A small, shy woman comes into our clinic in far-western Nepal. "What is your problem?" I ask her. "I am pregnant, but." she breaks off. I figure she wants to know whether she is pregnant or not. "No, she says, "I want you to help me to get rid of this." The health worker sitting next to me is shocked: "But, it's illegal. It's a crime."
The patient looks puzzled: isn't it true that the government has passed a new law now making abortion legal? The health worker says that's not true, where did she hear such a thing? Both looked at me.
I asked the patient how she new abortion was not illegal anymore. "I heard it on the radio," she replied. The patient knew, but this health worker in far western Nepal hadn't yet heard that parliament had, indeed, passed the law. At that time two months ago, it still needed the formal approval of the king.
Most of us health activists think that our work is done when we lobby to change the laws. We think that by addressing the legal aspects of the problem, somehow it will be solved. Alas, as with everything else in this country: it's not the law that is the problem but its implementation.
And in this case, it is that even health workers don't know when the law has been changed. What is the value of all our lobbying and activism in Kathmandu if doctors and health workers haven't heard of it yet? The other issue is that even though abortion may be legal, most health posts like the one I was in do not have the proper facilities for carrying out the operation.
The patient looked sad and worried, and slowly left the clinic. She probably went to a quack down the road, which is the reason why so many pregnant women die in this country because of unsafe abortions, and why the law needs to be passed.
We in Kathmandu think that if we know something, the whole country knows it as well. That is a wrong impression. We now know that even within Kathmandu, and even among professionals knowledge does not travel. And in many cases this lack of knowledge makes the difference between life and death.
A few weeks ago I was on Channel Nepal to discuss the new law on abortion. When we were asked the question, one of the panelists said with a straight face on camera: "According to the law a woman can have abortion only after her husband gives her permission." I was quite astonished by his ignorance, and I asked that this section of the tape be expunged because it was patently wrong.
Nepal is a good example of a country where persistent advocacy efforts by women's reproductive rights activists and strong support by research findings have significantly influenced the government to reforming the abortion law. The challenge now is to disseminate accurate information among health workers, lawyers, police as well as activists and cadre of political parties.
The medical profession is as much in the dark as any one else about the exact provisions of the new law. One male medical student recently asked me: "Don't you think that it would be inappropriate to give legal rights to women on the issue of abortion?" My response was that the rights had already been granted. The priority now was to make sure that the services are available in the district hospital.
From field experience so far of the medical sector, it will not be easy for the government to implement this law. We may soon see that private hospitals will start providing abortions at high cost, government hospitals in cities will also have the service, but a vast majority of rural areas will be left out. Legalising abortion does not ensure accessibility, nor affordability. Passing the law was only the first step.
(Dr Aruna Uprety is a women's health and reproductive rights activist.)