As regulations have not been formulated till date, there is no uniformity in service charges at health facilities

Kathmandu, August 26

Although the Parliament endorsed the Safe Motherhood and Reproductive Health Right Act one-and-a-half-years ago, regulations related to the act are yet to be formulated.

Delay in formulating regulations has created confusion regarding standards. The provisions mentioned in the act haven’t been implemented.  The stakeholders have, therefore, demanded that the government come up with the regulation at the earliest.

The act states that non-governmental and private health institutions that meet the standard prescribed by the  government shall provide obstetric care in a dignified manner. Health institutions providing obstetric care shall make provisions related to health care of newborns as per the standard prescribed. “But due to lack of regulations and other by-laws, there is  confusion regarding the standard,” said advocate Sabin Shrestha.

The act also states that a licensed health worker, who has met the prescribed standards and has the required qualification should provide safe abortion service. “But the act does not explain the prescribed standard and required qualification which has led to more problems in implementing the act,” Shrestha added.

As no regulations have been formulated till now, there is no clarity in service charges of health facilities that provide reproductive health services. “There is no uniformity in the service charges imposed by hospitals,” added Shrestha.

The new act allows women to have abortion up to 12 weeks after pregnancy, but in the case of rape and incest, women are allowed to have abortion till 28 weeks of pregnancy. This act has not been implemented because there is no regulation. It has affected women with disabilities. When the family comes to know about pregnancy it’s already late. “This law will help such women,” said Madhabi Bajracharya, programme adviser at Ipas Nepal, an organisation that has been providing technical support to the Ministry of Health to initiate and expand safe abortion services in the country since the legalisation of abortion in 2002.

The act also states that private,  non-governmental and community health facilities and health workers shall make health services easily available,  and provide free health service to people who are unable to pay health service charges. But this provision has also not been implemented due to lack of regulations, according to Shrestha.

The act also has the provision for safe motherhood and newborn care. The health institutions providing emergency obstetric and newborn

care services should have separate rooms for pregnant women to rest, but most of the health facilities do not have these rooms.

“Non-governmental and private health institutions meeting the standard prescribed by the government shall provide emergency obstetric and newborn care. But we are not sure what sort of institutions ill provide emergency obstetric and newborn care,” added Shrestha.

A pregnant woman who wants to get safe abortion service should give her consent in the prescribed format to the health institution or the health worker conducting the abortion. “The format for consent has not been finalised yet due to lack of regulation,” Shrestha said.

The act has also not clearly defined family planning services. The act states that service related to family planning should be provided as prescribed. But no standards have been set in the act. “The government standard will be stated in regulations,” Shrestha added. Though the new act has been endorsed, we are

still working as per the old act due to delay in formulating regulations, according to Jageshwor Gautam, director of Paropakar Maternity and Women’s Hospital.

“In the absence of regulations, women cannot get maternity allowance, and maternity leaves. There are possibilities of problems if complications occur or some unfortunate incident takes place during abortion.

Disputes are likely to occur if regulations are not drafted on time,” said Aruna Uprety, a public health specialist.

“We have drafted the regulations. The draft will be released after sometime,” said Mahendra Shrestha, spokesperson

of the Ministry of Health and Population.