<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016110/636d12069c7e80680e0a98b4jpeg.jpg" alt="" width="844" height="570"/><figcaption></figcaption></figure>I knew I wanted to get vaccinated as soon as the Covid-19 jabs were made available to the general public in the US, and that when it was my turn I would have access to it.It was not the same for people in Nepal, and I remember family and friends back home telling me how hard it was to get a vaccine earlier this year. And a lot of it depended on whether you had the right connections.People in Nepal were <a href="https://www.nepalitimes.com/banner/anger-grows-in-nepal-over-covid-vaccine-delays/">struggling to find their first doses</a>, whereas in the US people did not want to get vaccinated against Covid-19 despite a raging pandemic. Those without access to jabs were confused with those who did not want to get vaccinated.All international students studying in the US must provide proof of immunisations against <a href="https://www.nepalitimes.com/banner/a-shot-in-the-arm-for-vaccines-in-nepal/">MMR (Measles, Mumps and Rubella)</a>, Varicella Tdap (Tetanus, Diphtheria, Pertussis) and Meningitis.I completely understand the reasoning behind requiring those vaccinations, it is to keep people safe, and it never entered my mind to argue the logic.Did I ever feel like my freedoms were being curtailed because I needed to show proof of those inoculations? No. Did I feel like someone was infringing on my choice? No. Did I have a problem getting the necessary vaccine for the greater good? No.So why is it different with the Covid vaccine? The main reason to be vaccinated was so that I do not spread the infection further, as well as protect myself. The sooner we all got vaccinated, the sooner we would be post-pandemic.Which is why it surprised me that unlike <a href="https://www.nepalitimes.com/latest/too-early-for-nepal-to-let-its-guard-down/">Nepal</a>, where the vaccine acceptance rate is 97%, many in the US were choosing to not to get the jab because it curtailed their freedom of choice. The anti-vaxxers were also anti-maskers — and the puzzling thing was that they would however not protest against wearing seat belts to abide by laws against drinking and driving.They say Pfizer and Moderna have side effects. Of course they do, every modern medicine has some side effect. Even junk food has horrible side effects, but that hasn't stopped people from eating fries and burgers.And while anti-vaxxers are worried about their health, they have not taken the time to consider the health of millions of others they directly or indirectly interact with.I had spent most of my life in the US in liberal and progressive cities, so when I was met with the comparatively conservative crowd, I felt it was pointless to argue the subject because they had made up their minds and were not open to other opinions.Nothing has brought out the gap between haves and have nots than the Covid-19 pandemic. The global gap between the jabbed and jabbed nots is growing, increasing the chances of mutant strains evolving.In Nepal, we are not privileged enough to choose whether or not we will get a vaccine for a disease that has killed millions. We cannot even choose which vaccine we want: <a href="https://www.nepalitimes.com/banner/despite-doubts-nepal-sticks-with-astrazeneca-jabs/">AZ-Covishield</a>, VeroCell, J&amp;J. We take whatever is available.For most Nepalis, if there is a disease and there is a way to protect yourself from it, you just do it. There are no what-ifs.The fact that you even have the option to decide if you want to get inoculated against the virus in a country which has the highest national total of fatalities from Covid-19 shows how privileged people are in the US.When you are a <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/">daily wage worker</a>responsible for feeding and clothing your family, and when your government doesn’t give you a weekly unemployment allowance for staying at home unable to go to work, you want to return to your job as soon as possible. The only way to do that at the moment is to vaccinate and make it safe for everyone to be out again.I would respect the choice of the anti-vaxers not to get vaccinated if they stayed home and did not interact with the public. But they are out and about (and without masks) claiming that it is their right to do so.Being a citizen means having a sense of responsibility towards oneself and others and not using selfish excuses in the name of freedom to do whatever you want.It is a sensitive topic, and those who are most vocal and against the vaccine seem to be also the least informed about masks, <a href="https://www.nepalitimes.com/banner/climate-change-is-a-disaster-in-the-nepal-himalaya/">the climate emergency</a>, guns, abortion and politics. They live in social media echo-chambers where algorithms expose them to ever more radical posts.Recently, I asked a friend in the US if he had been vaccinated. Later, I was told that it is impolite to ask such questions. But if someone is out in public, mingling and exhaling, they need to be responsible about the health of those around them.The boundary of an individual’s freedom is when it infringes on someone else’s freedom.The decision not to be vaccinated is a matter of life or death for those not fortunate enough to have access to doses. While Americans are refusing to take <a href="https://www.nepalitimes.com/opinion/to-boost-or-not-to-boost/">booster third shots</a>, 70% of Nepalis have not even got their first doses.The next time I see a person drinking a beer while smoking a cigarette trying to rationalise their choice to not vaccinate, you know how that conversation will go.I can already tell you that my Thanksgiving and Christmas in the Land of the Free and the Home of the Brave will be a lot of fun.Anjana Rajbhandary writes this fortnightly Nepali Times column Life Time about mental health, physical health and socio-cultural issues.

Anjana Rajbhandary

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To vax or not to vax

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03729c7e80680e0a36d4jpeg.jpg" alt="" width="2048" height="1536"/><figcaption>Srijana Singh Thakuri in 2008 as a student in Surkhet. Photo: KOPILA VALLEY</figcaption></figure>My Dad wanted a son.I was the first daughter and after me came three younger sisters. My mother became pregnant three more times after that, all of them would have been girls.They were all terminated at illegal clinics where parents can learn the gender of their baby and opt for abortion if it is a girl. I know now that the practice is called <a href="https://archive.nepalitimes.com/news.php?id=19627" target="_blank" rel="noopener noreferrer">female foeticide</a> and common particularly in South Asia.My parents kept trying for a son, hoping a son would eventually come along. I was already old enough to notice the sadness and worry in my mother's eyes every time she found out that she was carrying another girl.My mother was blamed for being cursed and broken. Why was I not enough? Why were we daughters not enough?Eventually, our Dad abandoned us. One night, without a word, he disappeared, leaving us behind with a broken home, broken hearts, and a mob of debt collectors at our door at all hours of the day.My mother's health deteriorated. I hardly saw her smile. I began to work as a cook at a bus station to try and ease her pain. We sold bananas, fruits, and tried our best to get by. I promised my mother through her tears that I would be just as good as a son that she and my father so desperately wanted.I do not blame my Dad. Actually, I feel sorry for him. A <a href="https://www.nepalitimes.com/opinion/coping-with-the-patriarchy/" target="_blank" rel="noopener noreferrer">victim of patriarchy</a>, he never knew any different. Society had convinced him that girls are never worth the investment, that all they do is get married and go off to someone else's house, that families need sons to carry on the name and inherit ancestral property.But the irony is that we had no land for anyone to inherit. We had nothing. While trying for a son our family had plummeted deeper into poverty, debt, and depression.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03759c7e80680e0a36d5jpeg.jpg" alt="" width="1500" height="1000"><figcaption> </figcaption></figure>Eventually, things began to look up. I took an entrance exam for <a href="https://www.nepalitimes.com/banner/starting-nepals-green-school-movement/" target="_blank" rel="noopener noreferrer">Kopila Valley School in Surkhet</a>. The teachers came to know of my story, and by a stroke of luck I got one of the very few spots available to my age group. In the interview I explained that with a chance at education, I could help my mother care for my three little sisters, and help educated them too.I tried to channel my sadness and my anger into determination. I wanted to be the best at everything. Because of my Dad, I felt like I had something to prove. I became class captain. I joined the girl's empowerment club. I took traditional dance lessons.I wrote poetry and participated in debate competitions. I checked out books from the library. I studied late into night and completed all my assignments to catch up with my classmates. I grabbed every opportunity that came my way.One day there was an announcement that Kopila Valley School was starting the first-ever football team for girls. I showed up at that first practice on a dirt field without sneakers, sweat dripping down my forehead, ready to try something new. I had never seen a field before, watched a match, or even worn shorts.In my village every square inch of land was used to grow food, and sports were for boys on fallow terraces between growing seasons. I never knew that football was for me.I showed up every day to practice with coach Gopi. He treated me as he would boys. He yelled at me but also encouraged me. I still remember my first match and how it felt like putting on a uniform, chasing the ball down the field.Over time I started to get good at football and our team began winning matches. I scored goals and was particularly strong at defence, head balls, and corner kicks. But I also kept up with my studies, and started to get noticed as a student and an athlete.I made it into bigger teams and got recruited for tournaments. Rumours also followed. Neighbours gossiped about me, saying I came home too late or left too early. I was called selfish and that I had my head in the clouds. It got worse <a href="https://www.nepalitimes.com/editorial/that-time-of-the-month/" target="_blank" rel="noopener noreferrer">when I got my periods</a>, people telling me where I could go and where I could not, what I could do and what I could not.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d03799c7e80680e0a36d6jpeg.jpg" alt="" width="2016" height="1512"><figcaption> </figcaption></figure>I was going against how girls in my village were expected to behave: stay quiet, keep your head down, try not to get noticed, and when it is time, <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/" target="_blank" rel="noopener noreferrer">be marriageable.</a>I shook off the criticism and kept my eyes on my dream. I continued my education and graduated top of my class. I was eligible for scholarships, and enrolled in a college in Kathmandu. I kept playing football and showing up at tournaments, training all day and night.My story is not unique. It is just what happens when girls and women are given a chance, opportunity, and investment.I just turned 20, and last week I made the final roster for Nepal's national women’s football team. I signed a contract and my name was announced in the newspapers. I am now officially a professional football player representing my country.I have never felt so proud to be a <a href="https://www.nepalitimes.com/editorial/everyday-as-if-it-is-womens-day/" target="_blank" rel="noopener noreferrer">daughter of Nepal</a> even though there were times when I did not feel like my country was proud of me.I love putting on the red national jersey and walking into the stadium. I can still feel the thrill of kicking a ball, and a goal hitting the back of the net.I love football because it makes me feel free and strong and powerful. My next big dream is for the Nepal women’s team to play in the World Cup or qualify for the Olympics.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141156/636d037d9c7e80680e0a36d7jpeg.jpg" alt="" width="960" height="640"><figcaption> </figcaption></figure>After many years, my Dad came back to us. I would love to say that he had a big awakening and realised his mistakes, but that was not the case. Instead, he tried again for a son, and finally my little brother was born.I love my baby brother and hope he will get to grow up watching me play, so that he will have a different vision of <a href="https://www.nepalitimes.com/here-now/women-of-substance/" target="_blank" rel="noopener noreferrer">what girls are capable of</a>.My Dad got what he always wanted and I achieved my dreams. I had called him when I made the team, and I know he was proud of me.I also realised recently that I do not have anything to prove to him anymore. My dreams are for other girls like me whose fathers only want sons. My dreams are for my sisters and my mother. But most of all, my dreams are for me.

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Female foeticide to football

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221129151140/638619f69c7e80680e0cccd2jpeg.jpg" alt="" width="1500" height="844"/><figcaption>Photo: MARTY LOGAN</figcaption></figure>It should not be surprising that <a href="https://www.nepalitimes.com/latest/the-story-of-nepals-first-covid-19-fatality/" target="_blank" rel="noopener noreferrer">Nepal’s first COVID-19 death was a new mother</a>. What was surprising was to hear Prime Minister K P Oli admitting in Parliament on Tuesday that Nepal’s coronavirus deaths represented a failure of his government.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/3rd-month-of-lockdown/" target="_blank" rel="noopener noreferrer">Three Nepalis have died with coronavirus</a> since the pandemic hit Nepal. But that is the number of mothers who died every day across Nepal at childbirth. Despite dramatic strides in reducing the <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener noreferrer">maternal mortality</a> rate, 1,200 mothers still die while giving birth every year.Government statistics show that this number has risen dramatically in March and April, as women avoid hospitals because of the COVID-19 scare, as well as because of the lack of transport during the lockdown.The 29-year-old woman from Sindhupalchok, whose name has not been released, died on 16 May of post-partum sepsis and a <a href="https://www.nepalitimes.com/here-now/bhaktapurs-covid-19-heroes/" target="_blank" rel="noopener noreferrer">coronavirus infection</a> 10 days after safely delivering her baby at Teaching Hospital in Kathmandu, then returning home. There were delays in taking her to hospital after complications because the family could not find an ambulance.Even before the COVID-19 crisis, one of the reasons far too many Nepali women still give birth unsafely at home was the <a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNHGPAy4FgQc1EbtnlKIZJMxrFl6XA">high cost of ambulance</a> to take them to health facilities.Nepal has made <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener noreferrer">progress in reducing maternal mortality</a> and <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener noreferrer">newborn deaths</a> thanks to the Safe Motherhood program, for which it received global recognition. But that improvement was nowhere enough to conclude that the job was done and the country could rest on its laurels.Figures show that in 1990, 901 women died per 100,000 births. That number was slashed to 239 per 100,000 live births in 2015. Yet the target for 2030 under the global Sustainable Development Goals is less than 70.If the health of pregnant women is still a government priority it has not been obvious during the lockdown. Pregnant women have been too fearful to visit clinics for crucial antenatal checkups, but by now arrangements should have been made for them to do so safely — or alternatives put in place — and those plans communicated to women.Of course, post-partum mothers are not the only Nepalis dying because of the broken health system. <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">Non-communicable diseases </a> NCDs) are now the cause of most deaths in the country, led by heart disease, lung disease and stroke, but an NCD Multisectoral Action Plan spanning 2014-20 has yielded no visible results.The main causes of maternal mortality include post-partum bleeding, unsafe abortions, high blood pressure and post-delivery infection. Abortions aside — because there is still stigma attached to having one and a lack of knowledge about their legality — the other causes are treatable.Some initiatives have been taken. The President’s Women Uplift Program has used helicopters to rescue dozens of pregnant or post-partum mothers in emergency situations and many local governments have started programs to cajole or coerce women to give birth in facilities andto properly care for themselves and their newborns in the crucial days following delivery. But too many health facilities that should be providing services to pregnant women remain <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNEb9E7sQYw1XzmTTnMfGji3UmNybQ">under-staffed, ill-equipped and short of medicines</a>, and there is no visible national action plan, certainly no sense of urgency.Contrast media coverage of deaths of new mothers with those of women and girls practising chhaupadi in far western Nepal. Temporarily exiled from their homes during menstruation or after giving birth, they are at risk of snakebite, asphyxiation in tiny, windowless huts, and rape and physical assault. While outlawed, the practice continues.In recent years chhaupadi has been reported widely in Nepal and garnered numerous headlines in major global media. Yet, while roughly 15 women have died in <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/" target="_blank" rel="noopener noreferrer">chhaupadi</a> in Nepal since 2010, there have been 15,000 women who died in that time from causes associated with giving birth. For much of the media, death during pregnancy has become too routine to deserve coverage.The prime minister was right to admit failure over the COVID-19 deaths to date: his government <a href="https://www.nepalitimes.com/latest/has-nepals-lockdown-just-postponed-covid-19/" target="_blank" rel="noopener noreferrer">has had ample time to craft a much more effective response, and has not</a>  The deficits in the health system overall have been evident, and discussed, throughout the decades that the prime minister and his colleagues in all parties have been in power. That deserves an admission of failure, followed by corrective action.

3 Nepali mothers still die daily at childbirth

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58c19c7e80680e054852jpeg.jpg" alt="" width="1400" height="933"/><figcaption>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</figcaption></figure>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 <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/">unmet need for contraceptives</a>: 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: <a href="https://www.nepalitimes.com/?p=33714&amp;preview_nonce=033aa12640&amp;preview=true" target="_blank" rel="noopener">Nepal far from hitting contraceptive target,</a> Sewa BhattaraiAs our reports in this edition from Bajura and Chitwan show, there are cultural hurdles. With <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">husbands away working for long periods</a>, their wives are reluctant to use contraceptives because of what others will say. The result: women suffer unwanted pregnancies, <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">unsafe abortions</a> 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.<a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" target="_blank" rel="noopener">Complications during pregnancy or at childbirth</a> 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: <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">Implant service providers take contraception to Nepal's poor</a>, Rojita Adhikari

Born in Nepal

https://youtu.be/VaSUaALct0oParvati Thapa, 39, looks lost as she wanders into the district hospital in this isolated northwestern corner of Nepal. She and her husband have walked a whole day to get here, and they just found out she is 19 weeks pregnant.Thapa already has three children, and after they were born she lost four sons one after another. After her menstruation stopped, she suspected menopause but now knows she is pregnant for the eighth time.“My husband is away for months at a time, tending cattle in the mountains. Why should I use <a href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">family planning</a> when we meet so rarely?” asks Thapa, who looks much older than her age.Read also: <a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener">Born in Nepal</a>, Sewa Bhattarai<a href="https://www.nepalitimes.com/?p=33648&amp;preview_nonce=5c7e9df60a&amp;preview=true" target="_blank" rel="noopener"> </a>Like most women in the remote mountains, Thapa has never used contraceptives. <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">Doing so carries a stigma for married women with migrant husbands</a>, and there are misconceptions about the different methods available. The result is that women suffer unwanted pregnancies, <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/globe-rallies-to-aid-nepals-women,3841" target="_blank" rel="noopener">unsafe abortions</a> and end up with large families they are  unable to take care of.Nepal’s contraceptive prevalence rate is 53%, but in Bajura it is only 34%. Although this is a dramatic improvement from 20 years ago, it is still a long way from the government’s target of 75% contraceptive prevalence by 2030. The fact that the use of modern family planning methods has plateaued since 2006 points to futher deterrences.“The family planning rate is really low in Bajura because a lot of the men migrate to India for work,” says nurse Dhankala Khadka at Bajura District Hospital. “If the husband is away and the wife wants to use birth control, she is often questioned about fidelity and may be ostracised by her community. Even husbands do not support them.”<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58de9c7e80680e054862jpeg.jpg" alt="" width="1400" height="970"/><figcaption>Parvati Thapa went to Bajura district hospital suspecting menopause, but found out it was her eighth pregnancy. Photo: MONIKA DEUPALA</figcaption></figure>Almost every woman who visited nurse Khadka on a busy day last month had the same story: their husbands were away and they did not use birth control.There were 804 abortions in Bajura in the past year, which Rohit Giri of Bajura District Hospital says is very high: “Most who come to us are married women with children, and the abortions are due to the lack of birth control, which leads to unwanted pregnancies.”<a style="background-color: #ffffff; letter-spacing: 0.15px;" href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener">In Bayalpata Hospital</a> in neighbouring Achham district, the story is much the same — it performed 660 abortions in the past year. Bhawana Rawal, 33, has had two abortions at the hospital in the past five years and admits she does not used birth control.Read also: <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">Migrating males and population decline</a>, Om Astha Rai“I already have two children, and do not need any more, but I got pregnant twice by accident,” she says. “I still do not want to use contraceptives in future.” Rawal did try a Depo-Provera injection once but says it made her bleed too much. Other women have the same complaint. For those who do not want to use a permanent contraception, many felt pills were a hassle to acquire and take every day, and IUDs hurt.“Unwanted pregnancies often lead to anaemia because women lose so much blood,” says Kalawati Setthi, a nurse at Bayalpata Hospital. Nearly 40% of women in Far-western Nepal were found in a survey to be anaemic — most of them pregnant and <a href="https://www.nepalitimes.com/banner/back-to-the-nipple-in-nepal/" target="_blank" rel="noopener">breastfeeding</a>.The government has put up posters in rural hospitals to encourage contraceptive use but at this rate, it is unlikely that the target of 75% contraceptive use will be reached.<h2>Demand, but no supply</h2>According to the Nepal Demographic and Health Survey (NDHS) 2016, there is a 24% unmet need for family planning in Nepal — a quarter of women who need contraceptives are not using them. A report by Population Services international (PSI) Nepal found that unmarried youth aged 15-24 and married women aged 20-24 are the groups that use contraceptives the least.Married women like Parvati Thapa at a clinic in Bajura last month (left), normally tended to use contraceptives after their first child, and exposure to information about family planning through health workers and current users of family planning, as well as talking about it with husbands or relatives.Unmarried youth were likely to discuss family planning only with their sexual partners and most used condoms over other methods, which were bought and kept by the male partner. In contrast, married women visited health facilities themselves and chose the type of method they wanted.Unmarried youth, especially adolescents, had a higher unmet need and were more vulnerable to stigma associated with family planning. The report argues that the term ‘family planning’ only applies to married women and their plan to have children, whereas there are many contraceptive users who have no intention of having children, or use contraceptives to prevent sexually-transmitted diseases (STDs).Read also: <a href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/" target="_blank" rel="noopener">Child marriage in Nepal, eloped at 13, mother by 17</a>, Sewa BhattaraiWhen a woman goes to a public health facility for contraceptives, a register is filled out, which includes a column for ‘husband’s name’, which is another deterrent for unmarried women. Though the husband’s name is optional, there is no column for the wife’s name when it comes to male contraceptives like condoms or a vasectomy.A report by the UN Population Fund (UNFPA) about sexual and reproductive health says complications in pregnancy and childbirth are the leading cause 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.<h2>More choice for family planning</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e19c7e80680e054863jpeg.jpg" alt="" width="1400" height="1029"><figcaption> </figcaption></figure>Although Nepal’s contraceptive prevalence rate has increased dramatically, from 7% in 1981 to nearly 60% today, social taboos, patriarchy and unavailability mean that many women still do not have access to birth control.It usually falls on women to take the initiative, since many men refuse to use condoms or get a vasectomy. Popular contraceptives used to be the pill or Depo-Provera, an injectable that needs refrigeration and must be taken at a clinic, but the dosage is high and the injection painful.Now, women like Shanti Adhikari, 43, in Chitwan, (pictured, right) who have always used Depo-provera for short-term contraception, have a new choice: Sayana Press.Read also: <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener">Implant service providers take contraception to Nepal's poor</a>, Rojita Adhikari<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e49c7e80680e054864jpeg.jpg" alt="" width="524" height="531">Adhikari’s husband, who works as a security guard in India, will be coming home for Dasain, so she is at the health post in Nawalpur for her Depo-Provera progesterone hormone injection, which prevents pregnancy for three months.But auxiliary nurse midwife Sharada Rimal (pictured, left) tells her about Sayana Press. Its advantages over Depo-Provera are that it comes with its own small needle, the dosage is much smaller, it is less painful and can be self-injected.“Everyone in my neighbourhood comes to this health post for contraceptives, but no one told me about this new injection. The needle looks much smaller, I think I will go with this one,” says Adhikari, 43, as Rimal proceeded to inject her in the thigh.Sayana Press, a successor to Depo-Provera, is being launched in Nepal in two districts: Nawalpur and Sindhuli, by the reproductive health agency Ipas Nepal in coordination with the UK’s Department for International Development (DFID) and the Ministry of Health and Population (MoH). The drug has already been tried and approved, and is available for use in 40 European countries.What sets Sayana apart from Depo-Provera is the smaller dosage (104 mg compared to 150), it comes with its own needle, it can be stored at room temperature and is injected sub-cutaneously (just under the skin), rather than in the muscles like <a href="https://archive.nepalitimes.com/article/from-nepali-press/Ftnp-the-curse-of-the-contraceptive,493" target="_blank" rel="noopener">Depo-Provera</a>.Injectable contraceptives are the most popular reversible contraceptive among women, for a variety of reasons. Adhikari says she does not like pills because she has to remember to take them every day, and, because of her age, she wants to be discreet about using them.While most other methods, like IUCDs, implants, condoms and pills, are visible and can be discovered by others, an injection leaves no traces. 52% married couples use contraceptives in Nepal: 8.9% use injectables, 4.6% are on pills, 4.2% use condoms, 1.4% use IUDs and only 3.3% use implants. 9.8% use other traditional methods. Some have gone for permanent contraception, with 14.7% preferring female Sterilization and 5.5% male Sterilization.“Depo-Provera has been in use for 50 years, but it was so popular and effective not much further research was done on it,” explains Lhamo Yangchen Sherpa of Ipas. “But WHO studies found that a much lower dosage was enough.”<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141124/636a58e69c7e80680e054865jpeg.jpg" alt="" width="478" height="531">Health workers like Rimal confirm that Sayana Press is much easier to inject, more portable and less painful. Though it is self-injectable in some countries, in Nepal, where it has been undergoing trials in 14 health facilities of Nawalpur and Sindhuli since 5 September, it will only be administered by health professionals.Bhim Singh Tinkari of the MoH Family Welfare Division says that since 7% of pregnant women still die from unsafe abortions, making contraceptives easily accessible can save lives. Binod Bindu Sharma of the MoH links contraceptives to women’s choice and empowerment. “The availability of contraceptives is important for women’s rights, since it lets women choose when and how many children to have,” says Sharma, adding that the ministry is making Sayana Press available for free in health facilities.Lisa Honan, head of DFID Nepal, links contraceptives with women’s economic potential, adding that the country can make better use of women in the workforce if they have better choices of contraceptives. “DFID is committed to providing Sayana in any volume in Nepal until 2022 through UNFPA (the UN Population Fund), and would help Nepal scale it up all over the country if the results of the feasibility study are positive.”

Nepal far from hitting contraceptive target

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171116/63692f959c7e80680e03c0b2jpeg.jpg" alt="" width="1400" height="933"/><figcaption>Photo: Bikram Rai</figcaption></figure>When Deepak Gautam’s wife was pregnant with their second child, his older daughter came to him with a worried look. “I want a sister, but someone told me to wish for a brother. Otherwise I will have no one to celebrate Bhai Tika with,” said the then 7-year old.<a href="http://archive.nepalitimes.com/news.php?id=17564#.W77-bXszbIU" target="_blank" rel="noopener noreferrer">Bhai Tika is the last day of Tihar</a> when sisters and brothers bless each other, and this year, it falls on 9 November. Gautam reassured his daughter she could celebrate the festival, no matter what. When his wife Usha gave birth to a second daughter, the family started a new tradition: their daughters, now 10 and 3, put tika on each other.“Our daughters do not need to miss tika just because they do not have a brother,” says the couple, “they can give each other gifts, pray for each other’s happiness. We even decided to rename Bhai Tika as Tihar Tika.”Bhai Tika is an opportunity for reunions and celebration of sibling affection. There is a growing sense that like other festivals, it prioritises men and the rituals entrench a gender hierarchy.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171116/63692f989c7e80680e03c0b3jpeg.jpg" alt="" width="1992" height="1121"><figcaption> </figcaption></figure>“Women pray for the longevity and prosperity of brothers, but brothers do not wish for the same for their sisters, so the sisters are given less importance,” explains the girls' mother Usha Acharya. The hierarchy is even more evident in the festival of raksha bandhan, marked in southern Nepal and India in spring. That festival also celebrates siblings, but places men in the role of protectors of their sisters.“Seeing men as protectors and women as objects that need protection promotes aggressive masculinity in society,” says Pallavi Payal, 27, who has always celebrated raksha bandhan with her sister.Read also:<a href="https://www.nepalitimes.com/?p=14876&amp;preview=true" target="_blank" rel="noopener noreferrer">Go easy on the booze this holiday season</a>, Sonia Awale<a href="https://www.nepalitimes.com/?p=14800&amp;preview=true" target="_blank" rel="noopener noreferrer">Octoberfest</a>, EditorialIn other festivals like jitiya celebrated in the Madhesi community, women fast for the longevity of their sons, but not daughters. Says Indian feminist scholar Kamala Bhasin: “Patriarchal traditions like these harm not just women but also men. Little six-year-old brothers are sent to guard their teenage sisters. It places burdens upon men that they cannot possibly carry. It is worse for women, of course, because it entrenches their secondary status in society.”Women are barred from rituals if they are menstruating, which reinforces their ‘impure’ status. Many women then blame themselves for ‘spoiling the festival for everyone’.Nirmala Bhetuwal, 40, of Jhapa checks the calendar before Dasain, wondering if she will have to spend it in a corner. She has been taking hormone pills to delay her periods during major festivals at great cost to her health. Her husband has no idea she has to put herself through this.“Thank god these medicines exist, otherwise, the festivals would be soured for everyone,” says Bhetuwal.Read also: <a style="font-weight: bold; letter-spacing: 0.15px; background-color: #ffffff;" href="https://www.nepalitimes.com/?p=14883&amp;preview=true" target="_blank" rel="noopener noreferrer">The sacrifice of animal sacrifices</a>, Aashish Mishra<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/where-are-you-going-this-dasain/" target="_blank" rel="noopener noreferrer">Where are you going this Dasain?</a>, Sikuma RaiDasain and Tihar also come with added chores for women already over-burdened with day-to-day work.Saraswati Niraula, 48, of Tehrathum has not visited her parents during Dasain for ten years because she is too busy making festival arrangements for her husband’s family. She says: “My Dasain starts a month ahead, I walk seven hours to get the white clay to decorate my house. Then I beat rice for sel-rotis, and prepare for the Dasain feasts.”Dasain this year falls on 16-20 October, and men spend time in family reunions, card games, eating and drinking, while the women are usually busy cooking and cleaning up. Nepali women have traditionally accepted these unwritten rules as ‘their work’.Gender rights activist Meera Dhungana says discrimination prevails because of the sense of duty instilled in women by society: “The women’s economic, social and educational status, which are still low, are at the root of discriminatory festivals."Activists say that Nepal’s festivals must now change with the times, and many men have also begun to ask these questions and advocate for change.Read also: <a style="font-weight: bold; letter-spacing: 0.15px; background-color: #ffffff;" href="http://archive.nepalitimes.com/news.php?id=8860#.W77-UHszbIU" target="_blank" rel="noopener noreferrer">Between Dasain and Tihar</a>, Kunda Dixit<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="https://archive.nepalitimes.com/article/nation/dasain-goes-global,3950" target="_blank" rel="noopener noreferrer">Global Dasain</a>, Julia ThomasMen Engage Alliance, a group formed in North America in 2004, found its way to Nepal in 2007 and since then, has continued to raise its voice against the culture of masculinity.“While we worship women as goddesses during Dasain, they are barred from many Devi temples. Yet, the burden of organising the rituals lies disproportionately on women,” says Kapil Kafle, former South Asia coordinator of the alliance. “It benefits men if they share the labour. If a man portrays himself as an intimidating head of household, he may escape the work, but will not be loved. Men who help out at home gain the affection of family members.”As more young women are educated and their socio-economic status improves, things have begun to change. They now participate in rituals that were forbidden earlier, including last rites of parents. Families now make time for women to also enjoy festivals.“Men rarely visited their in-laws during Dasain in the past, but it is now the norm,” says Usha Acharya.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107171116/63692f9b9c7e80680e03c0b4jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Pallavi Payal also believes things are changing for the better. Women now fast not just for their sons, but also daughters during jitiya. And her inclusive raksha bandhan and bhai-bahini tika is not so rare anymore.Says Payal: “People used to accuse us of distorting culture and tradition, but our parents insist that we should celebrate our sisterhood as well.”Read also: <a href="https://archive.nepalitimes.com/article/nation/vegetables-and-famous-veggie-dishes-this-Dasain,3951" target="_blank" rel="noopener noreferrer">This dasain, vegetate</a>, Sonia Awale<a href="http://archive.nepalitimes.com/news.php?id=16337#.W77_zXszbIU" target="_blank" rel="noopener noreferrer">Enduring relevance of Dasain</a>, CK Lal<a href="http://archive.nepalitimes.com/blogs/mycity/2015/11/10/kukur-tihar/" target="_blank" rel="noopener noreferrer">Kukur Tihar</a>, Gopen Rai

Festivals of sisterhood

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221107111148/6368e2689c7e80680e033326jpeg.jpg" alt="" width="1500" height="856"/><figcaption>HEROINES: Nepal’s rural female health volunteers are at the forefront of protecting children and mothers and informing women about reproductive health. Pic: UNFPA Nepal</figcaption></figure>I am the daughter of a formidable campaigner for women’s reproductive rights in Nepal. Decades ago, when such issues were not part of the playbook for development activists, my mother, a medical doctor, started setting up family planning programs after seeing women die in childbirth, shifting from hospital work into public health.She established health posts for maternal and infant care. She fought for the reproductive rights of women and girls including access to contraception and comprehensive sexuality education. And most important, she instituted a network of female health workers all over Nepal.For a woman raised at a time when it was unusual for girls to be educated, my mother has travelled long distances. Not only did she fight for Nepali women to have a choice, but she ensured that her two daughters had the same privilege.I am myself now the mother of a daughter, who will soon enter adulthood.  She will then make her own decisions, including about her reproductive choices. My daughter is an Irish national.So I spent the weekend of 26 May, during the <a href="https://www.hrw.org/news/2018/05/26/ireland-votes-overwhelmingly-repeal-abortion-ban" target="_blank" rel="noopener">Irish referendum on abortion rights</a>, vacillating between crying with joy in one moment, and overwhelmed with anxiety about the outcome at another. My colleague Aisling Reidy, who is Irish, wrote movingly about her own experience of emotion and exhilaration that weekend. And about the need for other countries to move toward that arc of justice for girls and women.Many Irish women and men travelled back to Ireland to cast their yes votes. The hashtag #HomeToVote was trending on Twitter that weekend. The resolve to give women rights over their bodies was quite incredible.I write this not only because I care about my daughter’s rights. I write because the rights of so many women and girls in Ireland will hopefully change as a result of this vote. But above all, I write this also because it is occasion to be proud of my own country.Nepal, often in the news because of its urgent development needs, was, on this crucial issue, ahead of many of its neighbouring countries, decriminalising <a href="http://archive.nepalitimes.com/news.php?id=19627#.WxkWRu6FPIU" target="_blank" rel="noopener">abortion</a> in 2002.Women who had been imprisoned for abortion were released. Women today who want to exercise their choice over their bodies can legally do so, without restriction and with access to safe health care. Much remains to be done in Nepal, however, to ensure that those rights are available to all girls and women, regardless of financial or geographical situations.But today I celebrate my Nepali mother. And I rejoice for my Irish daughter.Tejshree Thapa is a senior Asia researcher at Human Rights Watch.