1 in 2 pregnancies in Nepal unintended

Over 600,000 pregnancies in Nepal in 2017 were unintended, close to two-third of which ended in abortion, reveals a new report released this week by the UNFPA, the United Nations sexual and reproductive health agency aimed at shedding light on the often neglected health crisis affecting women of reproductive age worldwide.

The State of World Population 2022 report titled Seeing the Unseen also estimated that nearly half of all global pregnancies, totalling 121 million each year, are unintended and that 'for the women and girls affected, the most life-altering reproductive choice — whether or not to become pregnant — is no choice at all.'

“This report is a wakeup call. The staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights,” says UNFPA Executive Director Natalia Kanem. “Our report reveals that rates of unintended pregnancy strongly correlate with gender inequality, with lower socioeconomic development, and with more restrictions on sexual and reproductive rights.”

The report further states that over 60% of unintended pregnancies end in abortion and an estimated 45% of all abortions are unsafe, responsible for 5-13% of all maternal deaths. After taking dramatic strides to reduce maternal mortality rate from 539 per 100,000 live births to 239 between 1996 to 2016, Nepal’s progress has since stagnated, further affected by the pandemic in the last two years.

Some 44% of Nepali women of reproductive age who want to avoid pregnancy do not use any contraceptive methods. Similarly, use of modern methods of birth control among married women of reproductive age stands at 43%, leading to high rates of unintended pregnancy and unsafe abortion, while 50% of those who do use contraceptives discontinue within a year. Prevalent gender norms that prevent women and girls from accessing reproductive health care including contraceptives have been identified as a key factor.

In addition, half of all pregnancies among adolescents are estimated to be unintended, as only 23% in the group are reported to use contraceptives -- much lower compared to the national average of 43%.

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The report further states that for every additional dollar spent on expanding modern contraceptive use, Nepal would save $2 on maternal and newborn care as a result of fewer unintended births, induced abortions and maternal deaths.

"The perception among some policy makers that investing in family planning is no longer necessary due to the decline is fertility in Nepal is very concerning," says Lubna Baqi, UNFPA Country Representative, "as it does not take into account the high levels of unmet need for family planning, which currently stands at 24%, and the high rates of unintended pregnancies, and unsafe abortions that take place because of the gaps in services.”

Women and girls from minority groups face further challenges and discrimination in accessing services and information. Given that child marriage is still prevalent in Nepal with nearly 41% of adolescents married before 18, adolescent girls are at a higher risk.

Abortion services on the other hand are largely unsafe. Despite being legalised in 2002, majority of abortions continue to be conducted by untrained personnel or induced by pregnant women themselves. On top of this, most women and girls face structural and informal hindrances barring them from safe services.

The report urges decision-makers and health systems to improve accessibility, acceptability, quality and variety of contraception methods to reduce unwanted pregnancies by expanding sexual and reproductive health care and public awareness. Equally crucial is to empower women and girls to make their own decisions in the matters of sex, contraception and motherhood.

Says Baqui: “Contraceptives save lives and it is high time the Nepal government allocated the necessary financing to fulfil this fundamental human right."

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