Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care

Nepal is a poor country whose rugged terrain and political unrest exacerbate the significant challenges of providing health care to its population of about 28 million. Until recently, Nepal reported one of the highest maternal mortality ratios in the world, with a significant proportion of maternal deaths and injuries attributable to unsafe abortion. In March 2002, responding to public health and human rights imperatives, the Nepali Parliament passed landmark legislation to reverse its archaic abortion law. For the first time in the country's modern history, the government granted women legal access to abortion. Under the new policy, which went into effect in 2003, women are permitted abortion for up to 12 weeks of gestation on request and under certain medical/legal conditions thereafter (see below) [1].Pregnancy termination is available under these circumstances:？ Up to 12 weeks gestation for any indication, by request？ Up to 18 weeks gestation in the case of rape or incest？ At any time during pregnancy if mental/physical health or life of the pregnant woman is at risk (approval from a medical practitioner required)？ At any time during pregnancy if the fetus is deformed and incompatible with life (approval from a medical practitioner required)Additional considerations:？ Only providers certified in safe abortion care are eligible to provide induced abortion services;？ The pregnant woman alone has the right to choose to continue or discontinue pregnancy？ In the case of minors (< 16 yrs of age) or mental incompetence, a legal guardian must give consent？ Pregnancy termination on the basis of sex selection is prohibitedThis significant policy change followed an intensive period of advocacy and rigorous planning for implementation of safe legal abortion services. The scope and speed of abortion services scale-up in Nepal--in an extremely challenging geographic, political and economic environment--engaged multiple stakeholders from a variety of sectors in a well-coordina