Born in Nepal

WELCOME TO THE WORLD: A child sleeps in a hammock while its parents work in a workshop making idols for the Dasain festival in Kupondol. Photo: GOPEN RAI

Giving birth is a life or death issue in Nepal. Even though the maternal mortality rate dropped from 1,000 per 100,000 live births 40 years ago to 239 today, inadequate birthing facilities is still a problem. But attention is now also shifting to preventing pregnancies.

There is a big unmet need for contraceptives: nearly a quarter of women surveyed nationwide in 2016 said they were not using birth control, even if they need it. Social stigma, patriarchy, ignorance and lack of access were reasons.

Nepal’s contraceptive prevalence rate is 52%, but in remote Bajura it is only 34%. Although progress is being made, we are still a long way from the government’s target of raising the rate to 75% by 2030.

Read also: Nepal far from hitting contraceptive target, Sewa Bhattarai

As our reports in this edition from Bajura and Chitwan show, there are cultural hurdles. With husbands away working for long periods, their wives are reluctant to use contraceptives because of what others will say. The result: women suffer unwanted pregnancies, unsafe abortions and ultimately struggle to take care of large families.

Almost every woman who visited a hospital in Bajura on a busy day last month had the same story: their husbands were away and they did not use birth control. Some were suffering from botched abortions.

More than 800 abortion cases were registered in Bajura last year. Just one hospital in Achham terminated more than 600 pregnancies in one year. Meanwhile, Nepal’s total fertility rate has dropped from 6 in 1960 to near-replacement level at 2.05 today, and the country’s population growth rate is also down from 2.5% in 1990 to 1.1% today. Surveys in Province 2 and Far-western Province have shown a clear correlation between unwanted pregnancies, child marriage and fertility in regions with entrenched patriarchy.

Among Nepalis, 21% use injectable contraceptives, 10% are on pills, 10% use condoms, 8% have IUDs and only 3% have implants. Depo-Provera was among the most used injectables, but it was difficult to administer and painful. Now, the government, with donor support, is field-testing in Nawalpur and Sindhuli a lower-dose injectable called Sayana Press, which could make contraceptives more accessible to women.

Interventions like these, the government hopes, will reduce unwanted pregnancies, thus preventing unsafe abortions and reducing the number of women who have to take care of larger families.

Complications during pregnancy or at childbirth are the leading causes of death among girls aged 15-19 in low-income countries like Nepal. Unwanted pregnancies also hamper women’s education and economic independence, and impact their family life, fuelling an intergenerational cycle of poverty and poor health.

Read also: Implant service providers take contraception to Nepal's poor, Rojita Adhikari