Public Education and Advocacy Against Unsafe Abortion Anand Tamang CREHPA

Public Education and Advocacy

Against Unsafe Abortion

Anand Tamang

CREHPA

Translating Research into Policy AdvocacyPublic Education and Advocacy Against Unsafe Abortion

Nepal has one of the highest maternal mortality (539 per 100,000 live births).

Over half of the maternal deaths are due to unsafe abortions.

Induced abortion is a criminal act in any circumstances, even in case of rape or incest.

Both women and service providers are punishable by imprisonment

ISSUES CONCERNING ABORTIONS


ISSUES CONCERNING ABORTIONS (Contd…)

Despite legal restrictions, every year thousands of induced abortions are performed illegally.

Nepal is the probably the only country in the world where women are incarcerated for abortion

Prevention and Management of complications of abortions is one of the eight components of National RH Strategy 1998 of Ministry of Health/Nepal


1. Determinants of Abortion and Subsequent Reproductive Behavior Among Women of Three Urban Districts of Nepal 1991-94 (Tamang, et al , IIDS)

2. Opinion Polls on Abortion Rights for Women. 1996

3. Induced Abortions and Subsequent Reproductive Behavior among Women in Urban Areas of Nepal, Nov. 1996 (Published paper)

RESEARCH ON ABORTIONSBetween 1991-2000, a number of abortion related research conducted and their results disseminated by CREHPA:


4. Factors Behind Women’s Imprisonment in Nepal with Special Reference to Women Imprisoned for Abortion, Sept. 1997-98

5. A Study on Implications of Restrictive Abortion Law on Women's Social Status and Health 1998 (Published Paper and Advocacy Paper in Nepali)

6. Knowledge and Perception of Rural Married Women on Abortions in Seven districts of Nepal. 1999

7.7. Perceptions on Safe & Unsafe abortions among frontline Perceptions on Safe & Unsafe abortions among frontline health providers and village opinion leaders in Eastern health providers and village opinion leaders in Eastern Development Region of Nepal. 1999Development Region of Nepal. 1999

RESEARCH ON ABORTIONS (Contd..)


8. Management of abortion related complication in hospitals of Nepal: A Situation Analysis. 2000

9. Unwanted Pregnancy, Sex Determination Tests and Abortion Seeking Behavior in Private Clinics of Nepal. 2000

10. Extent of Contraceptive Failure, Unwanted Pregnancy and Induced Abortions Among Married Couples in Kathmandu Valley. 2000 (Analysis on Progress)

11. Role of Private Pharmacist in Preventing Pregnancy related Complication Including Unsafe Abortions. 2000 (Analysis on Progress)

RESEARCH ON ABORTIONS (Contd..)


The large majority of the women are unaware of the legal status of abortion

The 1997 nationwide prison survey reveals that 80 women (20%) as against 14 men were imprisoned for charges of abortion or infanticide (CREHPA, 2000).

20% and 60% of all obs & gyne admissions in six major hospitals are abortion complication cases.

KEY ISSUES EMERGED FROM RESEARCH


Women with abortion complications occupy hospital beds for about 3 days to over 7 days and spend on an average Rs. 3,918 for treatment.

Most women resorting to unsafe abortion procedures were unaware about the possible health risks of the act.

Majority of the government hospitals lack sufficient manpower, equipment, space, beds, etc., to deal with abortion related complications.

KEY ISSUES EMERGED FROM RESEARCH (Contd…)


FELT NEEDS

Advocacy for Legalizing abortion Advocacy for Legalizing abortion Education about health implications of Unsafe Education about health implications of Unsafe

abortionsabortions Enhancement of providers' skills and services at Enhancement of providers' skills and services at

government hospitals to deal with abortion government hospitals to deal with abortion complicationscomplications

Discouragement of abortion services by Discouragement of abortion services by

Unqualified personsUnqualified persons Periodic updates of abortion dataPeriodic updates of abortion data


Planning and strategies development workshop Planning and strategies development workshop organized in October 1998 to initiate organized in October 1998 to initiate PUBLIC PUBLIC EDUCATION AND ADVOCACY PROGRAMEDUCATION AND ADVOCACY PROGRAM (PEAP) (PEAP)

Purpose:Purpose:

STRATEGIES DESIGN & NETWORKING

To develop appropriate advocacy messages and slogan

To develop logo for PEAP

To develop non-threatening messages

To identify the medium for disseminating advocacy messages

Networking with Ministry of Health (MOH)


To identify and analyze strengths and weakness To identify and analyze strengths and weakness of district level NGOs and explore the ways and of district level NGOs and explore the ways and means of empowering them under PEAPmeans of empowering them under PEAP

To plan appropriate supervision and monitoring To plan appropriate supervision and monitoring mechanism for PEAPmechanism for PEAP

To prepare suitable strategies for reopening To prepare suitable strategies for reopening policy dialogue with law makers at district and policy dialogue with law makers at district and central levelscentral levels

STRATEGIES DESIGN & NETWORKING (Contd…)


ActionEvaluation

Situation Analysis Strategies

Mobilization

Continuity/

Expansion

PEAP

THE FRAMEWORK


"Do not rely on unqualified Persons "Do not rely on unqualified Persons Do not resort to unsafe abortions"Do not resort to unsafe abortions"

"Unsafe abortions can claim women's lives"Unsafe abortions can claim women's livesAbortion is not a method of family planning"Abortion is not a method of family planning"

"Unsafe Abortion may put women's lives at risk"."Unsafe Abortion may put women's lives at risk".

"Healthy life of mother and child, "Healthy life of mother and child, Use methods of family planning,Use methods of family planning,Avoid Unsafe Abortions"Avoid Unsafe Abortions"

ACTION : Slogans & Text Messages Developed Appropriate non threatening advocacy messages and slogans developed in Nepali:


ACTION: Medium of Communication & Dissemination Identified

Printed

Communication & Dissemination Media

Press Electronic Community

- Posters

- Brochures

- Banners

- Policy Briefs- Advocacy Papers - Photo story- Articles- Advertisement

- Press Conference

- Journalists Forum

- Radio Program

- Web-site

- Advocacy workshops

- Educational Workshop

- Street Drama

- NGO Empowerment


ADVOCACY STRATEGIES: Media Coverage


Target Audience for PEAP

Advocacy

- Parliamentarians

- Political Parties

- Policy Makers/ Administrators

- Lawyers

- Women Associations

- Journalists

- NGO/INGOs

Education

- Women Groups

- Social Workers

- Community Health Providers

- Pharmacists

- Community Leaders

- School Teachers / High School Students


Technical advisory committee with representatives from NHEICC/MOH formed for IEC development

Formal launching of the posters and brochures by representatives from NHEICC/MOH

ACTION: MOH Involved From the Start


More District level NGOs identified and trained

District level advocacy workshop held by partner NGOs

Village level PEAP activities launched by partner NGOs

Demand created for replication of the program

Formation of Network : SMHEAN (Safe Maternal Health Education and Advocacy Network)

ACTION & OUTCOMES OF PEAP-I


INFLUENCING POLICY INFLUENCING POLICY

Acceptance and ownership of the IEC materials (Posters) on abortions by MOH

Inclusion of PEAP related strategies in government's 15 years health plan

District Health office (MOH) demand orientation training for TBAs against unsafe abortions

Formation of seven member committee (with the inclusion of CREHPA) by MOH for advocacy towards legalization of abortion (submission of a separate abortion bill by MOH)


LESSONS ResearchResearch is key to influence Opinion & Policy. is key to influence Opinion & Policy. Since abortion is highly divisive issue, Since abortion is highly divisive issue,

sensitizationsensitization should start from the top. should start from the top. Wide range of Wide range of Approaches Approaches needed. needed. Cost-effective Cost-effective yet expensiveyet expensive Concerned Concerned Policy Makers' involvementPolicy Makers' involvement required required

from planning stagefrom planning stage

CredibilityCredibility of the organization of the organization CreativityCreativity & & ContinuityContinuity Necessary Necessary


Thank YouUniversity of Southampton

&John Snow International, UK

Documents

Public Education and Advocacy Against Unsafe Abortion Anand Tamang CREHPA