‘One-man anti-abortion army’- shadow of US global gag rule looms over Nepal’s family planning services

Since the country legalised abortion, maternal mortality rates have plummeted. But US-funded programmes and a Trump victory could reverse that progress, warn experts
Supported byAbout this contentPete Pattisson in BeniMon 21 Oct 2024 00.00 EDTLast modified on Mon 21 Oct 2024 00.01 EDTShare“One, two, three,” says Soman Rai slowly, to the click of his fingers. “Every three seconds a baby dies by abortion. One, two, three,” he repeats. Behind him, the word “Abortion” is projected on to a screen in a red font that drips down the slide to resemble blood. Underneath is written: Abortion is world history’s greatest genocide.
It is an uncompromising message in an unlikely location; a church in a remote valley in Nepal.
A self-proclaimed “one-man army”, Rai says he has been taking his anti-abortion message to more than 30,000 people across Nepal since he founded his organisation, Voice of Fetus Nepal, in 2009.
As an audience of about 65 gathers for his talk in the church in Beni, a small town in the foothills of the Himalayas, they greet each other with “Jay Mashiah”, meaning “praise the Lord”, instead of the traditional namaste. While Rai speaks to schools and colleges, the focus of his work is among Nepal’s growing Christian community, who eagerly embrace his anti-abortion pitch.
View image in fullscreenSoman Rai, an anti-abortion activist in Nepal, would welcome cuts to funding for abortion services. Photograph: Pete PattissonRai speaks with the fluency and confidence of an evangelical preacher, taking his mostly female audience on an emotional journey. His message is built on the belief that life begins at the moment of conception, and underpinned by the teachings of the Bible. Instead of abortion, Rai promotes parenting, adoption and abstinence.
If his argument sounds familiar it is because his work is – at least partly – funded by anti-abortion Christian groups in the US and draws heavily on their messaging and methods.
Rai’s preaching comes at a time when providers of women’s healthcare around the world are preparing for potentially disastrous consequences should Donald Trump win the US presidential election in November. When he last took office in 2017, one of his first acts was to reinstate, and later expand, an order known as the Mexico City policy.
US law has long prohibited the use of foreign aid for abortions, but the policy also bars foreign organisations that receive US family planning funds from providing advice on abortion services or advocating for the liberalisation of abortion laws, even if they do so using funds from other sources.
View image in fullscreenRai’s anti-abortion message is helped by the lack of awareness of abortion laws and provision in rural areas. Photograph: Pete PattissonTrump greatly expanded the policy so it applies to any organisation receiving US healthcare funding. Foreign organisations wishing to access this funding must sign up to the policy, which is often referred to as the global gag rule (GGR) because of the restrictions it places on organisations to even discuss the option of abortion.
Nepal first legalised abortion in 2002 and today women have the right to an abortion up to 12 weeks of pregnancy and in limited circumstances up to 28 weeks. The legalisation of abortion has been credited with contributing to a 72% fall in maternal mortality rates – from 539 deaths for every 100,000 live births in 1996 to 151 in 2022.
It takes guts for a woman to come here. Some communities believe abortion is wrong. Pre-marital sex is not acceptablePuja Karki, MSI Nepal Those gains are being put at risk by the GGR, say experts. A study on the impact of the policy in Nepal by the Center for Research on Environment, Health and Population Activities (Crehpa), a Nepali organisation, found that it had “created a major obstacle to improving women’s lives”, in particular among “marginalised and underserved populations”.
Since the GGR was first introduced by Ronald Reagan in 1984, successive Republican administrations have imposed it, while the Democrats have revoked it, leaving family planning organisations such as MSI Nepal (formerly Marie Stopes International) – which refuses to sign it – caught in a cycle of funding and defunding.
The consequences have been dire, says Tushar Niroula, the executive director of MSI Nepal. “You can’t strengthen the health system in four years and then stop for four years. Next time you have to start from scratch.”
View image in fullscreenPuja Karki, team leader of the MSI Nepal clinic in Pokhara city, Nepal. Photograph: Pete PattissonNiroula says his organisation had to shut down projects soon after the Trump administration took office, due to cuts in funding. “There was a huge gap overnight,” he says.
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Global health charities warn of ‘huge and terrible’ threat to abortion rights if Trump returnsRead moreThe prospect of a Trump victory in November is already hampering MSI Nepal’s work. Members of a consortium bidding for US healthcare funding have been reluctant to collaborate with MSI Nepal because its refusal to sign the GGR could put the whole bid at risk, says Niroula.
“US government funding is huge and extends for five to six years, which is enough time to build systems and make them sustainable. That is why the global gag rule is such a barrier,” he says.
Puja Karki sees what is at stake every day in her role as team leader at MSI Nepal’s clinic in Pokhara, a city about a three-hour drive from Beni.
“It’s a big deal for a woman to come here, it takes guts,” says Karki. “Some communities do not accept family planning and they believe abortion is wrong. Pre-marital sex is not acceptable, so unmarried women are afraid of taking up the service.”
Karki says a combination of social stigma, lack of awareness and difficulties accessing family planning services puts women at severe risk. Some turn to “unsafe and unauthorised places for abortion”, says Karki, or attempt to abort themselves using traditional herbs or a sharpened stick.
View image in fullscreenParticipants react to material in Rai’s presentation at a church in Beni, Nepal. Photograph: Pete PattissonWhile there is limited accurate and recent data, a study by Crehpa estimated that in 2014 almost 60% of abortions in Nepal were carried out illegally, meaning they took place at unapproved facilities in potentially unsafe conditions. Another study put the figure at 52% in 2021.
“The main challenge is they lack awareness of abortion in rural areas. They do not know how to access proper services,” says Karki. “Many are not even aware that abortion is legal.”
That challenge is only likely to grow under a second Trump presidency, but that does not seem to concern Rai. Although he says he does explain the law in his talks, he adds that if Nepali women do not know that abortion is legal, “that is good news for me”.
Asked if he would prefer Donald Trump to win the election, Rai replies, “Of course.”