002/hsr2.1877 

[7] Rogers, C., Sapkota, S., Tako, A. et al. Abortion in Nepal: perspectives of a cross-section of sexual and reproductive health and rights professionals. BMC Women’s Health 19, 40 (2019). https://doi.org/10.1186/s12905-019-0734-1 

[8] Safe Abortion Guideline | FAMILY WELFARE DIVISION. (n.d.). https://fwd.gov.np/cms/safe-abortion-guideline/

[9] Annual Report- 2076/77 (2019/20) – Department of Health Services. (2021, July 6). http://dohs.gov.np/annual-report-2076-77-2019-20/

[10] Rogers, C., Sapkota, S., Paudel, R., & Dantas, J. a. R. (2019). Medical abortion in Nepal: a qualitative study on women’s experiences at safe abortion services and pharmacies. Reproductive Health, 16(1). https://doi.org/10.1186/s12978-019-0755-0

[11] Access to quality abortion care for the health and rights of women and girls in Nepal. (2021, November 25). https://www.who.int/nepal/news/feature-stories/access-to-quality-abortion-care-for-the-health-and-rights-of-women-and-girls-in-nepal

[12] Puri, M., Singh, S., Sundaram, A., Hussain, R., Tamang, A., & Crowell, M. (2016). Abortion Incidence and Unintended Pregnancy in Nepal. International perspectives on sexual and reproductive health, 42(4), 197–209. https://doi.org/10.1363/42e2116 

[13] Singh, S., Sundaram, A., Hossain, A., Puri, M. C., Sathar, Z., Shekhar, C., Crowell, M., & Moore, A. M. (2020). Abortion service provision in South Asia: A comparative study of four countries. Contraception, 102(3), 210–219. https://doi.org/10.1016/j.contraception.2020.05.015

[14] Assessment of the impact of COVID-19 on functionality and utilization of RMNCAH services by clients in public sector health facilities of Nepal. (2021, November 15). UNFPA Nepal. https://nepal.unfpa.org/en/publications/assessment-impact-covid-19-functionality-and-utilization-rmncah-services-clients-public

[15] National Safe Abortion Policy-2002 | FAMILY WELFARE DIVISION. (n.d.). https://fwd.gov.np/cms/national-safe-abortion-policy-2002/ 

[16] World Health Organization (WHO) and World Bank. (2014). Trends in Maternal Mortality: 1990 to 2013, https://www.unfpa.org/sites/default/files/pub-pdf/9789241507226_eng.pdf

[17] World Health Organization (WHO) and Human Reproduction Programme (2022). WHO recommendations on self care interventions.

[18] Channon, M., Puri, M., Gietel‐Basten, S., Stone, L., & Channon, A. A. (2021). Prevalence and correlates of sex-selective abortions and missing girls in Nepal: evidence from the 2011 Population Census and 2016 Demographic and Health Survey. BMJ Open, 11(3), e042542. https://doi.org/10.1136/bmjopen-2020-042542

[19] Horan, C., Palmer, M., Shrestha, R., Erlank, C. P., & Church, K. (2022). The impact of COVID-19 lockdown on abortion care: a time series analysis of data from Marie Stopes Nepal. Sexual and reproductive health matters, 30(1), 2079185. https://doi.org/10.1080/26410397.2022.2079185

[20] Mishra, S., Rana, T., Adhikary, S. P., Paudel, S., & Sah, P. (2021). Impact of COVID-19 pandemic on safe abortion and family planning services at a tertiary care women’s hospital in Nepal. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(6), 2453. https://doi.org/10.18203/2320-1770.ijrcog20212192

Abortion in Nepal

• 1Abortion Rating
• 2Law & Abortion Rights
• 3Facts & Numbers
• 4Public Opinion
• 5Abortion Seekers
• 6Accessibility & Methods
• 7Online Abortion Searches
• 8Social & Cultural Context
• 9What we don't know
• 10Sources