The PHD Group successfully completed this qualitative research for the Family Planning Association of Nepal (FPAN). Since legalization of abortion in March 2002 and provision of counselling and services since 2004, a large number of first trimester abortions have been performed by government, private and NGO clinics including FPAN. FPAN is providing counselling and safe abortion services since 2004 and its share in national programme in safe abortion is about 10 percent.
Although in recent years maternal mortality has declined from 539 MMR in 1996 to 281 in 2006, still low level of awareness among community people about safe abortion, limited availability of safe abortion services in the country and impact of unsafe abortion on health are major factors leading to high maternal mortality and morbidity in Nepal. Most Nepalese are Hindus and Hindu as well as other religions abhor abortion practices. Hinduism places a high value on female fertility and at the same time seeks to rigidly control female sexuality, which shows strict prohibitions against abortion and these types of myths and misconception still exist in the community. This study was carried out with the view to understand myths and misconception about abortion. Information on knowledge, attitude and practices among marginalized, underserved community people towards myths and misconception on abortion in Nepal was collected.
The methodology of the study included review of relevant literature, some secondary data analysis and primary data collection using qualitative techniques mainly FGDs and in-depth interviews with target populations. In all 13 FGDs were conducted in FPAN Global Comprehensive Abortion Care Project (GCACP) six districts (Kailali, Kanchanpur, Banke, Palpa, Sarlahi and Ilam). FGDs were conducted with female sex workers, women living with HIV, women in ethnic minority, poor women in urban slum, poor rural women, housewives and NGO/CBOs staff. In addition, in the same districts in-depth interviews with people with different walks of life were conducted. The IDI participants included NGO/CBO staff/service providers, trained birth attendants, traditional birth attendants, female community health volunteers, private chemists and druggists, community leaders (male), community leaders (females), school teachers, religious teachers, political leaders, lawyers, police, married youth, married adolescents, unmarried youth and unmarried adolescents.
The local terms used for abortion in Eastern hill region is “bachchafalne” or “getting rid of child in the womb” or it is called “khulaune” or “opening” too. Educated women call abortion as “garvapatan” or they also use the English word “curette”. In BahunChhetri community they also use the term “bhrunhatya” or “killing of foetus” or “garvatuhaune” for abortion. In KailaliBahunChhetri community they use the term “bachchanikalne” or taking out the baby from the womb. In Kanchanpur, “tuhaunu” (expelling) or “adhigrophalne” (getting rid of foetus or “safaigarne” (cleaning) are also used to denote abortion.
Central Terai people call abortion as “bachchagiraibachhai”. In Western Terai Tharu community they use the term “bachchagirachh” for abortion. The Muslim community use the term “bachchagirawe” or “get rid of child in the womb” or “bachchasaphai” meaning cleaning of womb. Tharus of Kailali use the term “bachchamarana” or killing of baby in the womb or “bachchakhasaune” or dropping of baby. In Muslim community of Banke “bachchagiraye” or “bachchasafaigarne” or “bachchagiraune” terms are used to denote abortion.
Overall, women do not like to have abortion at home; they prefer to go to a health facility for safe abortion. All women participating in six different FGDs said women seek abortion service away from home because at a health facility it is safe and privacy is maintained. They say aborting at home is an old way; most women go to a government listed health facility for abortion because it is safe, counselling is given and privacy is maintained.
Drawing upon the findings of the study the following myths and misconceptions are listed.
Having an abortion is as safe as undergoing a minor surgery.This is false because possible physical consequences include but are not limited to: a) Infection; b) Infertility (damage to the uterus resulting in infertility; inability to carry subsequent pregnancies to term after multiple abortions); c) Miscarriage in subsequent pregnancies; d) Breast cancer; e) Mutilation (Perforation of the bowel) and f)Death (due to excessive bleeding/haemorrhage)
Other misconceptions about abortion were 1) Abortion solves the problem of an unplanned or unwanted pregnancy; 2) Abortion solves the problem of rape; 3) Abortion solves the problem of incest; 4) Abortion only affects the mother of the baby; 5) Abortion is a sin; 6) Kupindo (a type of pumpkin) causes abortion; 7) Kachosindhur (red vermilion) causes abortion; 8). Taking gagat (a kind of bean) causes abortion; 9) Taking gur (sugarcane molasses) causes abortion; 10) Taking aanpkoamilo (sour mango), sour stuff along with powdered ginger cause abortion; 11) Abortion helps couples to get rid of additional girls in the family; 12) Abortion is an alternative to contraception for couples who have achieved desired family size and 13) Abortion helps to achieve small family size and thus help escape poverty.