<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109141112/636ba77e9c7e80680e073787jpeg.jpg" alt="" width="1728" height="1296"/><figcaption>A woman gets Sayana Press suring the lockdown. Photo: IPAS NEPAL</figcaption></figure>For the past two decades, Basanti Paudel, 41, of Nawalpur had always used Depo-Provera to <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/" target="_blank" rel="noopener noreferrer">prevent unwanted pregnancies</a>  Then last year, she was given a new choice: Sayana Press.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/nepal-far-from-hitting-contraceptive-target/" target="_blank" rel="noopener noreferrer">Sayana Press</a>, a successor to Depo-Provera, was introduced last year in  Nawalparasi and Sindhuli and is a better option because it has a smaller dosage, comes with a small needle, can be stored at room temperature and is injected sub-cutaneously just under the skin rather than in the muscles, making it less painful. Sayana can also be self-injected at home and lasts for three months just like Depo-Provera.Basanti Paudel immediately took to the new contraceptive. “It is a much better, but I worry about its availability during the lockdown, and that I may have to go back to using Depo-Provera,” she says.Pabitra Acharya, 42, of the same neighbourhood also started using Sayana Press after her husband who was working in India came back home following Covid-19 pandemic. She would also like to continue using the injection but is also worried about its availability.“Once we decide on the contraceptive best for us, we should be able to access it each time. Using different methods affects our health,” Acharya says.Both women were at the Rajahar Health Post in Nawalpur this week to express their concern about availability. At the health post, Dev Bahadur Dahal  Nawalpur assured them that they would not have to go back to using Depo Provera.“The drug used in Sayana Press and Depo-Provera is the same, the only difference is the dose, which is 30% lower. We thought why not go for an option that has lower drug but is just as effective and not as painful,” says Lhamo Y Sherpa of Ipas Nepal, adding that depending on the results in the two districts, the new contraceptive would be scaled up to the rest of the country.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/implant-service-providers-take-contraception-to-nepals-poor/" target="_blank" rel="noopener noreferrer">Nepal’s contraceptive prevalence</a> rate at 53% is a dramatic improvement from 20 years ago, but it is still a long way from the government’s target of 75% contraceptive prevalence by 2030.Furthermore, the use of modern family planning methods has plateaued since 2006 <a href="https://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener noreferrer">due to labour migration</a>. But the <a href="https://www.nepalitimes.com/here-now/workers-return-to-jobless-nepal/" target="_blank" rel="noopener noreferrer">return of hundreds of thousands of migrant workers from India</a> and the Gulf following the Covid-19 pandemic is leading to an increase in the demand of contraceptives. Which is why there is a <a href="https://www.nepalitimes.com/here-now/baby-boom-expected-after-lockdown/" target="_blank" rel="noopener noreferrer">fear of shortages</a>  and also a break in the supply chain because of the lockdowns.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.Sayana Press offers a new and easy to use contraceptive that can help meet the country’s unmet needs for family planning. It also gives women agency, especially because their husbands often refuse to use condoms.The new birth control device is already popular with women in Nawalparasi and Sindhuli districts and very few users have complained of side effects normally associated with contraceptives. In fact, users have reported fewer reproductive health complications.“For 20 years, I never got my periods regularly, once I did not have them for two years, and had to resort to medications to force my period,” says Basanti Paudel. “Since using Sayana, it has become more regular. It evevn seems to have brought down my blood pressure, and I don’t have nausea anymore.”Dilmaya Pariyar, 29, has been using contraceptives for 12 years and once every three months she needed to go to a health post to get a Depo-Provera injection, which was always followed by a week of pain in her arms, preventing her from working.“With Sayana Press, I haven’t had any pains. In fact, this has been the most suitable contraceptive for me so far,” she says. The other advantage is that Sayana Press can be injected at home with some basic training.There are some women who have complained of excessive bleeding for up to seven days after switching to Sayana Press, but according to a survey, the new contraceptive appears to have been well accepted in the trials which are conducted by the reproductive health agency Ipas Nepal and the Ministry of Health and Population (MoH) with financial support from the UK’s Department for International Development (DFID). Sayana Press is already used in 40 European countries.Of 1,112 women from 17-49 years of age who participated in the Ipas Nepal comparative study, 12% said they preferred Sayana Press to Depo-Provera. Participants also found the fact that it was self-injectible quite appealing.Says Bhim Singha Tinkaro, head of Family Welfare Division in the Health Ministry: “Given the positive results so far, Sayana Press can now be expanded to other parts of the country, and the ministry is expected to make a decision soon.”

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New contraceptive for increased lockdown demand

<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

<h2>A Nepali Times survey shows adolescents want to know more about reproductive health, but don’t have anyone to turn to</h2>https://www.youtube.com/watch?v=eybD2-yOuc8&amp;feature=youtu.beAlthough Nepal has shown <a href="http://archive.nepalitimes.com/blogs/thebrief/2011/09/22/nepals-work-in-maternal-health-noticed/" target="_blank" rel="noopener">remarkable progress</a> in <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener">child and maternal health</a>, somehow not as much attention is paid to the needs of adolescents in the 10-19 age group who make up a quarter of Nepal’s population.Adolescence is a critical developmental transition from childhood to adulthood in which an individual goes through changes at all levels: physical, emotional, psychological and social. These changes bring with them special health needs and risks.Yet, the specific problems of this age group are overlooked by health care providers and the government. Surveys have shown that school-going adolescents do not get enough answers to questions about reproductive health, <a href="ttps://www.nepalitimes.com/here-now/migrating-males-and-population-decline/" target="_blank" rel="noopener">contraceptive use</a>, sexually-transmitted diseases. Rarely do they get this information from parents, either.“I have irregular <a href="http://archive.nepalitimes.com/article/nation/Girl-talk-period,2377" target="_blank" rel="noopener">periods</a>, and my gynaecologist just gave me medicines without explaining what was wrong. After I stopped taking them, I am irregular again, but I don’t want to keep taking medicines. I don’t know what to do, who am I supposed to ask?” said 16-year-old Nisha Thapa who often misses school because of her condition.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110711110/6368d7319c7e80680e0314cajpeg.jpg" alt="" width="720" height="400"/>All the girls interviewed for a recent Nepali Times focus group said it would have been much easier if there was a separate health facility for adolescents where they would feel comfortable and open to share problems, without feeling rushed or judged. Both girls and boys in the survey also said their schools did not explain puberty and reproductive health adequately."Our level of understanding is book-based. We know the definitions and basic concepts, but I cannot really apply that in real life," said 17-year-old Renu Adhikari. "I know what menstruation is, but I don’t know what is actually happening inside my body. I don’t know what causes cramps and how to ease it."Even in Kathmandu, there isn’t any separate department for adolescents in hospitals or health posts. Teenagers are directed to adult doctors where they may be too shy to express what is happening to them. Unsatisfactory treatment and lack of privacy are other fears.Many of the teenagers will be voting-age in less than ten years, and preparing them for life’s struggles should be a critical part of the education they get. But because of the lack of guidance from parents and teachers, they turn to peers or the internet for information, both of which give inadequate or inaccurate information.All this leads to mental stress and anxiety in many adolescents. A survey showed that one in every five teens in Nepal suffers from some sort of mental disorder, and suicide is the leading cause of death among 15-19 year olds worldwide. Cultivating a safe and non-judgemental environment for adolescents is therefore of key importance, health experts say.<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110711110/6368d7339c7e80680e0314cbjpeg.jpg" alt="" width="575" height="563">Investment in adolescents can be cost-effective, too. For example, safe motherhood is a top priority in Nepal’s public health. And if adolescent health had been given more importance, girls and boys would have had a more comprehensive understanding of reproduction – leading to fewer complications later in life.Surveys have shown that many Nepali women are unaware that giving birth before age 20 is not safe. Adolescent reproductive health education is urgent in a country where <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/child-marriage-in-Nepal,3863" target="_blank" rel="noopener">more than half of women are married by age 18</a>. Pregnancy related complications is the number one cause of death among girls aged 15-19 in Nepal.The Nepali Times survey of boys and girls aged 14-19 showed girls were mostly concerned about abdominal and body pain during menstruation, or irregular periods. (See box) For boys it was mainly wet dreams and sexually-transmitted diseases, especially HIV/AIDS.Sita Limbu, 19, is training to become a flight attendant. She has bad cramps and excessive bleeding. Instead of going to the gynaecologist, she takes pain killers.  Like many others, she doesn’t know that sedatives are not the answer to painful periods.Although 24-year-old Bina Gurung is not an adolescent anymore, she still has doubts about reproductive health: "I talk to my friends and older cousins, or go to Google to look up information, but I still cannot say that I know the pros and cons of various contraception methods. We never really had in-depth lessons in school, and we never spoke about it at home."The Nepal government developed a National Adolescent Health and Development Strategy in 2000 and revised it in 2015. In 2011, a National ASRH (Adolescent Sexual Reproductive Health) Program Implementation Guidelines, and a National ASRH Communication Strategy was introduced. Adolescent health was also given priority in the National Health Policy 2014.So Nepal seems to be well-placed in terms of plans and guidelines, but there are big gaps in  implementation. The Family Health Division has set up over 1,000 Adolescent Friendly Service (AFS) centres throughout the country, with at least 13 in each district. But only 56 are certified. In a recent visit, one of the clinics in Kathmandu was understaffed and there was not enough information to the public, especially adolescents, about where it was located. None of the adolescents or school teachers interviewed for this article knew about the government AFS centres, or of any counselling organisation.Birendra Pradhan at UNICEF says: "There are no controlled mechanisms for adolescent health care in urban areas. We need a multi-sectoral and coordinated effort. The government and development partners need to work closely."<h2>The silence</h2><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110711110/6368d7359c7e80680e0314ccjpeg.jpg" alt="" width="1500" height="1000">Most girls, even in Kathmandu Valley, do not know much about <a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/removing-menstrual-shame,4148" target="_blank" rel="noopener">menstruation</a> prior to getting it. Nirvani Sharma, a teacher at Uma Maheswor School in Lalitpur, had to send a Grade 6 student home after she came to school without wearing a sanitary pad when her periods started.“This situation could have been easily avoided if her parents had told her about periods,” Sharma said. Many school girls miss classes because of lack of awareness, or social and physical discomfort during menstruation. Some even drop out of school.Pranisha Adhikari, 17, says that although she is comfortable talking about most things, learning about menstruation in school wasn’t easy, mainly because of the attitude of boys in her class.“It is important for boys to also take interest in learning about <a href="http://archive.nepalitimes.com/news.php?id=19199#.WwvYTO6FO73" target="_blank" rel="noopener">menstruation</a>, so that they are aware of what is happening to their classmates, instead of making it more uncomfortable for us,” Adhikari said.This natural aspect of reproductive health is still largely viewed as something negative, shameful, dirty and embarrassing. All the adolescent girls interviewed for this story said that they were not satisfied with their knowledge of menstruation, and there was a lot they were still confused about. How to deal with period cramps, for example, was the top question everyone had. The second concerned menstrual hygiene.They suggested that since students spend so much time every day in school, it would be most effective if schools had regular programs discussing these issues, normalising the talk and attitude towards menstruation.Says Pranisha Adhikari, “What we learn through textbooks is helpful, but it still doesn’t equip us to deal with real life situations. For example menstrual hygiene is not discussed in depth, it is too important a matter for us not to know much about it. ”Read also:<a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/removing-menstrual-shame,4148" target="_blank" rel="noopener">Removing menstrual shame</a>, Clara Hare-Grogg<a href="http://archive.nepalitimes.com/news.php?id=19199#.WwvYTO6FO73" target="_blank" rel="noopener">That time of the month</a>, Rubeena D Shrestha<a href="http://archive.nepalitimes.com/article/nation/Girl-talk-period,2377" target="_blank" rel="noopener">Girl talk: period</a>, Anjana Rajbhandari

Let's talk about it

Fenerbahçe Beko won the Turkish Airlines EuroLeague finals in Abu Dhabi, held 23-25 May, defeating Monaco 81-70 in the final. Olympiacos, who defeated Panathinaikos 97-93, finished the series in third place. The Most Valuable Player (MVP) of the final match, Nigel Hayes-Davis from Fenerbahçe Beko, received a prize of 1,000,000 Miles&amp;Smiles from Turkish Airlines’ Chief Commercial Officer Ahmet Olmuştur. The carrier has been the title sponsor of the Turkish Airlines EuroLeague, a top tier tournament, since 2010.

Turkish Basketball

In the black and white photograph, General Wangdu smiles broadly in front of the dusty cactus garden in Kathmandu’s Annapurna Hotel. With an ill-fitting jacket and shaggy hair he looks benign enough, but this was the last leader of the Tibetan freedom fighters who led the resistance against the Chinese from their remote mountain hideouts in <a href="https://nepalitimes.com/here-now/comings-and-goings-in-mustang">Mustang</a>. Five months later, Wangdu was dead. Snapped in March 1974, I had only recently arrived in Nepal. How did I meet this legendary fighter? Possibly with his devoted camp follower, Lynne Klapecki, and probably in the Om Restaurant near Freak Street which was the preferred <a href="https://nepalitimes.com/banner/hippie-trail-nostalgia-in-kathmandu">hippie hang-out</a>. Om Lobsang and his brother Yeshe were <a href="https://archive.nepalitimes.com/page/earthquake-brings-back-memories-of-camps-for-tibetan-refugees">refugees from East Tibet </a>whose cafe offered a friendly welcome and<a href="https://nepalitimes.com/multimedia/momo-loco"> the best momos</a> - they became my in-laws after I married their eldest brother Tenzin, but that was a decade later.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1.jpg" data-media-id="editor_4" data-image-id="2025052403054_4573b34282b0f5395c007243d6bef12c7ba76bfd520419e994cdcea048d795a1" data-rendition-name="original" width="1000" height="1583" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Photo: LISA CHOEGYAL</figcaption> </figure>  Wangdu’s English was enthusiastically rudimentary, but even riding around town with him on the back of an aging <a href="https://nepalitimes.com/here-now/kathmandu-s-new-motorbike-museum">motorbike</a>, he was a commanding presence. Always flanked by armed outriders, impressive scars marked his forearms and a pistol hung from the cord around his neck. A charismatic guerrilla leader, Wangdu was celebrated by his followers for his tough commitment and respected for his measured pragmatism. He seemed so young to have shouldered such a responsibility of command, leading hundreds of hardened <a href="https://archive.nepalitimes.com/article/nation/50-years-after-the%20raid-into-Tibet,1012#google_vignette">Khampa combatants </a>through what had been a particularly <a href="https://nepalitimes.com/news/heavy-snowfall-over-nepal-himalaya">brutal winter in Mustang</a>, the last bastion to hold out against the Chinese invasion of their Tibetan homeland.&nbsp; The freedom fighters of Tibet, known as the Chushi-Gangdruk, had emerged to resist the <a href="https://nepalitimes.com/editorial/territorialism">Chinese takeover</a> of Tibet during the 1950s. Estimated to be 80,000-strong at the time of <a href="https://nepalitimes.com/here-now/what-or-who-after-the-dalai-lama">the Dalai Lama</a>’s final escape to India in 1959, the sheer number of Chinese deployed into Tibet eventually forced the Chushi-Gangdruk to retreat to Mustang, From this high Himalayan stronghold, they continued cross-border raids on the Chinese People’s Liberation Army (PLA) throughout the 1960s.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd.jpg" data-media-id="editor_10" data-image-id="2025052403054_8a4a935ba25ae79dc3a63bb5c14626927020e5ec098093c45ccb9a5982e009fd" data-rendition-name="original" width="1114" height="676" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Guerrillas known as the Chushi-Gangdruk emerged to resist the Chinese annexation of Tibet during the 1950s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>  Their Kathmandu base was a small discreet lodge in a back lane near Rani Pokhari. Sipping sweet tea from a blue mug with a chipped lid, I sat bemused in a corner of the Mustang Hotel room whilst Wangdu and his cohorts received a battered brown suitcase from their CIA connection, a tousle-haired American in a leather jacket. Heaved onto the dingy bedspread that covered the thin mattress, it was clicked open to reveal piles of neatly stacked dollar bills.&nbsp; I cannot think why Wangdu allowed me to witness this handover but I was clearly no threat, a newly arrived world traveller with no understanding of the stakes nor any Nepali or <a href="https://nepalitimes.com/multimedia/tibetan-music-in-nepals-sacred-valley">Tibetan language</a>. Despite armed guards in the corridor,Wangdu radiated confidence and bravado, and there was a practiced familiarity to the tense transaction. This deadly dance for many years had been funded by the Americans, tolerated by <a href="https://nepalitimes.com/here-now/the-kingdom-within-a-republic">Mustang’s residents</a>, and permitted by King Mahendra and the Nepali authorities who it suited to turn a blind eye.&nbsp; But Mahendra died in 1972, and times were changing. Richard Nixon’s ping-pong diplomacy thawed the cold war and signalled a fresh entente with China. Nepal’s yet-to-be-crowned <a href="https://nepalitimes.com/here-now/if-birendra-was-alive-nepal-could-still-be-a-monarchy">King Birendra </a>was under pressure to curb the irritating incursions against the PLA launched from the Nepali territory of Mustang. Keen to appease his northern neighbour, on several occasions the King summoned Wangdu for peace talks but, despite increasingly overwhelming odds, Wangdu refused to surrender.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb.jpg" data-media-id="editor_14" data-image-id="2025052403054_a8efd5cfb92cd997bd7cb74296a936fef46e2f7428f9cd642b03f1ac4ea11ecb" data-rendition-name="original" width="1055" height="885" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>General Wangdu flanked by two Tibetan resistance fighters in Mustang in the 1970s. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31.jpg" data-media-id="editor_15" data-image-id="2025052403054_75969125a745847a2ef82b6fe8b9106c0b21a116d85b8efdf5d2ee89a347bb31" data-rendition-name="original" width="1044" height="792" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>King Birendra with General Wangdu (right in dark glasses) taken in 1974 possibly in Mustang after one of their few attempts at negotiation. Photo courtesy: RAJRNDRA KUNWAR</figcaption> </figure>  While I naively rode pillion around Kathmandu in the spring sunshine, Wangdu was in the midst of what turned out to be his final round of negotiations with the Nepal government. Refusing to cease hostilities with the Chinese, Wangdu must have suspected the cost of his decision, making his cheerful smile in the photograph all the more poignant and brave. It was only much later that I appreciated the significance of the moment. Wangdu had been sent to replace the first resistance leader in Mustang, Baba Gen Yeshe, a much derided corrupt character who stole money meant for his troops and exploited fleeing refugees by seizing their treasures. Baba Gen Yeshe never forgave Wangdu,and sought revenge in May 1974 by betraying him and his commanders to the Nepal authorities. Renewed Chinese incursions from the north, active PLA collusion with the Nepali forces under the new King, and treachery from within the Chushi-Gangdrukranks combined to seal their fate.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0.jpg" data-media-id="editor_16" data-image-id="2025052403054_e0987a7c90d76431b0d7d5e6115ebfe3dbda7ab939e5941e079c18d722e884c0" data-rendition-name="original" width="1400" height="769" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>British television journalists George Patterson and Adrian Cowell embedded themselves with Khampa guerrillas and accompanied them from Tsum Valley on a cross border raid on a Chinese Army convoy in 1964. Photo: ESSAYS ON NEPAL / SAM COWAN</figcaption> </figure>  Mikel Dunham, renowned author of Buddha’s Warriors, writes: ‘It is possible that Wangdu was waiting for some cue from the Dalai Lama’s government-in-exile in Dharamsala, India. It is equally possible – during that last, <a href="https://nepalitimes.com/multimedia/the-human-cost-of-nepal-s-yarsa-gold-rush?fbclid=IwZXh0bgNhZW0CMTEAAR31-Cqw8oyIwMPzf_35e4Skr0ululJvLf3_vDkzHn-AYG2h8uPw2rqqErg_aem_tGVn5coY1-jA7fze_xqhew">desolate winter </a>– that he made the decision to go out in glory rather than admit defeat. Over the last fifteen years, Wangdu had experienced Tibet’s organized resistance being squeezed and shoved around by every conceivable outside force.&nbsp; First they had been pushed out of their own country by the PLA; then they had been refused sanction while on <a href="https://nepalitimes.com/opinion/borderlines/nepal-india-trans-boundary-bonds?fbclid=IwAR0PpJ5zUEbwdug3g_U3ar6FUugngRY0S8Tl2v_7wqzrsHmXWcXsKjvL4t4">Indian soil</a>; then they were abandoned by the Americans because, apparently, Nixon wanted to make friends with Wangdu’s mortal enemies, the communists; then they had been betrayed by the vampiric Baba Gen Yeshe – a Tibetan and, even worse, a fellow Khampa; and now, finally Wangdu’s army was being evicted by the Nepalis. One thing was certain: Wangdu was a warrior. To imagine Wangdu simply giving up and settling down in the pacific squalor of a <a href="https://nepalitimes.com/here-now/elderly-left-in-bhutan-refugee-camp">refugee camp </a>was unthinkable.’  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49.jpg" data-media-id="editor_20" data-image-id="2025052403054_8fc1ffef4ae751628b90ae781b66e11e51e4fdde2787207c9042efbee345ce49" data-rendition-name="original" width="500" height="746" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>The much derided Baba Gen Yeshe, the first Tibetan resistance leader in Mustang, who betrayed Wangdu for personal gain. Photo courtesy: MIKEL DUNHAM</figcaption> </figure>   <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3.jpg" data-media-id="editor_21" data-image-id="2025052403054_b1d833cdb00d3ac4416b844d8730475cd88c238caaaf8da69889a584eea229a3" data-rendition-name="original" width="500" height="656" loading="lazy" alt="The last days of the Khampa NT"> <figcaption>Aditya SJB Rana of the Royal Nepal Army whose team ambushed Wangdu and his cohorts at the top of Tinker Pass in Darchula, West Nepal. Photo courtesy: GAUTAM SJB RANA</figcaption> </figure>  By August 1974 the game was up. Wangdu and six of his exhausted party were killed on their horses by <a href="https://archive.nepalitimes.com/news.php?id=7270">the Royal Nepal Army</a> on the brink of escape. The officer in charge, Aditya SJB Rana, cleverly predicted their route into India after they failed to silence a police radio in Yari. A carefully laid ambush trapped them near the summit of the Tinker Pass in Darchula,at 5,000 meters the highest military operation of its time. Wangdu’s body was helicoptered to Kathmandu, and a big show made of the royal Nepal victory.&nbsp; The Tibetan armed insurgency against China had reached its end.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4.jpg" data-media-id="editor_23" data-image-id="20250524030520_3ff9c6fc85a65bc9a2c3afe9736d9f5f9413de752e790a5d9dca0981ea94f9b4" data-rendition-name="original" width="1136" height="702" loading="lazy" alt="The last days of the Khampa NT"> </figure>

The Last Days of the Khampa

Starting 17 September Turkish Airlines will fly daily to Seville, one of Spain’s major tourist draws. This is Turkish’s sixth destination in Spain after Madrid, Barcelona, Valencia, Malaga, and Bilbao. Seville is in the Andalusia region on Spain’s south coast with a rich Moor history. There are approximately 30,000 Nepalis living in Spain.&nbsp;

Turkish to Seville

The newly-formed Himalayan Art Council is set to launch Nepal’s National Art Protection Platform that seeks to preserve <a href="https://nepalitimes.com/banner/the-history-of-heritage">Nepal’s unique cultural heritage </a>using<a href="https://nepalitimes.com/here-now/artificial-censorship"> AI-powered tools</a>. The Council seeks to safeguard <a href="https://nepalitimes.com/banner/nepali-art-going-places">Nepali art works</a> from neglect, theft and counterfeiting as well as preserve existing artwork and celebrate living masters by giving them a cultural space to continue the <a href="https://nepalitimes.com/banner/sacred-survival">sacred art traditions</a>. "We are introducing a new digital platform designed to preserve, verify and elevate <a href="https://nepalitimes.com/banner/nepals-new-generation-of-alternative-artists">Nepal’s art for generations to come,</a>” says a statement from the Council, adding that the digital platform will use AI told for authentication and blockchain to keep track of works of art. Artists can now be protected by <a href="https://nepalitimes.com/multimedia/ayo-ai?fbclid=IwAR1uwmTVq4gUB70ljfRezjzukD9ArWXPuMnUikopeQ8PoiZMjicToPSwhKE&amp;=1">AI tools</a> that detect forgeries, identify their work even when unsigned, and ensure they receive proper recognition and credit. The archives will be searchable with translated inscription and interactive guides. Says curator Meena Lama: “AI and blockchains are tools that give us the power to detect fakes and identify unsigned paintings and track every piece. With these tools we can restore trust, secure authorship and give artists the dignity they deserve.”  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53.jpg" data-media-id="editor_6" data-image-id="20250514170544_2ab58f6313c0458f75114a692b0016bd9efb3b59d5f8f07f0da72e1e37b82f53" data-rendition-name="original" width="1300" height="1000" loading="lazy" alt="Artwork at the Traditional Art Exhibition at Patan Museum."> <figcaption>Artwork at the Traditional Art Exhibition at Patan Museum.</figcaption> </figure>  The Council is also holding an exhibition of Nepali cultural masterpieces with 50 historical <a href="https://archive.nepalitimes.com/article/Nepali-Times-Buzz/Buzz-the-art,671">thangka and paubha </a>by past masters and <a href="https://nepalitimes.com/review/between-the-sacred-and-everyday">contemporary works by current artists</a>. This curated collection is a living tribute to <a href="https://nepalitimes.com/here-now/when-yaks-go-so-does-culture">Himalayan culture</a> with economic depictions of deities, mandala and sacred narratives. The exhibition at <a href="https://nepalitimes.com/multimedia/a-portal-into-patan-s-past-and-present">Patan Museum</a> also provides an opportunity to meet painters and custodians of art and culture. Read also: <a href="https://nepalitimes.com/review/golden-deities">Golden deities</a>, Sewa Bhattarai ‘The exhibition is only the first step in a long journey to ensure that Nepali art is no just seen but fully understood, <a href="https://archive.nepalitimes.com/article/nation/Narratives-of-Faith-and-Memory-Remembering-the-Lost-Sculptures-of-Kathmandu-exhibition,987">protected and remembered</a>,’ the Council says. Artist Kailash K Shrestha of Artudio has spent decades promoting thankha and paubha traditions because of their beauty and devotional meaning. But he also says artists are underpaid, exploited and ignored. He adds, “AI and blockchain are not just buzzwords, they are powerful tools that can protect Nepal’s artists from fraud, verify authenticity and build a permanent record of provenance.” Traditional Art Exhibition Till 17 May Patan Museum

contraceptives