Women's and Girls' Health in South Asia: Challenges for Global Policy

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A woman suffering from HIV/AIDS uses a stick to walk back to her bed in hospital. Cambodia. (© Masaru Goto / World Bank)

To learn more from our colleagues in Nepal about their heroic efforts and current challenges, staff from Planned Parenthood of New York City spent two weeks in May 2003 working with the Family Planning Association of Nepal. This exchange visit was sponsored by Global Partners of Planned Parenthood Federation of America. On our visit we met many extraordinary women: advocates, government officials and ordinary women, who have come together to work for change. These are their voices.

First let us hear from Uma, a woman who directs a woman's micro-credit association that provides loans to women to start small businesses. Uma thought the women in the village couldn't make any decision or attend meetings to participate in any social change. Now her organization provides vital services to widows, young single mothers and girls, including economic development, health care and literacy. Hear her story.

(Voice with subtitles)

The doctors and ob/gyns have seen firsthand the suffering of women who have had self-induced abortion or who have gone to unskilled and unsafe providers out of fear and desperation. Dr. Suda Sharma is the president of the Nepal Society of Obstetricians and Gynecologists. She and others in the medical community have worked to change the harsh anti-abortion laws. Hear her story.

Dr. Sharma: We have seen many women who come to the hospital with complications of abortion. If I tell you what are these kinds of complications, you would be shocked because some of them range from making a hole in the womb, rupturing the uterus and pulling out intestines. Those are the kind of complications we have seen. And we have seen practically everything from cow dung to sticks being inserted inside the wombs of the women. And some of them have died; some have recovered with a lot of morbidity. So all of this made us think, me personally and all of us in our OB/GYN community, that we really need to do something about this and it is high time that this was a legal service provision in all the government hospitals so that women do not have to resort to this clandestine abortion and invite all these complications. Basically the state of the women is what prompted me to advocate and to plead for everything that happened.

Announcer: Women journalists are banding together to raise the media's awareness about the status of women in Nepal. Among these groups is Women Communicators, founded by Banda Narana, a journalist and Nepali TV anchorwoman, who intends to harness the power of the media to raise awareness among Nepali women and girls about their reproductive rights. Hear her story.

Ms. Narana: My mother and grandmother never thought of information as a power. They never thought that they needed information. The only information they got was what was told to them by their husbands, by their fathers, by their brothers. And they were never taught that they needed to acquire this information. But interestingly now there is a growing number of women who are interested in information technology.

Announcer: Sapna Malla, founder of the Forum of Women, Law and Development is particularly concerned with the impact of US policies such as the Global Gag Rule and the restrictions on funding for United Nations Population Fund, which has had a negative effect on Nepal's efforts to increase access to reproductive health services and safe and legal abortion procedures. Hear her story.

Ms Malla: I am a direct impact of what we have been seeing with Family Planning Association itself and even UNPF funds. Even though it is not direct funding, we have been affected. In a critical time like this in Nepal where abortion has been legalized and now we are in a situation where we need to have services. We really need support from all the countries that could provide technical as well as services. We also see reproductive health rights as one of the fundamental human rights of women and on one hand we see America as a model. We also think that when abortion is not illegal in America, how can the government introduce such policies, which have such a negative implication in the lives of women, in developing countries?

Announcer: The strength and commitment of these women is moving Nepal forward. US policy should not be holding them back. We must make their voices heard by the policy makers who can make a difference. You can do something to help. Write your senators and representatives and tell them you support unrestricted international family planning assistance. Tell them to fully fund the United Nations Population Fund. Tell them to end the Global Gag Rule. Inform yourself and your neighbors about international sexual and reproductive health and rights. Take action. Thank you for heeding the voices of the women of Nepal.

Adrienne Germain: Now we should move to Dr. Bista, who is a key actor in one of the most important NGOs in Nepal, working to serve girls and women.

Dr. Nirmal Bista: Good evening ladies and gentlemen. I am here to talk about the Global Gag Rule (GGR) and how it is affecting the health and lives of women in countries like Nepal. From the film just shown one can easily know about the poor status of women in Nepal in all fields.

The problem is even more serious in the case of the reproductive health of women and the exercise of reproductive rights. Our society is characterized by early marriage. Almost 40% of girls get married by the time they reach 17 years of age. According to a Kathmandu based study, about one third of women in the rural area and one fifth of women in urban areas experience unwanted pregnancies. And due to early marriage, there are a lot of teenage pregnancies, with serious implications.

About one third of women have unmet needs in contraception and another one-third never expressed a desire for contraception. Both together are at high risk of unwanted pregnancy.

Nepal is considered the country having one of the highest maternal mortality rates in the world.I would like to share this figure: that 2,675 women become pregnant everyday, 991 women face unwanted pregnancies and 399 get pregnancy related direct risk. And it is heart breaking to know that everyday, 13 maternal deaths take place. A significant proportion of these maternal deaths are due to unsafe abortion. In the past women were sent to jail for having an abortion. Therefore the organizations like us, working in the field of reproductive rights and reproductive health, the major concern for us was the elimination of unwanted pregnancies and prevention of unsafe abortion.

Fortunately we came to the point in September 26, 2002, when both houses of Parliament approved the 11th amendment to the Civil Code Act which has liberalized the law relating to abortion and also provided the right to women to inherit property. That is a significant turning point in the history of Nepal. We popularly call it the 11th Amendment. We are not only talking about the high maternal mortality and how the liberalized abortion law can lower the maternal mortality rate. We also have to look at the high incidence of health-related morbidity, which affects the women, which affects the family, which affects the children.

Family Planning Association of Nepal, FPAN for short, is a leading non-government organization in the reproductive health and family planning field for 44 years and it contributes to one-third of the family planning services in the entire country.