Seeking change – taking charge of their bodies

Women and girls should have autonomy over their bodies

On Friday, March 1st, ‘She Decides Day’ will be held in Nepal. She Decides is an international movement that was sparked in response to the Global Gag Rule. The message is clear: Women’s should have complete autonomy over their own bodies. And that governments should respect, recognise, and reaffirm women’s autonomy and agency in doing so. The movement aims to bring change through action in communities, with young people at its heart.

Sexual and reproductive rights comprise of rights and fundamental freedoms about our bodies—the most personal realm each one of us possesses. Amongst these rights, the right to safe abortion remains the most heavily contested and the most frequently limited right—across nations, cultures, and religions. Estimates of the incidence of unsafe abortion and the percentage of maternal deaths attributed to unsafe abortion continue to be high in the Asia-Pacific region. In most parts of the Asia-Pacific, the majority of young abortion seekers are unmarried. The regional abortion rate is roughly 24 per 1,000 for unmarried women. The incidence of pregnancies among unmarried teenagers is on the rise in this sub-region, especially in urban areas. The rate of abortion is estimated to be 36 per 1,000 for married women. In South Asia, almost half (45%) of all women aged 20-24 years reported being married before the age of 18. Almost one in five girls (17%) are married before the age of 15. Most unwanted pregnancies occur within marriage in the context of delaying a first birth or spacing a subsequent one.

Although access to safe abortion services has been proven to be linked to a lower incidence of unsafe abortion (and lower percentages of maternal deaths due to unsafe abortion), progress on amending laws seems slow. Where abortion laws are restrictive, it is important to look at how women’s NGOs are working to amend these laws as clearly mentioned in the Beijing Platform for Action. In countries such as Lao PDR, the Philippines, Indonesia, Bangladesh and Pakistan, legal barriers continue to curb women’s access to abortion, because there can be no services without laws. It is also useful to note that abortion services for women are being provided safely through the private sector (Malaysia and Thailand), through the family-planning methods of menstrual regulation (Bangladesh) and through private provision of medical abortion (South-East Asia).

Taking charge of their bodies

The right to safe abortion is a highly intersectional issue that simultaneously cuts across  gender equality, bodily integrity, and personal liberty. According to Nancy Northup from the Centre of Reproductive Rights, it cannot be perceived as a separate right detached on its own, but as one that helps define and clarify all other rights and contributes to the overall framework on sexual and reproductive autonomy of individuals. The denial of safe abortion services inflicts death, disability, and psychological trauma only on girls, women, and biological females. Forced pregnancy by the state denies girls and women the right to decide how many children to have, if at all, and when to have them. The state then vests its authority in deciding which pregnancies should be carried to term, and which need not be; which groups of women and girls, and for what particular reasons, may procure safe abortion services and which groups may not. Ultimately, this imposed authority over the bodies of women and girls violates personal decision-making on individual reproduction.

Nepal enabled these rights when abortion was legalised in March 2002 under the 11th Amendment of  the Civil Code. Prior to this, abortion was illegal, women who miscarried or aborted were imprisoned. The change in law indicated a major shift in perspectives on gender equality, especially the fundamental right for women to take control over their bodies, including their own fertility.

Although abortions had been made legal, several barriers for women to access these services persist. In 2009, Lakshmi Devi Dhikta, a poor, rural woman, who already had five children, was forced to continue an unwanted pregnancy. She was denied abortion services as she could not afford the fee. The Lakshmi Dhikta v. Nepal case served as a watershed moment for reproductive rights in Nepal. The court emphasised that abortion was a woman’s human right. The court ordered the government to reduce the financial burden associated with reproductive healthcare and held the government accountable for ensuring affordable and accessible abortion services.

After this landmark case, the government embarked on a process of drafting a separate piece of legislation: the Bill on Safe Abortion Services 2014. Moreover, a Safe Abortion Service Program Guideline was endorsed in 2016 including the provision of free abortion services at all the government facilities. In 2018, after ten years of negotiations, the Safe Motherhood and Reproductive Health Rights Act was passed. Under the new law, abortion is permitted with the consent of pregnant women for up to twelve weeks of gestation. Abortion is permitted for up to 28 weeks of gestation in cases of rape or incest, if the woman is HIV positive or has an incurable disease, in cases of foetal malformation, and to save the life of a woman.

In Nepal’s scenario, where the legal framework enables and empowers women to access safe abortion, the last frontier is tackling abortion stigma. ARROW’s ongoing research on safe abortion in Nepal with our partner Beyond Beijing Committee, endeavours to uncover the role of abortion stigma. Initial findings indicate that stigma leads women to seek unsafe abortions or continue with an unintended or unwanted pregnancy. The study posits that though abortion is legal and services are available, many women have little awareness of the exact parameters of these legal conditions. When unaware, this also creates a fear of consequences. Ultimately, a prevailing lack of awareness over legalisation helps spearhead the stigma around abortion.

Abortion stigma is derived and strengthened by different variables and perceptions coming from society, service providers, community, and family members—as well as from ourselves. Stigmatisation by definition is related to the ‘disgrace of an individual through a particular attribute he or she holds in violation of social expectations.’

The earlier research conducted by Beyond Beijing Committee in 2015, indicated that 62 percent of the study’s respondents’ believe that abortion is a ‘wrong’ concept. In many patriarchal societies, women also bear the burden of protecting the family honour and are judged as being a discredit to their families. Women must negotiate these judgments in both formal and informal spaces.

Changing mindset

Stigma is contextual. For example, within the frame of marital contexts, the need for abortion is relatively detached from the perceived ‘promiscuity’ of women. But these labels and the stigma faced by women are relatively more prominent in cases that are related to premarital sex. Abortion with the consent of spouses and family members is also less stigmatising. Unmarried women and adolescent girls face greater stigma because they are seen as misusing the services and claiming these services from those who (much of society believes) should have primary access: married women. The initial findings show that abortion, as a woman’s choice, still carries far more stigma than if it is procured based on conditionality (for reasons of rape, incest). Multiple abortions are also more stigmatising, signalling the use of abortion as a method of family planning. But this perception does not take into consideration whether these women had access to quality contraception and a method of choice or if they were victims of violence within their own families.

Young people have a right to learn about pregnancy choices and abortions, and to learn about them before they have to go through pregnancy themselves. Furthemore, although it will be girls and young women who make the final decision, boys and young men should also be educated on this. Hence there is a great deal of work that needs to be done to create the acceptance that abortion is a normal, medical procedure that women and girls have the right to seek regardless of their status. And for us, as women, to trust in our own judgment, and know it is our right to seek an abortion.

Just as the gains in safe abortion laws have cascaded and created an enabling environment for gender equality overall, the gains that can be made with eradicating abortion stigma can also help topple age-old beliefs on the roles and status of women in society.

Changing mindsets is more difficult that changing laws, which is why it is absolutely critical that we respect, recognise, and reaffirm the sexual and reproductive autonomy of women and girls. Every single time. Without exception.