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Maya Thakuri was three months pregnant. Her husband, Jay Ram Thakuri, was worried that this was complicating his relationship with his first wife.

So, he had been shopping around. He chose Manakamana Medical Hall in Koteswor where the fee was Rs 5,000-considerably less than other pharmacies. When she was taken in, Maya was unaware her husband was getting her an abortion.

According to legal depositions at the Kathmandu District Court, Guna Raj Awasthi performed the operation. Soon after, Maya started having severe abdominal pains, vomited and her blood pressure dropped alarmingly. She was rushed to Teaching Hospital, but died on the way. The post-mortem result showed probable cause was 'amniotic fluid embolism', essentially a botched abortion.

Awasthi and two nurses from the clinic were sued by Maya's brother and were detained, but are now out on bail. The doctor and his staff deny that they performed an abortion on Maya, saying she had come for a check-up and died from a spontaneous abortion.

Maya Thakuri died three months before the cabinet in January passed a directive laying out terms and conditions under which hospitals can perform abortions. This follows up on a two-year-old law that makes abortions legal in certain situations. Under the new directive, only registered medical institutions and doctors with valid licenses can perform abortions, which can only be done with the woman's consent, and only if the foetus is less than 12 weeks old. In cases of incest and rape, abortions are allowed up to 18 weeks.

But till the directives are finalised, the regulations enforced and the law followed, women's rights activists say, there will be more unnecessary deaths of women like Maya in under-equipped and clandestine clinics.

When Sabina Shakya became pregnant for the third time after having two daughters, her ultrasound showed the baby was also a girl. She came to a clinic in Patan known for secretly performing abortions. The doctor told her that ultrasound sex-selection was unreliable, but said he could perform a DNA test to find out. When we spoke to her, Sabina was unaware that she would be breaking the law if she went through with a sex-selective abortion.

Aside from a lack of awareness among women about the new law, abortion is also a class issue. Urban-based women have always had access to safe abortion, without the fear of criminal sanction. And because they can afford it, they get discrete and safe medical attention. Poorer mothers, burdened by previous girl children or husbands who force them to have unsafe abortions do not have a choice. That is when abortions become a life-and-death issue not just for the foetus, but also for the mother. Although specialists say sex-selective abortions are not as common in Nepal as in China or India, it is a growing phenomenon and could be one of the unforeseen consequences of partial legalisation of abortion without proper guidelines and enforcement.

"It is the duty of the medical community and practitioners to lay down the ground rules and follow them," says Bhola Rijal, a maternal health doctor. "A good law is not enough, we need it to be implemented with a strict code of ethics." He says some unethical doctors are earning money by claiming they can tell the sex of a child even within a few weeks of pregnancy. Ultimately, Rijal admits, sex preference for boys is more difficult to change and can only happen with a transformation in societal values.

Sapana Pradhan Malla has been trying to provide legal assistance to women convicted of abortion who are in jail. Most of the 35 women currently serving sentences are poor and illiterate. Men are rarely charged even though they coerced women into having abortions. "The only way we can address this problem is by raising the status of Nepali women with literacy and awareness, boosting their self-esteem and empowering them," says Malla.

But such behaviour change will take time. What can be done till then? For now, activists like Malla want all the women in jail for abortion to be released, and for the regulations in hospitals to be passed urgently so more women do not lose their lives in unsafe and underground clinics. "Women don't have the negotiating power to have a child, have no access to family planning, they are compelled to give birth or terminate a pregnancy and when they do have a child, they don't even have the power to confer it Nepali citizenship," Malla says.

Maili Magar was 14 when she was raped by a co-worker in a restaurant in the Valley. She was so young, she didn't even know she was pregnant. She started falling sick so decided to go home to her family in Dhading. There, she had a miscarriage. But the neighbours complained to the police that she had killed her baby after it was born. She was sentenced to six months in jail for infanticide. After spending three years and seven months in detention, she was released in Feburary 2003 with help from the Rural Women's Development and Unity Centre. She is now living at the centre's rehabilitation unit where she is getting skills training. For the first time in her young life, Maili is optimistic about her future.

"Imprisoned women have suffered injustice and need help to get back into society," says Sambhu Jung Rana at the centre. Despite her suffering, Maili is luckier than most. For thousands of other women who will be forced to have unsafe abortions, the government's new rules and medical directives will be meaningless unless they are shown to work.

More importantly, Nepali society also has to change and treat its women better.

Some of the names of the women in this article have been changed.

(11 JAN 2013 - 17 JAN 2013)