Persistent advocacy efforts by women's reproductive rights activists and strong research findings eventually convinced the government to reform Nepal's abortion laws two years ago.
The challenges in coming years will be a very different: disseminating information about the new law and about safe abortion to doctors, health workers, advocates, law enforcement officials and politicians. We have taken one giant leap toward saving thousands of women from unsafe abortion in Nepal each year, but many more little steps still need to be taken to begin improving the maternal mortality crisis in Nepal. (See: 'Double loading', #184)
As long as young Nepali mothers don't have access to adequate nutrition, basic health services, minimum supplies of cotton wool and IV fluids in far-flung health posts, bills passed in Kathmandu will have little impact. While the Ministry of Health takes its time to draw criteria for abortions in hospitals, illegal abortions in hospitals, and unsafe and costly operations by private providers continue.
It was late in the afternoon at a rural health camp in western Nepal last year when a woman came in hesitantly. She looked uncomfortable and unsure. I was used to this, most women have never spoken about their intimate health problems with anyone. "I am pregnant," she told the nurse, who asked her if she wanted to make sure.
"No," said the woman, more loudly this time and meeting the health worker's eyes. "I want you to help me get rid of it."
The nurse explained that it was illegal. The woman turned to me and said: "But I heard that the government passed a law saying abortions could be done in hospitals."
"That is definitely not true," the health worker told her abruptly. The woman looked crestfallen. For a moment I was unsure who to deal with first, the patient or the health worker.
"I heard it on the radio," the woman said. "Isn't it true?" I told her she was partly right. "Parliament has passed the bill, but it still needs the king's approval. It is a formality, but we can't legally perform abortions until then."
She was downcast as she left the clinic without another word. The sadness in her eyes haunted me and I hoped that she wouldn't seek some illegal and untrained quack to terminate her pregnancy and put her life in danger.
The nurse turned to me once we were alone: "We health workers don't know anything about making abortion legal. We knew there was a discussion going on in Kathmandu, but no one ever told us the law was passed."
Having worked for more than a decade as a reproductive rights activist, researching, writing and lobbying the government to have abortion legalised, I believed we had made an enormous impact when parliament passed the bill. But if my co-worker in this clinic in western Nepal hasn't even heard of the bill, what was the value of our work? At the rate we are going it will take another 50 years for the bill to make an impact on our maternal death rate. What had seemed an enormous step suddenly seemed frighteningly small. Little did I realise when I told the woman that we still had a long way to go, how long we really had to travel.