Women with Disability and SRHR 

The disability prevalence rate in Nepal is nearly 2% according to National Demographic Health Survey, 2011. It is nearly 1.7% when it comes to women. Disability is both a cause and a consequence of poverty, where persons with disabilities are not only economically disempowered, but socially and culturally disempowered and excluded.

Women and girls with disabilities face triple discrimination: by being female, having a disability and being amongst the poorest of the poor. They are often subjected to discrimination in accessing education, employment and health care and are at a greater risk of violence, injury, abuse, neglect or exploitation. They are often excluded from the social life of their communities and family. Women with disabilities are particularly disadvantaged due to the multiple forms of discrimination they experience. For example, disabled girls are the least prioritized in terms of access to school and education. Development activities such as income-generating programs for women are largely not accessible to women with disabilities and do not take active steps to include disabled women. Furthermore, girls and women who have a disability are more likely to become victims of physical and sexual abuse.

Approximately 15% of the population, nearly 1 billion people live with a disability. Of which, 80% live in developing countries- 19% of women and 12% of men. Various health related issues are leading to disability. People with a disability face many obstacles in their physical and social environments that prevent then from fully excising rights and participating in social, cultural and professional life as others in society do.

Women with disabilities have traditionally remained invisible in both disability and gender policies. Effective inclusion of women and girls with disabilities in development interventions requires specific strategies and mainstreaming strategies, often referred to as a twin track approach.

Women with Disabilities and their SRHR

Last week I met one of my friend who is also person with disability and she shared her experience on the assumption that disabled women are asexual. This has led women with disabilities a barrier to access reproductive health care, contraception, and sexuality information and social resistance to reproduction and mothering. Disabled women are at risk for a range of undesirable outcomes, including coercive sterilization. This remains me that persons with disabilities have the same sexual and reproductive health needs as other people. Yet they often face barriers to information and services. The ignorance and attitudes of society and individuals, including health care providers, raise most of these barriers, not the disabilities themselves.

Talking to her I remember an incident when I was traveling to Jumla. I met a mother of mentally retarded girl. Her concern was safety of her daughter. At home there is no one for her daughter to look after her 24 hours. She came to the headquarter of Jumla to inquiry about the female sterilization service to a girl with disability. 

The interim constitution of Nepal ensures equality, freedom, justice and dignity of all individuals and implicitly mandates an inclusive society for all including persons with disabilities.

The persons with disabilities are often overlooked or neglected. Many persons with disabilities are marginalized, they are deprived of freedom, and their human rights are violated. Persons with disabilities have been denied information about sexual and reproductive health. Furthermore, they have often been denied the right to establish relationships and to decide whether, when, and with whom to have a family. Many have been subjected to forced sterilizations, forced abortions or forced marriages. In crisis situations these risks are multiplied.

It is hard to estimate the exact number of persons with disabilities who are affected by the earthquake or died in Nepal by the 25th April’s earthquake since there is no any system with government or any other agencies to track disability specific data at the time of emergency and post emergency situation. 

National Federation of the Disabled Nepal (NFDN), in coordination with its member organizations, has started collecting data of persons with disabilities who are affected by earthquake and have lost their lives. But due to the heavy destruction caused by disaster in district and lack of resource the data collection is getting a bit slow. So far, NFDN has updated the information of 1000 persons with disabilities. 930 out of that are affected in different ways and 30 have been killed. As per the information updated from different districts, the affected persons with disabilities are living on the following condition in the post quake situation.

Violence against persons with disabilities is intermingled by the fact that the victims may be physically or financially dependent on those who abuse them. When they come forward to report such abuse, the medical, legal and social service system are often unresponsive and inaccessible. They face many barriers to care and information about SRHR, GBV and abuse. There is a myth regarding persons with disabilities that they might not be sexually active has reinforce the obstacle toward accessing SRH services. However, research shows, the persons with disabilities are as sexually active a persons without disabilities. SRH services are often inaccessible to persons with disabilities for many reasons, including physical barriers, the lack of disability-related clinical services, and stigma and discrimination.

Attitudes of people differ from place to place and among different types of disability. The great majority of persons with disabilities face prejudice and stigma in their daily lives.Parents of children with disabilities often find themselves socially isolated. Stigma, poverty and lack of support systems take a toll on such families.

The most effective way to advocate for women with disabilities and their access to SRH services is to establish a dialogue with local organizations of and for persons with disabilities and other organizations working on behalf of persons with disabilities. “Nothing about us without us” is a key principle among persons with disabilities. The Convention on the Rights of Persons with Disabilities reflects this principle. It underscores the importance of including persons with disabilities at all stages of policy development, program planning, and implementation. Too often, persons with disabilities and organizations of persons with disabilities are consulted only after a policy or program has been designed. Persons with disabilities must be more than just recipients of SRH programs and resources. Policies and programs at all levels are consistently better when organizations of persons with disabilities take part in planning from the outset.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

My life At 15

I am born in a middle class family with good reputation and environment. My parents are educated and they are well known in the society. The priority of my childhood was to complete my schooling. Well there has been always a pressure on me and my cousins to score good marks and always be within top 5 in the class. I was in grade 9 when I was just 15. I was messing with my study and my physical changes. I hated going school in my periods. In my fifteen, none shared me that periods are normal and its natural. Nobody empowered me saying it is indeed good to bleed which symbolizes that I am fertile and I am able to give birth to new ones. I felt really embarrassed whenever I had my periods. I stopped playing with my male cousins and stopped siting in same bench with my male friends. I was juggling with my bodily changes and the societial norms. In school I was learning son and daughter are equal, I found its different in my family and surroundings.

In my fifteen I was suggested to join school scout by my principal but my mother denied. She said to become a Girl Scout I need physical strength which she thought I lacked. I had interest in sports. My dad indeed was the best football player in his time. He wanted a son with whom he could fulfill his dream to become national football player. Although he never showed that he actually wanted a son, he supported me to participate in sports. In my fifteen, I joined my school’s basketball team. We were trained for few months and we discontinued with the reason that we had to attempt School Leaving Certificate examination which means a lot. SLC exam was seen as iron gate and my family + my school had great expectation from me to score atleast 80% as they wanted me to join medical line in the future.  

 Even though my family is educated, it is influenced by societial norms and values. It’s a patriarchal community where daughters are believed as the responsibility of parents; to be married off in time. While I was studying in my fifteen, there were my relatives who were eager to fix my marriage. In my fifteen I got my first marriage proposal. I still remember it was winter and it was on holiday when my cousins started giggle. I asked them what’s the matter. They didn’t share instead laughed at me singing songs. My mom didn’t share this to me but my grand mom did. I didn’t know how to react. Is that a good news for me? Should I be happy? Mixed feeling. But my parents were against getting me married in my teen. They said they wanted me to complete my higher education, get job and decide what I wanted in my life. Although my parents stood for me people in my society did not digest that I should take my own decision to decide when, where and with whom I should get married. 

  I would like to thank my parents for standing with me. If they had not decided about my future to independence, I guess today I would have been mother of two children depending totally on my husband and getting drepressed of my life. Today I am a youth activists advocating for young girls and women for their right to access information and services to sexual and reproductive health. I have never regret of being girl. But the story is not similar to other girls. Girls in Nepal are deprived of education, information and health services. 

Today world celebrated International Day for Girl Child. In Nepal 17 percent of girls become pregnant or mothers for the first time as early as at the ages between 15 and 19 and almost 83 percent adolescents of the same age group lack access to modern contraceptives in Nepal. As a result of early and frequent pregnancies, many women and adolescent girls are undergoing sexual and reproductive health problems. Nepal comes to top 10 position among countries in the world and ranks third in South Asia with the highest child marriage rate.

 Stakeholders have said that rampant child marriage is the root cause of many problems such as gender-based violence, reproductive health troubles and school dropout, among others. As a result of rampant child marriage in Nepal, health of both women and girls is at risk.

The data of Nepal Demographic and Health Survey (NDHS), 2011, even suggests only 38 percent of women in Nepal know that abortion is legalized in the country and seven percent of maternal mortality is due to unsafe abortion. Nepal had legalized abortion on September 26, 2002.

So there are unfinished business when it comes to ensuring sexual and reproductive right of girls. Our society must realize that girls are not brides. Gender equality with equity should be ensure for girl. Girls should not hate themselves for being girls. The stereotypical concept of gender should be totally ignored and empower girls in education, sports, technology to achieve national health objectives.