It is hypocritical of the United States, the supposed champion of democracy, to impose the Global Gag Rule on other countries, when it could not impose this in its own country. In my view, the Global Gag Rule inappropriately seeks to influence Nepal’s democratic process. We are struggling to decide how to deal with restrictive legal provisions that have led to the death, disability and imprisonment of thousands of women. Reproductive health non-governmental organizations (NGOs), like CREHPA and many others, are crucial contributors to this process, as we are the ones providing health services or research.

The Global Gag Rule could [ ] severely impact our government’s health policies – including its new safe motherhood policy...

My organization, CREHPA, has made the difficult decision not to certify to the Global Gag Rule, as we feel that advocating and providing research on the impact of our abortion laws is crucial. Yet we understand our NGO colleagues that have made the opposite decision, not wanting to disrupt their work providing services to thousands of low-income women. NGOs we have worked with that have accepted U.S. funds are now being forced into silence.

The Global Gag Rule could also severely impact our government’s health policies – including its new safe motherhood policy (which comprises numerous strategies to address unsafe abortion, including public education) and its efforts to legalize abortion. The Global Gag Rule will have a "chilling effect" as it will discourage NGOs receiving U.S. funds from assisting the Nepalese Ministry of Health (MOH) in Safe Motherhood activities, such as public education and advocacy on the proposed abortion law changes, that will help prevent unsafe abortions in Nepal. These organizations, in turn, will refrain from providing any support to NGOs like mine willing to complement MOH advocacy and public education activities against unsafe abortions. Some NGOs would like to volunteer to provide safe abortion services in their clinics once abortion is legalized to help avert the tragic deaths we see everyday. Many of those organizations are being forbidden by the Global Gag Rule from doing so.

While working as a domestic servant, Indu Kamat (widow and mother of four children) was impregnated by a man who promised to marry her. When he learned of the pregnancy, he gave her medication to expel the fetus. Indu confided in a friend about the abortion, who then informed the community. She was arrested and sentenced to life imprisonment. Her male partner bribed police while in custody and was released without charge.*

There are many tragic stories of the desperate lengths to which low-income women go to end an unwanted pregnancy, despite abortion's illegal status. Women and untrained providers use unsafe methods such as inserting sticks, catheters, powdered glass, herbal mixtures, lemon juice or cow dung into the uterus, taking large doses of contraceptive pills or otherwise physically harming themselves to induce abortion. In one recent case, a stick used to induce an abortion punctured the wall of a woman’s uterus and intestines. She died of gangrene.

Background on Nepal

• Nepal has one of the highest maternal mortality rates (539/100,000) in the world (as compared to 7 in 100,000 in the U.S.). Unsafe abortion accounts for more than half of all maternal deaths.
• Despite over three decades of national family planning programs, less than a third (29%) of married couples in Nepal use contraception. Consequently, the unmet need for family planning is high, as are unintended pregnancies among married women. Over a third of unintended pregnancies, and more than half of those due to contraceptive failure, end in induced abortions.
• Abortion is a crime, even in cases of rape or incest, punishable by imprisonment for both the woman and the abortion provider. In fact, CREHPA’s 1997 nationwide prison study* revealed that 20% of incarcerated women have been charged with abortion and infanticide. Legal restrictions do not prevent abortion. They prevent women, particularly rural and poor women, from accessing safe abortion services at low costs, forcing them to end unintended pregnancies under clandestine and unsafe conditions.
• Hospital-based studies show that between 20-60% of all women admitted to obstetric and gynecological wards are suffering complications from unsafe abortion. Most are admitted in critical condition, requiring blood transfusions and lengthy hospital stays. Post-abortion care drains Nepal’s finite health resources and comes at high financial costs to the women.
• The MOH has recently committed itself to preventing unsafe abortion practices. Its recent safe motherhood policy strongly recommends legalizing abortion to save women from death and chronic disability due to unsafe abortions.
• At a recent high-level ministerial meeting, the ministers supported the possibility of the MOH introducing a bill in the Nepalese Parliament to legalize abortion. An expert working groups was formed by MOH to prepare advocacy packages to influence law makers to pass the Civil Code Amendment Bill on women’s rights (pending in the parliament since 1997) which would also legalize abortion on certain grounds.
• Various public opinion polls and surveys conducted by CREHPA and other organizations show that Nepalese people from all cross-sections of society are in favor of legalizing abortion.