(Kamala Sarup wrote a booklet on “Rural Women's Empowerment and Reproductive Health in Nepal”)
Reproductive health, as defined by the World Health Organization and adopted by the Programme of Action of the International Conference on Population and Development (ICPD) means “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so” .
The World Health Organization has estimated that as many as 20 million abortions each year are unsafe and that 10 to 50 percent of women who undergo unsafe abortion need medical care for complications. This is especially true in the case of rural women. They receive less attention when they fall sick. Infact, the majority of women receive no primare health care, primary education, clean water and safe sanitation. The Jakarta Declaration and the UN commission on the status of women indicate that priority must be given to attaining the goal of equality through gender responsive development policies.
In Nepal, most of the women die each day from pregnancy-related complications. Ninety percent of deliveries are carried out at home without skilled care. There is no assistance available for 11 percent of the deliveries. Of the 2,786 physicians registered with the Nepal Medical Council, only 130 are obstetricians/gynecologists, and almost all of them are concentrated in Katmandu Valley and other urban centers. According to the national census, adolescents comprise 24 percent of Nepal’s 23.3 million population. With their reproductive life ahead of them, they are a vulnerable and under-served group. Even in urban areas, women are unaware about reproductive health.
In Nepal sixty percent of the married women do not want another pregnancy immediately after giving birth to their first child, but among them only 17.7 percent have access to family planning devices. Gender inequality is rampant in all aspects of Nepali society and although women comprise 50.3 per cent of the population, the literacy is only 30 per cent compared to 66 per cent for males.
Studies by the Family Health Survey show that only 29 per cent of married women use modern contraceptives although another 31 per cent seek to use it. in 1990 the maternal mortality rate in Nepal was estimated at 1,500 per 100,000 live births. Nepal has an infant mortality rate of 82 per 1000 live births, of those 40% died within the first 4 weeks of birth. Only 7 percent of births have trained personnel in attendance. Contraceptive prevalence is as low as 26 percent and the fertility rate remain high at 5.0 (World Resource: A Guide to the Global Environment, 1998-99).
The National Health Policy (1991) seeks to reach reproductive health services and family planning up to the village level through health institutions. In each VDCs 3199 sub health posts were supposed to be established and 205 Primary Health Care Centres in each electoral constituency. The concept of reproduction, the dangers attached with repeated pregnancy, abortion and safe motherhoods of birth control have to be taught and advocated right from the grass root level only then the maternal mortality rate can be checked and reduced to some extent.
In an article published in The Kathmandu Post daily, Bidhan Acharya states that “Women are the poorest even within poor households. The distribution of power, income, and decision making all contribute to male supremacy. Keen observation suggests that women are always closer to nature and environment. They are concerned with drinking water, fuel-wood and fodder, farming, childbearing and rearing, and food and shelter for the family. Since the quality and quantity of food for the household too depends upon the women, the nutritional status of the total population is also largely dependent on the knowledge of nutrition among women. The irony is that women have been serving submissively as sub-ordinates.
Also Bidhan Acharya further reflects that "Attempts to raise the status of women face hindrances. The poor educational status of women is connected with their employment and the nature of the jobs they can have access to. Most educated women are confined to secretarial and sub-ordinate jobs. Women are not proportionately represented at decision-making levels. A kind of hesitation is frequently found when talking about women’s empowerment and women rights. Several intellectual women are scared to talk about, and quite a large number of men and women are reluctant to express their views publicly in favour of women’s rights, because they do not like to be listed as ‘feminists’. Feminism is not an isolated approach, but a campaign to mainstream poor and powerless women, but it is losing the affection of contemporary intelligentsia.
Many governmental and non-governmental organisations have several women empowerment programmes that are focused merely on cutting, stitching and tailoring and making pickles. These programmes have rather projected a poor image of women. Only a few organisations have created awareness for women to participate in social and political decision making".
The contrast of women’s access to care between the urban and rural are highly variable in Nepal. In most rural areas illiteracy rates among women are high. In recent years, the adolescent Reproductive Health has been a matter of priority. As the problem of Sexually Transmitted Diseases (STDs) including HIV/AIDs is increasingly a major threat in Nepal. Therefore, information, education and counselling for responsible sexual behaviour and prevention of STDs including HIV should become integral components of Reproductive Health services. Even the government has been a proponent of quality family planning and has been committed to educating women about contraception. However, many women marry young, and a strong value is placed on having many children, especially sons. According to a family planning survey the desire to have a son by women without children was found to be 86 per cent and 100 per cent of women who already had three girls desired for a son.
Women in Nepal also have little say in pregnancy-related decisionmaking. Family members make decisions for them. Women are the poorest even within poor households. Nepalese women have long been denied their birth-right to be in charge of their individual lives and as such have been deprived of their decision making power even on such vital issues as their own health care, health power even on such vital issues as their own health care, health care of their infants and young children as well as education and socio-economic welfare of their families.
Thus, it is believed that unless appropriate and adequate education and employment programmes are launched, the life expectancy of rural women will decline. The increase in the education of women and girls contributes greater empowerment of women, to a postponement of the age of marriage and to a reduction in the size of families. Similarly in Nepal has a vast difference in sterilization between the males and females. The fact here is, that the Vasectomy operation done on the males is easier and involves less risk as copared to the women sterilization.
It is very necessary that the nation understands the importance of the overall growth of the women and provide them with the various training facilities. It is also necessary to make arrangements for the social and financial development.
The role played by the women's organizations in Nepal is generally very feebly and insignificant. The government has prepared policies to enhance reproductive health activities in Nepal but physical, political and social factors continue to hinder the implementation of these policies and the population growth rate is still high. According to reports, Nepal’s reproductive health indicators are among the worst in Asia. In Nepal, many women remain unaware of reproductive health issues due to lack of education opportunities and to cultural inhibitions.
A number of seminars, workshops, symposiums, meetings are being organized in different occasions on different issues on reproductive rights. There are several acts and laws related to reproductive rights but there is no real changes and development. Much of our legislation has remained on paper. They never reaches down to the women. Government should know the political, economic and social empowerment of women is a prerequisting for development.
