VIRGINITY: NOT A WOMAN’S INTEGRITY! — youthcannblog

VIRGINITY: NOT A WOMAN’S INTEGRITY! Written by Pramita Manandhar I was aghast when I recently read a story of a 22 years old female who attempted suicide. Apparently when the woman failed virginity test on her wedding night, she was brutally punished by her husband. As stated on her suicide note, her husband had started […]

via VIRGINITY: NOT A WOMAN’S INTEGRITY! — youthcannblog

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Rural Nepal and Women’s Health

IMG_7413Khotang is the nearest remote district to Kathmandu located Northeastern Nepal. This is a hilly region with very limited access to any road or any infrastructure. It has a population of 206,312, 53% being women and women with 5,000 pregnancies per year. The rate of childbirth with a skilled birth attendant, the single most effective intervention to reduce maternal mortality, is less than 25%. Most facilities lack power, running water and are under-staffed. Estimates of maternal and neonatal mortality are twice the national average. There is gender imbalance in the districts with high rates of seasonal migration.

IMG_7707Khotang has one District Hospital, 2 primary health centres, 10 health posts and 63 sub-health posts. health facilities are meant to be staffed by 333 personnel, but over a third of these posts (126) are vacant. The District Health Officer and Family Planning Office in district health office (DHO), Khotang are also vacant. The district has a low contraceptive prevalence rate (44%). Only Disctrict Hospital provides free Safe Abortion Service (MVA+MA). However, recently service providers from two PHCs and  seven health posts have been trained on Comprehensive Safe Abortion. But, the services have not started yet from those PHCs and health posts.

Recently, an incident occurred resulting death of a woman due to severe complications from abortion service. A mother of seven children from rural Khotang accessed  MVA from district hospital. The hospital was not able to immediately send/refer the client to Kathmandu or nearest districts for further treatment. The women died. This is due to inaccessible road. The district has three airports but due to bad weather the client was not able to be chartered in plane or helicopter. The situation is worse as women in Khotang use traditional methods and herbal remedies for terminating their pregnancy. Also, the district has unregistered providers providing abortion service through pharmacies and selling unauthorized drugs to women. There are more PAC (Post Abortion Care) cases in district hospital. 

IMG_6975According to Surendra Budhathoki, focal person from DHO- Khotang shared that there is prevalence of child marriage, high number of rape cases and the district is one of the top ranked when it comes to suicide. He also shared that the people are not aware of importance of family planning. Because of when women have to suffer and continue her pregnancy for 10th or 12th times. Married and unmarried, both access abortion service from district hospital. There is limited knowledge among villagers on legality of abortion and availability of family planning. Myths and misconception is the barrier for women to use family planning devices. Modern methods are still stigmatized. On asking him about stigma associated with abortion in the village, he shared that the community is not sensitize in abortion issue therefore people think it is a sin. However, people are also positive about free services available in health facilities and if needed they do visit and access service.

Surendra Budhathiki continued sharing about Christianity influencing villagers. There was only 2% of Christian residing in the village as per 2011 data. The trend is converting poor villagers into Christianity and its being challenge for health workers to convince the community to use contraceptives and access safe abortion services. Health workers are not allowed to conduct awareness campaigns regarding family planning and abortion in those communities. He said that last year, services providers from health posts were selected for Comprehensive Abortion Care training organized by Government of Nepal. One of the female service providers back out from the training as she is a Christain. She shared she is not allowed to even talk about abortion in her religion. Even if she wants her family won’t except her. She was afraid to be boycotted from her community.

The only reliable health workers to reach women in rural communities of Khotang with information on family planning and safe abortion are Female Community Health Workers (FCHVs). The DHO is under staffed and the team is not able to mobilize FCHVs in the communities. The team was only able to conduct 1 sensitization session for 40 people from different communities on “Free SA” service. “This is not enough”- said Surendra Buddhathoki. The district is also politically sensitive. Political pressure and influence are the biggest barriers for organizations and projects to implement programs effectively. Organization like PLAN International Nepal and project like SAAFAL were prohibited to continue their work in the district. The political instability, inaccessible road, under-staffed health facilities and religious beliefs are affecting the health of women. Women have to continue their pregnancy and give birth to more than 5 children degrading their health.

Nepal just conducted its district level election and all new bodies are on the board. The agenda for each and every rural municipalities must be advocating for women’s sexual and reproductive health rights. The priorities for health agenda could be meeting unmet need of family planning and accessible safe plus legal abortion service. The Government should give importance to mobilizing local qualified people as the district is under staffed. People outside of districts hesitate to travel and work in rural areas therefore, local human resources should be empowered.

 

 

Take on MA pills over the counter in Nepal

Marie Stopes_2017-6197“It’s a culture.” I answered to one of the freelance journalists. “When you have a headache or something you don’t rush to the hospital. You go directly to the pharmacist.” This article talks about the clandestine procedures are still common in Nepal even if abortion is legal. The abortion law in Nepal does not permit pharmacies to sell any abortion pills without prescription. However, thousands of women are easily accessing MA pills via medical shops/pharmacies nearby. I had causally discussed the reasons behind accessing MA pills in pharmacies rather than authorized health facilities with the women who used self administrative drugs. Most of them shared that pharmacies are convenient as they do not have to go through paper works; no forms, no personal information referring to easily accessible and the other reason is privacy.

Even if it is mentioned strictly that abortion should be performed within a standard health protocol; authorized/certified health facilities and by trained medical professionals, women are accessing services through unregistered medical shops and untrained medical professionals. The study done by CREHPA mentioned that nationwide, fewer than half (42%) of all abortions were provided legally in government-approved facilities. The remainder (58%) were clandestine procedures provided by untrained or unapproved providers or induced by the pregnant woman herself. When taken correctly, self-inducing abortions using misoprostol and mifepristone can safely terminate a pregnancy.

The studies also have shown that women prefer visiting pharmacies rather than any Government authorized health facilities for abortion service. However, the Government of Nepal does not have strong action against pharmacies selling various medical abortion pills and resulting to clandestine procedures. An estimated 80,000 women were treated in health facilities in 2014 for complications related to abortion and miscarriage. Sixty-eight percent of these women had complications that resulted from a clandestine abortion. Forty-four percent of women receiving post abortion care were treated in private facilities, 41% in public facilities and 15% in NGO facilities. Nepal’s pharmaceutical industry is difficult to regulate. Only four brands of misoprostol and mifepristone abortion kits are legal in the country, but at least 20 different brands are smuggled across its porous border with India. The pharmacists have a high incentive to sell them since they can pocket hundreds of rupees each time they sell medical abortion kits. This shows that cost is not barrier for women to access MA pills. They can pay for huge amount buying it from pharmacies rather than visiting government facilities which provides safe abortion free of cost.

Recently Government of Nepal has provided free abortion service in Government health facilities- District Hospitals, Primary Health Care and via Health/sub-health posts. This is in deed great progress while recognizing women’s health and prioritizing abortion to be safe, legal and accessible. However, to measure the impact of free safe abortion services and number of women accessing abortion without stigma in health facilities resulting in reducing clandestine abortion should be performed. This will give us clear picture whether “cost” is what women take in account when they have to access abortion service.

StickerVarious organization like Marie Stopes Nepal and PSI Nepal have recognized working in partnership with pharmacies could result in providing self administration drugs to women with accurate information and instruction to reduce complications. Marie Stopes Nepal has been closely working with pharmacists and orientating them about their mhealth program “Mero Swastha Mero Haath ma”.  The pharmacists provides stickers and wallet cards to the client accessing medical abortion pills over the counter. The client has to register in mobile health platform; type MA and send to 35565 and they receive 19 SMS for 8 days. The SMS are free of cost. It has clear instruction on how to use medical abortion pills step wise mentioning expected results and call to action for any complication. The SMS also provides information on Contact Centre number for emergency and complications (Contact Centre is toll free number and available every day from 7:00 am to 12:00 am). The SMS has information on post abortion family planning and information on Marie Stopes’ clinics.

The Government of Nepal should realize the fact that the pharmacies are more accessible for women that health facilities and they are buying abortion pills in medical shops. To reduce the complications after accessing MA pills over the counter and improve women’s health, government should reform its policy either resulting into strict actions for pharmacies selling unauthorized medical abortion pills (beside four registered MA drugs) or working in coordination with Druggists and Chemists Association to regulate the drugs and making abortion pills accessible to women all over  Nepal with clear instruction plus reasonable price. The restricted law for pharmacies selling MA drugs over the counter has created barrier for pharmacists and among women accessing the drugs. The pharmacists are afraid to be exposed and doing this under the table which has limited the women to get accurate information on usage leading to complications. Also, women have been cheated with high price. They would have accessed service free of cost. However, lack of information about free SA service and stigma associated with abortion is leading women to seek drugs from pharmacists and black market. This needs to be regulated by government of Nepal to reduce complication incidence and improve reproductive health of women.

Religious Belief – A hindrance for women to access SRHR

Traveling and meeting real people in the communities provide you a sense of satisfaction regarding your work in the field of sexual and reproductive health rights. It is always easy to assume the situation of women and young girls in rural Nepal and describe the barriers they face to access their right to choose. There is always a curtain between me and reality when it comes to discuss a situation of a woman living in remote areas and embrace her circumstances to access her sexual and reproductive health rights.

This year I decided to travel to meet women and young girls. Not only them, also have an informal interaction with service providers to analyze whether they are capable enough to provide services to young girls and boys. Meanwhile I travel;ed to western region of Nepal.

Kapilvastu

Kapilvastu is well connected via the East-West highway to the eastern and western part of Nepal and via feeder blacktop road to India in the south. Kapilvastu received reports of 568 cases of violation of women’s rights in 2011, 52% of which referred to domestic violence, 8% to property related disputes, 6% to social violence, 5% to citizenship-related problems and 3% to polygamy. Social and gender-based exclusionary and discriminatory practices continue to hamper the well-being of women in Kapilvastu. Women face unequal power relations due to a patriarchal social structure and the exploitative nature of the socio-cultural system, particularly in Madheshi and Muslim communities. Caste-based discrimination is also prevalent in Kapilvastu district. Seasonal migration to India is a means for households in Kapilvastu to increase their income. Kapilvastu is one of the districts with very low contraceptive prevalence rates (31%), less than half the government target for 2015.

There are discussion surrounding family planning in the Muslim community. I recently read a book prepared by UNFPA-  Islamic interpretation on sexuality, reproductive health and family planning. The book is prepared by Islamic religious leaders to present religiously sound interpretations (fatwa) on the subject. I always had questions like how is family planning & safe abortion perceived within the Muslim community? Does Islam address the issue of family planning & safe abortion? Is it permissible? Do young women have right to discuss about their sexual and reproductive health choices?

In this regard, I got an opportunity to speak with District Public Health Officer to put light on religious beliefs shaping people’s attitudes within the Muslim community. The level of awareness remains low, and there are many misconceptions related to family planning. Side effects of contraceptive methods and opposition from family members, particularly husbands are the main barrier for resistance to family planning. However, the book which I referred says Islam allows short term methods like oral pills and injectables if the methods do not have any effect on the woman’s body. It is clearly mentioned that wife should compulsorily consult with husband before using any contraceptive methods; discussion should be taken mutually. The DPHO, Kapilvastu also mentioned long acting family planning methods like IUCD/Implant is taken as foreign object, which could harm a woman’s body. The religious leaders shared the permanent birth control method is considered ‘Haram’ in Islam as it causes anatomical/physiological changes in the human body.

The Muslim religious leaders were gathered in Kathmandu to discuss about implementing program on family planning in their districts. One of the religious leaders shared that he is father of seven children. He is not using any family planning methods. He said its all Allah’s grace bestowed to his family and he does not know how many children he will have in the future. The religious leaders talked about exclusive breast feeding stating it is impossible for a woman to fall pregnant while she is breast feeding.  The religious leaders are against abortion. Even the organizer were not confident to talk about safe and legal abortion with them.

IMG_1255The DPHO further added to change the terminology परिवार नियोजन to खुसाल परिवार. He encouraged us to initiate discussion related to uterine prolapse before talking about family planning if I am thinking about sessions in Muslim communities. As he had really bad experience and was nearly beaten up by Muslim men when he had facilitated session on family planning in one of the Muslim communities in Nepaljung.

Similarly I met some service providers in Kapilvastu districts. As per service providers, they mentioned there is no such stigma related to women from Muslim community using short term or long term family planning methods. They shared that women are mostly accompanied by her husband or mother-in-law when they come for service uptake. Similarly, they mentioned that women come and access safe abortion service as well. However, the uptake of family planning after safe abortion is less. The women come for the service but they do not prefer to be counselled. The women always mention about limited time and always seek for privacy and confidentiality. The service providers shared that there are still few communities in rural side where the awareness is limited and it is very difficult to intervene the community with information on family planning. The community is conservative and they have strong religious belief. Women in those areas are suffering more as they have to give birth number of children without birth spacing.

_MG_1682In conversation with FCHVs, they are reliable source for Muslim women when it comes to family planning and safe abortion. They had shared about Muslim families limiting their family size and using modern contraceptives like oral pills and injectables. One of the FCHVs said it is difficult for her to convince women to use long acting methods like IUCD and Implant as the women think these methods affecting women’s body. They also talked about migration rate among men of Muslim community. Migration is another reason for women avoiding family planning methods. Muslim community is rooted with patriarchal ideologies women discussion is influenced by their husbands. Most of FCHVs had claimed that they had accompanied women to health facilities for safe abortion services.

The religion itself is not restricting women for accessing their right to access SRH services and rights. However, the translation of religious belief is male dominating where power relation exhibits clearly. I always wonder why religious leaders are only men. The religions put forward the concept of men and women being equal but when it comes to continuing generation only son is preferred. This has resulted to continue unintended pregnancy even if women want; they are not allowed to seek abortion service. The religious text books/beliefs/values need to be revised with gender lens and eradicate those terms which hindrance all gender to access their SRH rights and services.

FEMALE MIGRANT WORKERS AND THEIR SRHR

a3a11-number-of-women-migrantsA rapid globalization in the world has a permanent facet in migration and population mobility, Nepal is no exception. Economic migration or migration for employment has dominated the movement of people in Nepal. Labour migration trends are influenced by gender dynamics. In 2011, there were over 237,000 Nepali women working outside of Nepal, about 12 percent of the total number of the 2.2 million Nepali migrants. According to the Kathmandu-based Center for the Study of Labour and Mobility, Nepali female labor migrants work in countries such as India, Kuwait, Malaysia, Qatar, and the United Arab Emirates, primarily as domestic workers and caregivers. Only smaller percentage of women travel abroad for skilled work, most of these immigrants leave Nepal to do unskilled work at cheaper rated, such as domestic help, construction site labourers, factory workers, etc. Some of the women travel as legal immigrants and others often take a risk and entry without a permit.

While migration can provide new opportunities to improve women’s lives and change oppressive gender relations, it can also perpetuate and entrench traditional roles and inequalities and expose women to new vulnerabilities. The vulnerabilities are more sever and acute among women migrants in unsupervised and unregulated sectors like domestic work which includes violence, exploitation, abuse leading to labour rights violations.

foreign-employmentSRHR of women migrant workers are subject to regulation by both countries of origin and destination. These regulations begin even before their deployment, with the requirement of medical screening for various conditions and diseases including pregnancy, HIV and other sexually transmitted infections. About 60 governments have established pre-departure and post arrival medical screening of migrant workers. On the other hands, not all countries have done the same for providing health and rights information and education to migrants. Female migrants who are classified as semi-skilled or unskilled workers often have limited access to health services and information. They face multiple barriers in accessing SRH services including language. Also, they have to deal with the negative attitude of employers towards ill or pregnant workers and with fear to termination from the job due to illness and pregnancy.

Currently, there are no sustainable pre-departure, post-arrival and reintegration programs in Nepal that address SRHR of women migrant workers. These information are provided by few organization. Once, they migrate to other countries, they have even less or no access to SRHR information. International agreements like International Conference on Population and Development (ICPD)  which has comprehensive coverage of SRHR commitments and has an entire separate section on migration, it actually does not provide specific recommendations to address SRHR of female migrant workers. However, CEDAW has mentioned the health of women migrant workers and urges countries or origin to “deliver or facilitate free or affordable gender and rights-based pre-departure information and training programs which includes information on general reproductive health including HIV & AIDS prevention.

In 2015, a Nepali migrant worker- Nirmala Thapa was retried in Malaysia for getting an illegal abortion. Nirmala Thapa was 24 years old, who worked as an operator at a Sony factory, terminated her 6 week pregnancy  in Oct-24. She was arrested along with her doctor, while she was recovering post operation at a clinic. Abortion is allowed in Malaysia since 1989 but only when the pregnancy threatens the mother’s life or her physical and mental health. Nirmala was sentenced to a year in prison but has since been out on bail and living at a migrant workers’ shelter. Now, she has returned to Nepal. However, she is facing difficulties to re-establish in her community and sustain daily life.

In order to ensure SRHR of women migrant workers, origin and destination countries must ensure the provision of comprehensive SRH services and education at all phases of the migration cycle and facilitate the establishment linkages and referral networks with migrant friendly SRH service providers. To achieve this, governments from origin and destination countries must work together with civil society and other stakeholders in creating an enabling environment for female migrant workers to make life choices and exercise their Sexual Reproductive Rights.

New Bill ignoring SRHR of women with disabilities

We all believe that Sexual and Reproductive Health Rights are fundamental HUMAN RIGHTS. So does, Nepal. However, a new bill to protect the rights of people living with disabilities had ignored the reproductive health rights of women living with disabilities. Does this mean women living with disabilities are not HUMAN??

Rights of the people living with disabilities 2072 Bill, which has tabled in the Cabinet for discussion, briefly touches upon the reproductive right but is silent on reproductive health rights. The laws have always respected the rights of women in Nepal. For example, Nepal legalized abortion in 2002 allowing women to terminate pregnancies of up to 12 weeks on the consent of women. However, the policy makers in Nepal are insensitive. The recent decision had proved this where the constitution which has always enshrined the reproductive health rights of all Nepali women, this time ignored the reproductive health rights of women living with disabilities to have the right to their own body.

There is always a myth related to sexual rights of people living with disabilities. Women and girls with disability often face violence, discrimination and prejudice that affects their sexual and reproductive rights. These attitudes and practices, which pervade many of our communities and institutions, result in multiple and extreme abuses of the sexual and reproductive rights of women and girls with disability, including through state-sanctioned violence including forced sterilization, forced abortion, and forced contraception. These very severe and cruel forms of sexual violence – perpetrated largely against women and girls with disability, and which qualify as torture or inhuman treatment, have no place in our world.

The sexual and reproductive rights of all people, including women and girls with disability, are contained in many human rights instruments, including the Convention on the Rights of Persons with Disabilities (CRPD) and the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW). Nepal had even signed the CEDAW with promise to protect SRH rights of all human including people living with disabilities.

After a country formally agrees to a UN convention, they have a legal obligation to respect, protect, and fulfill the rights set out in the particular Convention.

RESPECT: Governments must not deprive people of a right or interfere with people exercising their rights. For example, governments must not perform medical treatments on people with disability without their consent, or exclude a child from school on the basis of disability.

PROTECT: Governments must prevent ‘third parties’ (such as police) from abusing the human rights of others. For example, governments must protect people with disability from violence and abuse in institutions.

FULFILL: Governments must take positive steps to make sure people can enjoy their human rights. For example, governments must make or change laws and policies so that people with disability can enjoy their human rights the same as everyone else.

I wonder if there is any treaty committee which plays a role of watchdog in respective countries which implement the particular treaty to which they have formally agreed. The violation of the agreed treaty should have a form of penalty for ignoring any relevant agreement in the treaty. The so called WATCHDOG committee should make sure the respective countries follows all the required details to implement agreed treaty in the country.

Follow the link to get the insight news on new bill in Nepal ignoring SRH rights of women living with disabilities. 

VAGINA MONOLOGUES

By Q1 of 2016, I have almost achieved few of my bucket lists. I desperately wanted to attend “The 3rd International Congress on Women’ Health and Unsafe Abortion” and advocated for “Working Together Towards Global Safe Abortion.” Similarly presented my poster presentation on “Use of social media: Engage youth and SRH” in most awaited youth conference “8th Asia Pacific Conference on Reproductive and Sexual Health Rights” in Myanmar. At the end of the Q1, on the occasion of International Women’s Day I attended “Vagina Monologues” – यौनिका कुराहरु. I had watched the vagina monologues in 2013 during first youth advocacy institute organized by Asia Safe Abortion Partnership. It was in Hindi and I am unable to share to what extend I wanted to experience the theater on Vagina Monolgues in Nepali.

 Vagina Monologues (योनिका कथाहरू) is a play produced by Madalenas Nepal and contains monologues of women revolving around their sexuality, positive and negative experiences, violence, abuse, struggle and realization. The play will be in Nepali and English. The play is going to performed on the occasion of celebration of VDAY worldwide to oppose all forms of violence against women.

The play had been staged at Mandala Theater, Anamnagar from Feb 02 to Feb 04, 2016 celebrating the V- Day in February with a huge response from audiences.


This time, to celebrate International Women’s Day on 08.03.2016 – Vagina Monologues staged at the Rato Bangala School in Patandhoka encompassing 400 spectators. This special screening was free of cost.

The Vagina Monologues is a script written by US-play writer Eve Ensler after interviewing approximately 200 women and girls about their view on sex, relationships and violence against women. To our knowledge it is the third time that the Monologues are being staged in Nepal and the first time that the majority of the script is translated into Nepali.

I got goosebumps when the performers started with “What would your vagina say if it could talk? … What would it wear?” I looked around when they delivered their dialogue- talking about the difficulties of “checking out their vaginas.” When they were done twisting their bodies, they stated over three dozen euphemisms for “vagina” which included, but were not limited to: “poonani, coochie, nappy dugout, vulva, monkey box, pussycat,” and an array of other less familiar terms. I believe the play is successful because of its comedic touch. It discusses sensitives topics in a funny, non-threatening and non-blaming way.

Each of the monologues deals with an aspect of feminine experience and touching on matter such as sex, love, rape, mestruation, masturbation, birth, orgasm and violence. These all are very sensitive issues of women. We do not want to be vocal about this but we all experience it. Our experiences are different. The difference is showcased in the play with message “knowing your body loving your body”. The play my own mother language was empowering. It empowered much on being comfortable talking about my VAGINA in my own native language. I love the line saying, “आफु संग राइफल हुदा हुदै किन पिस्तोल खोज्ने” directing to female masturbation linking it to being social taboo.

Another monologue which I like the most is the Woman Who Loved to Make Vaginas Happy, in which a sex worker for women discusses the intriguing details of her career and her love of giving women pleasure. In several performances it often comes at the end of the play, literally climaxing with a vocal demonstration of a “triple orgasm”.

And it continues with another series- Because He Liked to Look At It, in which a woman describes how she had thought her vagina was ugly and had been embarrassed to even think about it, but changed her mind because of a sexual experience with a man named Ajay who liked to spend hours looking at it.

 The most exhilarating part is, no kidding, the extremely virtuosic way with a series of orgasmic moans…When I watched this section in Mumbai, the actress performed the series of orgasmic moans with respect to women of different caste and culture. I never thought the Nepali actresses would perform the same in Nepali style.

The performers and their performances break the taboos by talking, talking and talking some more—stripping fear and shame from what they celebrate about their body. It makes for quite a party. Funny, outrageous, emotionally affecting, and occasionally angry…The Vagina Monologues confront words to demystify and disarm them. In so doing, The performances disarm the audience too.

I am hoping in near future we could tie up this performance with ABORTION experience of women in Nepal. Hope I could facilitate this play on 28th September, Global Day of Action for Access to Safe and Legal Abortion.