Let’s Talk Abortion

There is a general logic behind the existence of human-kind in the universe. The logic is human is born to reproduce and continue its generation. Not only humans but animals also have to reproduce because of their sexual instincts. However, we now have birth control and abortion which allows us more control over when and how many babies we will have. Thanks to the advancement in technology to control our own reproduction.

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I believe that every pregnancy should be wanted rather than an excuse saying it happened accidentally. Don’t you think this excuse is leading to global warming! I mean the planet Earth is already overpopulated and polluted resulting to natural disasters and unknown diseases which will definitely in the future will be a leading reason behind extinction of humans from the Earth. The main reason behind this is due to unwanted pregnancies. The best solution to control our population is to terminate pregnancies which are unwanted.

Thank God! We are in the society where we have the technology to control our own reproduction. This has provided us an advantage to control our own body and have babies when you are ready. This has helped us to have children by choice not chance.

Abortion is also an issue of personal choice. People should have access to safe and legal abortion. When we talk about abortion, we have to face various questions which are linked with social, cultural and religious sentiments. However, the people who arguing about abortion never think about a woman who has to face numerous difficulties to decide and go for termination on her own choice. Someone asked me: Who should make that choice? Her family, husband, state, friends, service providers or herself? The answer is so simple, it’s her body and she has all control on her body which is her human right, then the choice to terminating her unwanted pregnancy, ultimately, needs to be her.

Abortion is not only women’s issue. Whenever I have discussion regarding abortion, people forget that men should be also involved equally. They always rise a question “What if I (man) wanted the pregnancy? Where is my (man) saying on taking decision not to abort?”. This is really painful when people (especially men) do not understand the issue. They should empathize the situation to learn more about personal choice and freedom. I believe that reproduction is a personal right and that it is no one’s business other than the women to make that choice. People should respect and support a woman;s right to have a baby as well as her right to not have one.

Another hot issue you face while you stand for abortion is: Abortion is murder. For god sake please grow up. I am afraid there are people who will punish woman for wasting her eggs very month in the form of menstrual bleeding as eggs are important reason behind life. If we really care about life, why we are silent about Syrian war. Many children have been killed and affected by the war. Is that not murder? If you really care about the life of a fetus not the live one in Syria then please do not argue with me on abortion being murder.

 

safe abortion-10The religious sentiment on abortion is its being immoral. If this is immoral than why don’t you promote family planning. Every time you can’t only object. You need to support as well. If you think abortion is immoral and it is sin then why don’t you preach about use of any form of contraception. This will help to reduce abortion. The less women get pregnant, the less abortions you have. So simple! If you do so, I rally do not have to disagree with you.

imagesPeople come with the idea of adoption when I start to talk about abortion. Oh really, adoption! Is this the real solution? Forget it!! People who object to abortion they really do not care about the welfare of child after it’s born. These people take pregnancy as the punishment for woman. They are indeed sick people who do not support sex, contraception and abortion. Do you believe that we have awesome adoption law that will sort the issue of unwanted child after it’s born? If you really believe that adoption is the solution then request people to be fair and healthy without racist or sexist while adopting a child.

Abortion is not an easy choice to make. Women go through obstacles and challenges to finally choose abortion as an option to move ahead. I guess you do not want a 16 year girl to become mother before she completes her study. You do not want to be pregnancy that results from rape and incest. Also, you do not want to carry your pregnancy at the age of 50.

Therefore, respect the choice a woman makes. I just want her choice to be safe and legal. I request all to talk about abortion and preach accurate information about it. Always support women, to access safe and legal abortion rather than from back street quack doctors.

 

 

 

 

 

 

 

 

 

 

Working Together Towards Global Safe Abortion- 3rd IWAC

The conference is an international platform for global exchange, updates and sharing information on safe abortion as well as providing networking opportunities among committed health workers and SRHR safe abortion advocates. The theme of this congress was “Working together Towards Global Safe Abortion” recognizing that unsafe abortion still kills and disables thousands of women worldwide every day.   Highlights of the conference:

1. Conscientious objection: service providers should not deny the women access to abortion. (raised by Jon O’Brien and Dr. Choong from Malaysia).

2. Values clarification should be mainstreamed within medical education curriculum: To help future service providers understanding of the importance of women’s access to safe and legal abortion services and to enhance the quality service, non-judgmental service and maintaining privacy and confidentiality of clients.

3. “Trust Women”: The key to good medical abortion services (by Beverly Winikoff, Gynuity Health Projects.  

I came across the terminology “Conscientious Objection” during the refresher training organized for youth champions who had attended Youth Advocacy Institute organized by Asia Safe Abortion Partnership in 2014. Dr. sim-Poney Choong, Co-Chair, Reproductive Rights Advocacy Alliance Malaysia and a founder of Asia Safe Abortion Partnership said that it is a duty of a service provider to serve its client with non-judgmental attitude. He/she is not in the state of denial of service to its client because of his/her beliefs. If service providers do not perform abortion to a woman who needs, because it is against his/her beliefs then he/she is in wrong profession. Service providers before joining their profession as doctors or nurses take oath to serve every client. If they don’t, they are the reason for women seeking unsafe and illegal abortion resulting into complications and even death of women.

 Dr. Amar Jesani of the International Medical Journal of Ethics talked about abortion and how to handle ethical questions at Youth Advocacy Institute.

I agree that people come from different backgrounds and they have their own values and norms. However, when you serve nation as service provider on women’s health the important value is saving women’s lives rather objecting abortion service to them because it comes against own values. The best solution for this could be integrating Value Clarification Activities during the training for service providers on abortion. This helps to clear their values.

There was a presentation on trusting women by Beverly Winikoff- Gyunity Health Projects who talked about George Tiller, an American physician, an abortion provider and martyr for women’s right to choose. His motto was, ‘TRUST WOMEN’, an exhortation meant as moral and philosophical. It turns out that it is also very good policy and clinical advice. Her presentation spoke about medical abortion that has been made easier and more acceptable if women are included as major actors in the process and how many aspects of medical abortion treatment can be delegated directly to the woman with no loss of efficacy, safety or acceptability. Indeed, such a revamping of services seems to be more acceptable and preferable to many women.

An examination of what is required of medical abortion services using this lens raises the question of why the drugs are so often restricted to specialist services and to provision in clinics or hospitals only. Why shouldn’t medications for abortion be provided in pharmacies, like other safe and effective medicines? And why shouldn’t they be prescribed at the lowest level of the health care system that can use them effectively and safely- maybe by women themselves? This emphasized on trusting women and empowering them with information and self administrating the medical abortion pills.

Another interesting session was by Dr. Christian Fiala, MD, PhD Spezialist in Obstetrics and Gynaecology shouted asking question Why Is Abortion Illegal? What were the considerations and the intention of making it illegal in the first place? He, then clear the answer saying: monarchies, dictatorships and war leading countries wanted to increase their population and to have more soldiers. Care of children or women has never been a thought. It was only with democratic developments that people too, the freedom to vote for their political representatives and also wanted self-determination in the most intimate aspects of life: one’s sexuality and fertility. He also presented that respecting women implies to give the power to decide over all aspects of their reproductive choices. It also implies the duty for societies to rid of all remaining obstacles and patronizing restrictions.

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.

Opportunistic Sex

OPPORTUNISTIC SEX- the word is coined by our Marketing and Communications Director. It’s simple which means young people have opportunistic sex. It is neither planned nor they think about consequences but like to enjoy the moment of pleasure. “SEX” through media, novel and stories has been fantasized and glamorized. It is shown as if the only that moment needs to be treasured rather than enjoying moment with responsibility.

 Talking about young people of urban setting in Nepal, either they are brought up in joint family or migrated from rural areas to city for education and in search of job. In both context, there is no privacy. You have to share your room, even bed with siblings if you stay with your family or with roommates if you rent a room. We are never open to talk about sex, pleasure and orgasm among our siblings or friends. We still maintain silence on these stuffs. We are never open to this. Even if someone shares about their sex fantasy we tend to reject the idea and would not like to discuss on these topics. It is even worse case for young girls. Gender construction has allowed young men to exacerbate their sex life whereas young females are resilience and never commit on saying they ever had sexual attraction or sex.

Young people live in a close society where neighbor next door is a watch dog. They always have evil eyes on what you are doing and eagerly waiting for a chance to complain about their wrong doing to your family. Even in family, you won’t get your private time. Even if you asked for they tend to assume whether my son or daughter is a drug addict. Uff…. I need alone time and you are never provided with one. In these situation, how could you enjoy your sexuality; a self time to enjoy masturbation or even talk with your buddies about your sexual interest. It’s difficult. Each young people struggle with this. How could you respect your partner’s sexual pleasure until you enjoy yours.

You do not have a separate space in your home where you could invite your partner and enjoy the moment. You are always surrounded by family members. You can’t even enjoy private messages on phone or on social media. Even you have to share your phone and laptop. There is no privacy. Frequently your phone and laptop are logged in by your parents or by your siblings/ friends. The sexual desires and pleasures are now self centric. You are confused whether the feeling is only limited to you. You don’t enjoy being teen age nor growing up with feelings for opposite sex or same sex.

 You even can’t prepare yourself for safe sex. Advertisements on CONDOM are banded in family. Magazines with nude pictures are not allowed to be entered in the home. Radio programs on SRHR is not tuned in as parents think it is injurious to their young people in their teen age. Teachers feel shy to talk about sexual organs and their importance. In this situation it feels like you are closed in dark box where you suffocate but none realize. The only way to know what actually going on your body is surfing Internet and googling wrong site, maybe + 18 years site.

How easily could you carry a packet of condom in your pocket? We try to normalize sex and sexual behavior for safe sex but it is not digested in our family. Your room is cleaned by your mother. You clothes even are washed by your mother. How much possible to keep a condom in your bag or pocket where your pockets/bags are always investigated at home/colleges. It is said to carry a condom for safety. Unless people normalize their behavior seeing a condom in young people’s wallet and change their attitude towards young people having sex is crime, OPPORTUNISTIC SEX keeps on happening putting young people in risk behaviors.

There is an advertisement saying free condoms and other contraceptives are available in health facilities. You can easily get condom for safe sex in pharmacy. Enacting this into behavior and with courage if a young person goes to health facilities or pharmacy to get condom or EC, he/ she is judged by her age. They are stared with negative vibes and won’t let their eyes out of young people until their shadow is passed away. This is the situation for young people in our society and how could we expect they use safe methods to enjoy their sec life.


All these situations lead to having OPPORTUNISTIC SEX. You wait for an opportunity to have sex where everything happen without a plan where you fear the situation rather enjoying and your first sexual experience is never worthy to remember and rejoice. This tends to be painful experience ending with unwanted pregnancy or victim of sexual violence. This leads to imbalance power relationship where one only thinks about own sexual pleasure and enjoyment rather respecting partner’s feelings and desires. Let’s break the silence. Let’s talk about your sexual health. Let’s not stigmatize sexual desire of young people.

KUSMA BRIDGE 

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Kusma bridge is the tourist attraction in Parbat district. Kusma is a municipality and the headquarters of Parbat District in Nepal.

Kusma Bazaar is the main attraction of Kusma which seats in the inclined narrow strip on the top of two river’s banks, Kaligandaki and Modi. It begins from the base of Durlung hill from where it stretches to Chhamahrke toward Baglung in the North West and to Chuwa VDC towards Pokhara in the eastern-north. Kusma bazaar’s long narrow strip ends to the south where two rivers Kaligandaki from northwestern side and Modi from north-eastern side meet each other. The Kusma bridge joins Kusma to another village Gyadichour on the other side of a deep gorge. Gyadichour is a small village, which is also a birthplace of many scientists, doctors,artists, engineers, administrators, politicians and highly creative people. Many people come to Kushma just to walk over the bridge.

img_6584 Kusma – Balewa is the tallest suspension bridge in the country. It is also supposed as the longest suspension bridge in the hilly country Nepal. Kushma Balewa suspension bridge is the Nepal’s highest suspension bridge. Or say, it is the tallest suspension bridge in Nepal. After constructing of the bridge, there are 500 to 1000 passenger daily using this bridge. It has given another benefit for the villagers of this region.

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The municipality Kushma is also known as the home of mysterious Gupteswor cave.

UNSAFE ABORTION ALARMING AFFAIRS 

The article is originally published in fortnightly magazine- New Spotlight. You can read the original article here

Although Nepal has made many progresses in the last decade in establishing the rights of women, it is still a country with highest records of girl child marriages. Nepal’s law and constitution guarantee the right to reproductive health, but unsafe abortion continues to be a killer of young and adolescent girls. At a time Nepalese women celebrated the International Women’s Day calling for equal rights to women, unsafe abortion is creating a major health problem among the women.

When the Nepalese women were celebrating the International Women’s Day calling for women’s liberation, one hundred young women called Meri Sathi Free Helpline 16600119756 (ntc) or 9801119756 (ncell), the telephone counseling service run by Sunaulo Parivar Nepal (SPN), to acquire information about sexual and reproductive health.

The call center, which provides counseling service every Monday to Friday from 9:30 am – 7:00 pm and from 9:30 am- 5:30 pm on Sunday, is the lifeline for many young women who want to know about reproductive health, pregnancy and maternal health.

Their questions range from sex, women’s health, unwanted pregnancy, legal abortion, family planning methods and about the reproductive rights. The callers are overwhelmingly young people aged between15-21.

According to Shreejana Bajracharya – Senior Communications Consultant at Sunaulo Parivar Nepal, implementing partner of Marie Stopes International Nepal , a majority of queries are related to sexual relations, legal abortion, pregnancy and family planning. “We also respond to the queries through SMSes,” said Bajracharya.

“Our Meri Saathi Free Helpline has trained and skilled counselors on hand 6 days a week to offer expert advice and support – from your initial consultation to treatment aftercare,” said Bajracharya. “If one is unable to talk to friends or family, they can speak to a Marie Stopes Nepal counseling or service providers at Marie Stopes International (MSI) Centers. Marie Stopes Centers take one’s privacy seriously and any counseling conversations will be confidential.”

As a country with one of the highest numbers of girl child marriages in the world, Nepal is benefiting from the counseling service provided by organizations like Sunaulo Parivar Nepal, which has been a savior for many young and adolescent girls as sex related matters, family planning methods and reproductive health are still regarded as taboo topics in the society.

Although the counseling seems to be very ordinary, it helps to reduce the maternal mortality rate saving the life of young mothers who wanted to prevent unwanted pregnancy.

Along with the government hospitals, Sunaulo Parivar Nepal has been providing the much needed safe abortion clinical services with trained manpower. They provide the comprehensive abortion care that ensured pre and post care and usage of completely safe technology.

According to the data released by Ministry of Health, 751,694 women have benefited from the safe abortion services since it started. This saved many deaths of women and morbidity of women.

Abortion has become legal in Nepal and a safe choice for women seeking to end unintended pregnancies. But for many women, ingrained fear and shame about abortions have remained. Sunaulo Parivar Nepal has been working for the nation’s availability of SAS techniques with effective pail management and post-procedure family planning information and services. Despite availability of service, 47,000 women still die every year due to unsafe abortion in Nepal.

“ I feel proud to say that my initiative has played a vital role in reducing maternal mortality rate in the country and saving young and adolescent girls from untimely death,” said Kamla Thapa, president of Sunaulo Parivar Nepal.

Trauma of Unsafe Abortion

Subhadra Chand, 18, a resident of Darchula, died on the way to Dadeldhura Hospital due to complications related to unsafe abortion last month. Similarly, Kanchi Rokaya, 20, mother of two, a resident of remote Mugu district, died at the district hospital in Mugu due to complications during abortion.
 
These two incidents are not new as dozens of young women in far-west and mid-western region, are dying annually due to the complications related to the unsafe abortion.
Unsafe abortion risks lives of many women in Far-West as hospitals and other health facilities in these districts receive cases of abortion-related complications. As there is a lack of proper medical infrastructure for safe abortion, many pregnant women opt for unsafe abortion risking their lives.

According to a study, 25% of pregnancies are still unplanned in Nepal and only 38% of women know that abortion is legal. Knowledge is very low among illiterates (20%) and lowest health quintile (22%).

Although safe abortion became legal in Nepal from 2002 followed by national standards, protocols, guidelines, training materials and training centers and safe abortion services were available in maternity hospital from 2004, and with free services, a large number of women still don’t know about this.

Although the Ministry of Health and Population provides budgets for district hospitals to prepare for safe abortion, these services are inaccessible to many.  
“The government is serious about the trend. We have the District Public Health Division increasing the number of safe abortion centers in health posts,” said Shanta Kumar Shrestha, secretary at the Ministry.


Role of MSI AND SPN

Along with the government centers, Sunaula Parivar Nepal, national NGOs implementing partner of Marie Stopes International in Nepal, also operates 36 static service centers on Family Planning and Safe Abortion Services in 32 districts which are authorized under Government of Nepal.

It has also launched Meri Saathi Free Helpline. Trained counselors have been available to discuss a wide range of issues including birth control, pregnancy options, sexually transmitted infections including HIV & AIDS, and other aspects of reproductive health.
SPN contributed to prevent 126,000 unsafe abortions in 2014. Among non-government organizations, SPN/MSI has been one of the leading organizations in increasing access to modern FP methods and safe abortion services in the country.

SPN contributed about 55% of sterilization and 89% of reported cases of safe abortion services in Nepal. It is estimated that Sunaulo Parivar Nepal’s contribution has helped to avert 1,622 maternal deaths and 153,292 unsafe abortions in 2011.

Sunaulo Parivar Nepal (SPN), established in 1994, is a Nepali non-government organization (NGO) responsible for implementing the Marie Stopes International program in Nepal.

Abortion was legalized in 2001 in Nepal. According to the Abortion law of Nepal, “only listed doctors or health providers can provide abortion services at approved health facilities, clinics, and hospitals with the consent of pregnant women and according to the national standards.

About 800,000 Nepalese women get pregnant every year. Two hundred thousand of total pregnancies are defined as unplanned, unintended and unwanted by Nepalese women.
However, only 80,000 Nepalese women go to approved health facilities or clinics for abortion. About 120,000 Nepalese women go to non-listed clinics or health centers for the termination of pregnancy which is obviously unsafe.

Aananda Tamang, Director of CREHPA, an NGO working in the field of environment, health and population, believed that women opting for abortion no longer had to endure pain during the termination of pregnancy as various researches were being carried out to manufacture painkiller medicines for the same. Majority of the unsafe abortion cases in the country were attributed to social norms and values and cultural beliefs.

Both married and unmarried women are unaware of the abortion related complications and conformation to legal compliance.

“As the unmet need of family planning methods to the young people grows, there is a high possibility of unwanted pregnancy. Given Nepal’s young population’s sexual activity, Nepalese women face more serious complications related to unsafe abortion given the growing unmet need of FP,” said Dr. Ram Hari Aryal, a demographer.

The World Health Organization defines unsafe abortion as a “procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both”. The consequences of unsafe abortion range from minor complications such as bleeding, sepsis, gastro-intestinal disturbances to major complications such as excessive bleeding, hemorrhage, endo-toxic shock to name a few. Although minor complications are treatable some complications may cause long-term reproductive damage such as infertility due to infection.

According to DHS 2011, 34% of current married women have an unmet need for contraception. It means that “women are sexually active, are able to become pregnant, do not want to have a child soon and are not using any method of contraception.”


International Experience

According to new research by Susheela Singh and Isaac Maddow-Zimet of the Guttmacher Institute, there was an estimated 6.9 million women in developing regions who were treated for complications resulting from unsafe abortion in 2012.

Their article, “Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012,” published recently in BJOG: An International Journal of Obstetrics & Gynecology, highlights two alarming realities: the very large number of women who experience complications from unsafe abortions and the significant costs that women, their households and governments incur as a result of treating these complications.

In countries where abortion is illegal or highly restricted, the procedure is often carried out under clandestine conditions that jeopardize women’s health and lives. If a woman’s health is compromised, she may also experience severe financial burdens associated with missing work or receiving medical care. In addition, health systems in developing regions spend a significant portion of their already stretched health care budgets—an estimated total of $232 million each year—on post abortion care.

If the research recommendation is any guide, a country like Nepal should focus on provide family planning services, including counseling and provision of a wide range of contraceptive methods, which should be included as a key component of post abortion care. This would also reduce the incidents of unintended pregnancy, which is the root cause of most pregnancies.

Although women celebrated the International Women Day, sustainable development would not be achieved unless the women’s sexual and reproductive rights were established as fundamental human rights. This needs to be brought under the ambit of every eligible woman.

“Crossing the lines” 

Last two weeks I was busy with interviewing women who are social mobilizers. I got an opportunity to travel various districts and met amazing women in the rural areas. After meeting them and interviewing them I realized the meaning of empowering women in the field of sexual and reproductive health & rights. 

These women have been working as Female Community Health Volunteers for long time. They have an inspiring grass root level experience on working in the communities and making community people aware of pregnancy, pregnancy check ups (ANC & PNC), contraceptives, vaccinations, nutrition and other aspect of SRHR. They do not have received formal or intensive trainings on SRHR but have been received orientations from government and NGOs working in the field of SRHR. 

One of the social mobilizer shared, “It’s not easy to work as social mobilizer and go door to door for making women aware of their own uterus. Women are never open to talk about their private parts. It’s not only about educating them. We must realize the life cycle of women and how they survive. Their decisions are influenced by their mother-in-laws and their husbands. We have to aware their counter parts as well.” These FCHVs and social mobilizers are given targets every month to refer women for accessing contraceptives and pregnancy check ups in health facilities by government as well asNGOs. Therefore, they have to visit door to door and use their interpersonal communication skills to make people aware and convince women to use long acting reversible contraceptive methods like IUCD and IMPLANT. 

  One of the FCHVs shared, “I have to work in my own community and adjoining VDCs. I have not faced any difficulty to talk about women’s SRHR to other community people but have been facing challenges to convince my own family and community. When I started working as FCHV, I have to carry condoms and oral pills in my bag. I have to distribute it among men and women of my own community. People gave me a tag “CONDOM DIDI”. I have been harassed verbally many times. However, at the end of the day the same person seek advice with me regarding pregnancy, contraceptives and even asked for condom.” She continued saying she has been working and “CROSSING THE LINES”. This means she has been crossing the gender construction of women not allowed to talk about SRHR among her family and relatives. She added, “Till today it’s very difficult for women living in rural part of Nepal to their own decision regarding their uterus. She has been seek advice from her husband. We have to support her. Therefore, crossing the boarder Of socially constructed norms that we must feel shy talking about contraceptive to in-laws, I have been talking to my brother-in-laws on using condom or letting their wives using IUCD or IMPLANT. It’s not easy though. I have been accused of misleading their wives to promiscuity. Whenever I have to talked to husbands I have to apology them in the beginning saying ” I’m crossing the boarder” and I care about their health.”

It was also found that these mobilizers love their work and dedicated to work for women and with women. However, they have limited experience on working with young people. They shared it might be due to generation gap or age difference they have not experienced young girls and boys approaching them for contraceptives. Instead they have been in direct contact with young married boys and girls. The FCHVs said, ” Not a single pregnant woman is passed unnoticed through their eyes.” One of the FCHVs referred herself as an astrologer. She shared, ” As I am quite popular in their community as FCHV, I am invited in most of the functions. It’s Nepali culture that you have to dance and sing in most of the functions. I am jolly person and I insist everyone to join me during dance. If someone denies to dance, it catches my eye. I have to ask her indirectly whether her husband is here, whether she has morning sickness and then they start to explain themselves about their pregnancy. After that now it’s my responsibility they visit health post regularly or atleast 5 times before delivery. And I fee chance to talk to the couple regarding using contraceptives.” 

  We also talked about barriers and difficulties they face in their work. Most of them shared that they have to visit the same woman for more than 5 times to make her decision to use contraceptives. Sometimes, even if a woman is willing to use contraceptives her husband might not allow her. You convince her today and next day she decides not to opt for contraceptives. FCHVs also observed that there are various myths and misconception regarding contraceptives in the community. There has been challenge to address those myths. They have been cases like woman comes to them and insist to use contraceptive as she thinks they have enough children. The woman uses contraceptives. She is happy and return to her home. After few days she comes again and requests to remove the contraceptive. Most of the male in the community are migrant workers. Therefore, women comes to them insisting removing the IUCD or IMPLANT as their husbands are away. Later they ends with having unwanted pregnancies.

My another curiosity was whether all these FCHVs know about “ABORTION”. My assumption was they are not aware of legality of abortion. They might be against abortion. However, my assumption was totally incorrect. These FCHVs knew abortion is legal in Nepal. They are positive towards abortion services. They have been referring women with unwanted pregnancies to safe and legal abortion service centers like district hospitals, Marie Stopes Centres, Family planning clinics, etc. On asking how you determine whether the health clinics are safe and legal abortion providers, they shared the Health clinics should have safe abortion logo and service providers should be trained and certified. They also shared they are against sex selective abortion. Almost all FCHVs have observed women in their communities seeking traditional methods of abortion and ending their life with complication and resulting into deaths. 

  Few FCHVs shared their experience of having safe and legal abortion. One of them shared, “Two children was enough for me. We also need to think about our economic status and raising our children with quality life but I was forced to keep my third pregnancy. Somehow I heard about abortion service centre. I went there by myself and talked with service provider. She did my pregnancy check up and on same day I had my abortion. I never regret for that as now I have happy family with two grown up kids.” 

Another FCHVs shared, “In 2050 B.S. I was married. After 10 years , I became FCHV. By that time I had two girl child. It was embarrassing for me to go around my relatives or celebrate any festival together. Each and everytime I was asked when I am planning for another pregnancy. They wished my another pregnancy could result a baby boy. Until I had a baby boy even my daughters are not respected in my family. They were also looked down. This gave a sense of revenge and wanted to show my relatives that I can also give birth to a SON. I performed abortion for two times. I was not ready for another pregnancy. However, my husband and I decided to have one more child and we wished that to be male child. For god’s blessing my last pregnancy turns out to be male child. After that I opt for female sterilization. Looking back, I feel myself a stupid person that I took it as challenge to give birth to a male child. Now this means nothing as my daughters are more respected in my family. All of the are doing good in their studies.” 

This is a treasure of memory that will inspire me to be one of them in future. It was indeed great to meet them and interact on perception of SRHR in the community and how they are battling in it. All of them are champions and in real sense they are hero of our community. They are contributing a lot in our health sector and making it possible to achieve national health objectives and targets.