In early May, a 28-year-old woman was brought to Thapathali’s Paropakar Maternity Hospital in a critical condition. She had attempted to use what is colloquially known as a ‘medical abortion kit’—a series of pills that will abort a pregnancy after nine weeks—and was bleeding profusely.

“She was brought to our hospital in a life-threatening condition,” Suku Lama, in charge of the post-abortion unit, told the Post. “We transfused several pints of blood to save her.”

According to Lama, this was the second time in 18 months that the woman, from Tokha municipality in Kathmandu, had used an abortion kit to get rid of an unwanted pregnancy. When hospital staff asked her why she had used abortion kits so frequently, instead of other easily available contraceptives, she replied that her husband didn’t like to use condoms since he didn’t get much pleasure from sex. He had also forbidden her from using other means of contraception, like the Copper-T, an intrauterine device, as it apparently ‘poked’ him.

“When I expressed worries of getting pregnant, my husband said that he would buy me an abortion kit,” Lama recalled the woman telling her.

Even as safe medical abortions are being contested globally as emblematic of women’s rights to reproductive health and bodily autonomy, in Kathmandu, men are increasingly refusing to use other means of contraception and forcing their wives to undergo abortions.

About 50 such cases of complications resulting from the frequent use of medical abortion pills are seen every month at the Maternity Hospital’s post-abortion unit, said Lama. In the Nepali month of Baishakh, the hospital recorded 48 such cases, she said. In most of these cases, the husband refused to use condoms, relying on the easily available pills to abort pregnancies.

The frequent use of such medical abortion pills—and the emergency contraceptive, or ‘morning after’ pill—can have serious health consequences, said Dr Punya Poudel, focal person for the Safe Motherhood Programme at the Family Welfare Division of the Department of Health Services. Emergency pills are used after having unsafe sex to prevent pregnancies while medical abortion kits are used after getting pregnant.

Last month, a 32-year-old woman from Bhaktapur arrived at the Maternity Hospital’s emergency unit after an abortion kit failed to abort her foetus completely. Nurses were concerned after seeing a number of bruises on her thighs and other parts of the body. The woman reported that her husband would get violent if she refused to have sex with him, and would refuse to use condom.

The woman had already had two children and did not want a third, so her family had suggested that she take abortion pills. But this time, the pills did not work as intended, resulting in her hospitalisation.

The police were called, said Lama, and the hospital advised the woman to call the local women’s group or the police if he got violent with her again. 

Although data on the number of abortions or abortion-related complications are difficult to come by, the Department of Health Services is aware of the issue and is concerned, said Kabita Aryal, chief of the family planning and reproductive health at the Family Welfare Division. 

Abortions were legalised in Nepal in 2002, a milestone for women’s reproductive rights, their empowerment, and their right to bodily autonomy. With legalisation, persecution and jail terms for women who terminated unwanted pregnancies stopped and unsafe abortions decreased dramatically. Between 1996 and 2016, the maternal mortality rate fell from 539 to 239, achieving the Millennium Development Goal—a feat for which the legalisation of abortions played a significant role, doctors say.

But the frequency of such cases at the Maternity Hospital raises questions over whether women are undergoing abortions out of choice or are being compelled to because their husbands prefer pills over condoms and other means of contraception. 

“In my experience, even educated women residing in the cities have difficulties saying no to their husbands,” Dr Kiran Regmi, a former health secretary and consulting gynaecologist, told the Post. “We have legalised abortion but have failed to launch a awareness campaign simultaneously.”

Since most people are either unaware of the risks or in the case of husbands, unconcerned, there is a need for an awareness campaign aimed more at men than women, says Regmi.  

While the use of modern contraceptive means like condoms and IUDs has remained stagnant for about a decade, sales of emergency pills and medical abortion kits have risen significantly, according to ministry officials. These pills can be easily purchased over the counter, even though medical abortion pills should only be given under the supervision of health workers, said Poudel.

Repeated abortions pose risks for future pregnancies and to the health of the woman, Lama said, but the use of such abortion pills under duress from the husband can even be considered a form of violence against women.