<figure><img width="1125" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14329c7e80680e0a9967jpeg.jpg" alt=""/><figcaption>Married at 15, Dhiru Bista has been either pregnant or lactating every year since. Of the 12 babies she gave birth to, only seven daughters are surviving. All photos: SRIJANA DEVKOTA</figcaption></figure>Dhiru Bista is only 35, but looks much older. She has had 12 pregnancies, and the last one was a stillbirth four months ago that nearly killed her due to a ruptured uterus and internal haemmorhage.The struggle of her hard life is etched on Bista’s face, as she recovers from her ordeal. But there she is, not resting in bed but spreading the rice and buckwheat harvest out to dry outside her small clay brick house in Babala village of remote Achham district. Her young daughters play nearby, some babysitting younger siblings.Because her husband is within earshot, she is reluctant to open up. Only when she is taken to a quiet corner, does she finally whisper: “If sharing my life’s story will help other Nepali women escape the same fate, let me tell you.” <figure><img width="1125" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14359c7e80680e0a9968jpeg.jpg" alt=""><figcaption> </figcaption></figure>Married at 15, Bista first got pregnant two years later. Every year since, she has been either pregnant or lactating. Of the 12 babies she has given birth to, only seven daughters are surviving. The oldest is now 16, the youngest 18 months. Two of her daughters died shortly after they were born, while the other two were aborted.“There was always pressure for a son and every time I gave birth to a daughter, people questioned my inability to give birth to a son. My husband does nothing to comfort me,” says Bista, who despite the hardships, has managed to send five of her girls to school.Here in the culturally conservative society of far-western Nepal where all development indicators like female literacy, maternal and infant mortality are much below the national average, Bista is just one among <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/">many mothers with similar stories</a>.The preference for boys in the patriarchal culture means women are <a href="https://www.nepalitimes.com/banner/child-marriage-in-nepal-eloped-at-13-mother-by-17/">married young</a>, and are stigmatised every time they give birth to daughters. Because they are so young and undernourished at childbirth, many die at home or while being carried on stretchers to hospital.Read also:<a href="http://archive.nepalitimes.com/news.php?id=19596#.X4wTuNAzbIX">No time for school</a><a href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/ending-child-marriage-in-Nepal,3864">Not just a social problem, but an economic one</a>, Elizabeth Hanna Satow <img width="1125" height="1500" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d14399c7e80680e0a9969jpeg.jpg" alt="">Most women in rural Nepal still have no access to essential antenatal care during their pregnancy, resulting in grave complications at childbirth.“Her husband will most likely remarry now that she can’t get pregnant,” says a neighbour matter-of-factly.After she started getting contractions in her latest pregnancy in August, the neighbours carried her downhill for half-an-hour before they found a bus that could take her to Bayalpata Hospital. She was critical by the time she arrived at emergency, with dangerously low blood pressure.Her uterus had ruptured, and she had severe internal bleeding. The baby was in a transverse position with one of its hands sticking out of the cervix, already dead.The surgery took four hours, but Bayalpata’s doctors managed to save Dhiru Bista’s life. Fearing complications, the hospital referred her to the ICU in the district hospital in Dadeldhura, seven hours away. She was discharged five days later.Surgeons at Bayalpata said that this was one of the toughest maternity cases they have operated on. There have been 320 deliveries since the Covid-19 induced lockdown in April 2020, and all of them have been performed free of cost.<a href="https://www.nepalitimes.com/banner/bayalpata-hospital-in-nepal-wins-global-design-award/">Bayalpata is run as a public-private partnership by Nyaya Health Nepal (NHN)</a> with support from the Far-West Province, Sanfebagar Muncipality, and international funding. <figure><img width="1243" height="820" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d143c9c7e80680e0a996ajpeg.jpg" alt=""><figcaption> </figcaption></figure>The <a href="https://www.nepalitimes.com/banner/how-the-climate-crisis-adds-to-child-marriage-in-nepal/">Covid-19 pandemic has added to the already precarious healthcare</a> in these rugged mountains, as expecting mothers were unable to travel to health posts for regular check-ups. Institutional deliveries also dropped dramatically, which led to an increase in mother and infant mortality throughout the province.There have been cases of women giving birth while working in the fields, cutting the baby’s umbilical cord with their sickle, adding to the risk of tetanus infection for both new mothers and babies.Nepal has made <a href="https://www.nepalitimes.com/opinion/newborn-deaths-and-a-vision-for-a-post-pandemic-nepal/">rapid strides</a> in saving the lives of mothers and babies. The national average for <a href="https://archive.nepalitimes.com/news.php?id=18359#.YZ9jmVVByJA">maternal mortality</a> rate has dropped from 539 per 100,000 live births 25 years ago to less than 186, in 2017. But maternal deaths are still high in districts like Achham, and even the national average has stagnated in the last three years.Read also:<a href="https://www.nepalitimes.com/latest/child-marriages-up-during-nepal-lockdown/">Child marriages up during lockdown</a>, Namrata Sharma<a href="https://www.nepalitimes.com/here-now/on-air-to-deter-child-marriage/">On air to deter child marriage</a>, Shapira Jha<a href="https://www.nepalitimes.com/opinion/too-young-to-marry/">Too young to marry</a>, karuna Onta <figure><img width="1500" height="1125" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111016118/636d143f9c7e80680e0a996bjpeg.jpg" alt=""><figcaption> </figcaption></figure>Bista’s neighbour has two daughters, one of whom is handicapped. Her in-laws are already looking to remarry their son because they want a grandson. The daughter-in-law is not allowed to mingle with anyone, and works in the fields all day. There is no one to feed her children and her in-laws do not care for the girls – the youngest of whom, only one-and-half years old, weighs just five kg. Every household here has at least one male member working in India, and it is the money they send home that allows the subsistence farmers to survive. But when there is an illness or pregnancy in the family many cannot even afford the bus fare to go to hospital. Dhiru Bista would have surely lost her life if it had not been for the emergency surgery at Bayalpata Hospital. The facility has treated more than 1 million patients from seven surrounding districts in the Far-West and <a href="https://www.nepalitimes.com/banner/the-karnali/" target="_blank" rel="noopener noreferrer">Karnali</a> Provinces since it was set up 15 years ago, and many of them are maternity cases. Treatment and medicines are all free, and the hospital could be a model for other hospitals in rural Nepal. New investment to upgrade health facilities in remote settings is necessary to further reduce the maternal mortality rate in districts like these. Next comes education for girls, so that people are made aware of <a href="https://www.nepalitimes.com/here-now/can-nepal-end-child-marriage-by-2030/" target="_blank" rel="noopener noreferrer">the dangers of early marriage</a>. This would prevent <a href="https://www.nepalitimes.com/banner/no-conceivable-reason-for-unwanted-pregnancies/">unnecessary pregnancies</a>, thus saving lives. With elections approaching political parties are once more promising jobs and prosperity. But unless the lives of Nepali women and children are protected, there is no need for jobs.<a href="http://www.nyayahealthnepal.org/" target="_blank" style="letter-spacing: 0.01em;" rel="noopener noreferrer">Nyaya Health Nepal</a>

original

674x448

610x380

500x500

400x266

400x240

400x203

301x200

1084x550

Saving one Nepali mother at a time

<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

1250x600

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

The winter air pollution season started early this year with emissions, Diwali firecrackers and crop residue burning making the air unbreathable across north India. Much of the pollution was transboundary, with prevailing winds carrying the suspended particulates from Pakistan, across India to Nepal and beyond. All this pollution and domestic emissions killed 41,300 in Nepal in 2023, and 85% of all deaths were because of noncommunicable diseases such as heart and lung disease, lung cancer, diabetes, and dementia, according to the State of Global Air (SoGA) 2025 report released Thursday. With the onset of winter, Kathmandu Valley’s own emissions are trapped in a surface inversion layer and as in previous years will have some of the worst air quality in the world.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49.png" data-media-id="editor_0" data-image-id="20251023131016_7c42a4e8b0dce01dfeeaaf89dbb10dbfa036b41163f3ebada88c7ce17dbded49" data-rendition-name="original" width="921" height="850" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  The SoGa report says air pollution has now become the leading risk factor for deaths in Nepal, ahead of tobacco and high blood pressure. Interestingly, while the health impacts due to environmental risk factors such as unsafe water and sanitation have reduced significantly since 2000, the opposite is true for ambient PM2.5 (particles smaller than 2.5 microns). Globally, 7.9 million deaths were attributable to air pollution– about 1 in 8 deaths – in 2023. Of this total, 4.9 million deaths were attributable to PM2.5 exposure, 2.8 million were from household air pollution, and 470,000 were from ozone. Similarly, dementia attributable to air pollution resulted in 626,000 deaths and 40 million healthy years of life lost. And 95% of air pollution attributable deaths in adults over the age of 60 are due to noncommunicable diseases. The burden of noncommunicable diseases in relation to air pollution is rising worldwide and in Nepal. The SoGA report shows that nearly nine of ten global air pollution deaths are from chronic ailments, and half of all respiratory disease deaths are attributable to air pollution.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df.png" data-media-id="editor_1" data-image-id="20251023131020_8577f464b4a73007de5dd018b8ac91dae3a9c732dbb81a44b6aa5a0ced7df3df" data-rendition-name="original" width="1080" height="1080" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  In Nepal, air pollution is responsible for three out of four COPD deaths, one out of three heart deaths and one out of five diabetes deaths. More than one third of lower respiratory infection deaths were due to air pollution. “The data presented in the State of Global Air report highlight the significant impacts of poor air quality on the health and well-being of billions of people around the world, especially those living in Asia and Africa,” says Pallavi Pant of the Boston-based Health Effects Institute (HEI) that released the report in collaboration with the Institute for Health Metrics and Evaluation and the NCD Alliance. She adds: “Growing momentum on air quality management across those hard-hit locations, including expansion of air quality monitoring, adoption of air quality regulations, and sector-specific interventions are yielding improvements for those most impacted.” Low- and middle-income countries stand to gain most by reducing air pollution, with particularly strong impacts on children, older populations, and people with pre-existing health conditions. Indeed, of the 41,300 air pollution deaths in 2023 in Nepal, 31,600 were in adults over the age of 60 years and 3,500 in children below five years. Death rate for air pollution in Nepal, which is 178 per 100,000, is more than 10 times higher than high-income countries, which is at 17 per 100,000.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c.png" data-media-id="editor_2" data-image-id="20251023131020_604e852aed4ffde0dc7d1df72fcd3e73d904136dfb1bb2407e53b7445f3ef72c" data-rendition-name="original" width="1078" height="423" loading="lazy" alt="Air pollution killing season starts early NT"> </figure>  “Win-win solutions for air pollution and NCDs exist, with added benefits for climate, physical activity, nutrition, and many other global development priorities,” says Alison Cox, Policy and Advocacy Director at the Geneva-based NCD Alliance. “These policies are effective and deliver a strong return on investment - for the sake of our people and the planet we need to implement them faster.” Fine particle pollution (ambient PM2.5) is the largest driver of air pollution’s burden of disease worldwide as kit attributed to 4.9 million deaths and 124 million healthy years of life lost in 2023. Vehicles, power plants, factories, and homes, as well as agricultural and industrial activities, waste burning and wildfires are some of the biggest sources of pollutants. South Asia is among the regions of the world with the highest exposures to ambient PM2.5 , while more than 36% of people around the world live in areas where PM2.5 levels do not meet even the least stringent interim target. As per the report, 78% of Nepal’s 30 million population lives in areas where annual PM2.5 exposure exceeds the least stringent WHO Air Quality Interim Target of 35 µg/m3. Meanwhile, exposure to household air pollution due to the use of solid fuels for cooking remains an important driver for the disease burden in the country. “Ongoing efforts to meet global development goals are not achievable without directly addressing air pollution,” says Maria Neira, Commissioner of Our Common Air. “Countries and cities must focus their efforts toward reducing air pollution emissions, including household air pollution, which has particularly severe impacts on young children and older people across Asia and Africa.”

Air pollution killing season starts early

In 2004, Poet Durga Lal Shrestha asked me to translate 223 little poems from Newa into English. They were each written as sestet-- terse in their form but heavy in imagery and sentiment. The novice translator in me struggled to find the best way to convey his poetry in English-- but the process became a tour as I discovered my mother tongue anew. The highlight, however, was Shrestha’s handwriting. His calligraphy is immaculate. He had given me photocopies from the notebook he had written the poems in and each page looked as though they were freshly out of the press. The letters bore a consistency, unswayed by the emotions of his poetry. Sometimes, I would just stare at the handwriting in admiration.&nbsp; Someone else had been similarly besotted by his writing: “I met him 25 years ago in the UK when he was the chief guest at a Mha Puja event organised by Pasa Pucha,” recollects Ojesh Singh, writer and engineer. “We were roommates. I noticed he couldn’t stop writing.”&nbsp; Shrestha, an octogenarian now, was a teacher at Kanya Mandir School for many years, where his writing was admired by colleagues and students. Known as Janakavi or People’s Poet, a title bestowed on him by the Nepal Bhasha Parishad, Shrestha is also the recipient of the Jagadamba Shree Puraskar for his contribution to literature.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071052_b109f2ee6dbac911fb8002e8e8bb33a50a8f755d26662f333535d32c8573e782.jpg" data-media-id="editor_0" data-image-id="20251021071052_b109f2ee6dbac911fb8002e8e8bb33a50a8f755d26662f333535d32c8573e782" data-rendition-name="original" width="1600" height="900" loading="lazy" alt="Digitising the savant calligrapher NT"> <figcaption>From left to right: Suman Shrestha, Ananda Kumar Maharjan, Durga Lal Shrestha, Ojesh Singh, and Arbindra Man Singh. Photo: SUCHITA SHRESTHA</figcaption> </figure>  “He would write on anything he could lay his hands on. On tissue paper, envelopes, cigarette boxes. It struck me how neat and tidy his writing was,” says Singh. “The structure and size were perfectly in sync-- and as an aspiring graphic designer then, I fell in love with his writing. Later, whenever I read his books, I thought it would be nice to read them in his writing.” After sitting with the notion of turning Shrestha’s writing into a digital font for years, in 2024, he reached out to a small group of people who he thought might be allies.&nbsp; “It was during Ojesh Ji’s book launch that we met and talked about the possibility of turning Durga Lal Shrestha’s writing into font,” recalls Ananda Kumar Maharjan, who has designed the Durga Lal Shrestha font and is affiliated with Callijatra, an organisation promoting Newa calligraphy.&nbsp; For Singh, the desire to immortalise the poet's handwriting wasn’t only coming from personal admiration, it was also about preserving the writing of a language and literature leader and activist. He offered to fund the font project, which meant paying for Maharjan’s time and dedication. He also drew into the conversation Shrestha’s son Suman, who has been an integral part of the process.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071056_372dc34ac3ce3b70445128131a11ade8f321756c6cc7615825c4451e85f56374.jpg" data-media-id="editor_1" data-image-id="20251021071056_372dc34ac3ce3b70445128131a11ade8f321756c6cc7615825c4451e85f56374" data-rendition-name="original" width="616" height="728" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  The others involved in the process were journalist Arbindra Man Singh, who had been scanning Shrestha’s writing for the book Hastakshar, a collection of poems printed in the author’s handwriting. Also an enthusiast of converting Shrestha’s writing to a font, Singh provided help in bringing together the scans, based on which Maharjan picked the best letter for each alphabet to create a complete set.&nbsp; “Doing this was different from other font developments I have done in the past,” explains Maharjan, who has also digitised his own handwriting into a font, called Anand. “To create Durga Lal Shrestha’s writing as font, I had to analyse his writing archive and pick the best.”&nbsp; He adds: “There was a book published in his writing, so there were scans and digital archiving done by Arbindra Ji, which became the foundation for my work.” He had to find a prototype for each alphabet based on the scans. He traced the letters on Illustrator and copied them to a MAC software called Glyphs where he had to enter each letter, using a traditional Devanagari keyboard instead of Unicode.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/2025102108100_2f6b8c0f3cf91682707ac356e11ad50b342a4198f56490ab68d041e875b15edb.jpg" data-media-id="editor_2" data-image-id="2025102108100_2f6b8c0f3cf91682707ac356e11ad50b342a4198f56490ab68d041e875b15edb" data-rendition-name="original" width="818" height="766" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  “I had to be very careful to keep it accurate. Conjunctions need attention,” Maharjan says. “There are half letters, saint letters, ligatures and open type features to pay attention to, this is more advanced than the fonts I’ve created in the past.” &nbsp; Maharjan has designed this font in three different variations that users can play with. “Writing changes with age. While young, people write better, but with age, it starts to change. Since Durga Lal Shrestha hasn’t been very well lately, his hand shakes when he writes. So, we had to pick the best of his writing from the records,” he adds. “People also tend to write in different styles depending on their mood so we took the best four of every letter and traced and picked one.”&nbsp; Handwriting is deeply intimate and in this day and age of tech, becoming lost.&nbsp; What bothers me about the day of phones is that I no longer know what the writing of those close to me look like. I no longer know how you press the pen between our fingers or how you tilt it against the paper or how you pause to write periods or how the nib makes a perfect tiny orb before you drag it just so, to turn it into a comma. The familiarity of the nuances of someone’s writing is lost on us.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251021071056_2c83ab2c3ed4cfa42e6a6a637d88fd879218fb5b7391e086ab5db1a8ec173654.jpg" data-media-id="editor_3" data-image-id="20251021071056_2c83ab2c3ed4cfa42e6a6a637d88fd879218fb5b7391e086ab5db1a8ec173654" data-rendition-name="original" width="992" height="1280" loading="lazy" alt="Digitising the savant calligrapher NT"> </figure>  Ojesh Singh agrees with me. He says it’s important to keep handwriting alive as people become more and more tech-dependent. People are likely to interact even less with letters on paper, but at least we can have fonts, he says.&nbsp; A set of six books by poet Durga Lal Shrestha is set to be launched on 31October. One of them, entitled, Kawa, is typeset in the Durga Lal Shrestha Font. The font will be made available to the general public after the books have been released. In July, I had visited Shrestha, who I also call Durga Lal Taaba, as many Newa people in my generation do. Seated in the quiet of his home, he conversed about literature and language with my father and my uncle. Coming out of Taaba, Newa, which has a utilitarian function for me to communicate with my parents, sounded more like a lyric.&nbsp; I asked him what he thinks about his handwriting being archived as a font. He replied: “This body is going to be gone eventually, so I thought maybe my handwriting could live on.” Suburban Tales is a monthly column in Nepali Times based on real people in Pratibha’s life.

Digitising the savant calligrapher

Nepal needs to enact and enforce animal law

This year, the <a href="https://nepalitimes.com/opinion/quo-vadis-un-80-9vthn7mg">United Nations is marking its 80th anniversary</a> and it is being celebrated with special events across the world to commemorate its establishment on 24 October 1945. It has also been 75 years since the first UN adviser, the Swiss geologist Toni Hagen, was sent to Nepal to explore development opportunities. In 1950, there were no roads and Hagen walked on foot across the length and breadth of Nepal’s mountains, valleys and plains. This year also marks the 60th anniversary of the United Nations Development Program (UNDP) in Nepal, and much of Hagen’s work laid the basis for the UN’s involvement in education, health, and connectivity in Nepal’s future development. Despite frequent changes in government and political system, Nepal has made remarkable progress. The poverty rate has gone down by half in the past 30 years to 20.27% of the population. Much of it has to do with remittances from Nepalis working overseas, but it is also a result of the Nepal government’s investment in education, health care and social welfare.&nbsp; There have been special initiatives like the Prime Minister’s Employment Program that have provided jobs to nearly 800,000 people in the country’s 743 municipalities — especially in those areas with lower Human Development Index (HDI) like the far-west and the Tarai.&nbsp; This year’s HDI report by UNDP shows that Nepal’s score had risen to 0.622, whereas it was only 0.404 in 1990. In the past 33 years, the average lifespan of Nepalis has risen by 15.6 years to 70.4 years, whereas it was only 54.8 in 1990. However, the country’s HDI ranking is still 145 among the world’s 193 countries. “Yes, there has been significant improvement in living standards in the past 60 years, road connectivity has improved, the maternal mortality rate has gone down dramatically, almost everyone has phones, there are schools,” says Saru Joshi of the thinktank Nepal Policy Institute. But, she adds: “It is still difficult to get citizenship papers, especially in the name of the mother, and this has excluded many women from banking services, inheritance. After all our progress in physical infrastructure, Nepal now needs to prioritise inclusive social development.”&nbsp; Some of this is also happening. Eighteen years ago, Nabaraj Subedi, 49, of a village in Baglung decided not to join his peers &nbsp;fleeing the Maoist conflict to find work overseas. He invested Rs500,000 to buy a diesel generator and start a small furniture business.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031.jpg" data-media-id="editor_1" data-image-id="20251024071044_eeef308e19a73de507a425b2c6afc47269884549cf4c8fac07ca9a4898c8e031" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Nawaraj Subedi"> <figcaption>Nawaraj Subedi, 49, proprietor of Tarakhola Furniture Factory. </figcaption> </figure>  Today, with the installation of the 380 kilowatt small hydroelectric plant, he does not need to depend on his unreliable generator to power his equipment anymore. There is now a road connecting his village, and Subedi has generated local jobs, opened a sales branch in the city, and gets orders from as far away as Pokhara and Chitwan. “My costs have gone down drastically because of the electricity, and sales have gone up because of the road connecting my furniture to markets. My business has expanded,” Subedi says. Back in 1960 in a report he prepared for the Nepal government on behalf of the United Nations, Toni Hagen had emphasised just this: investing in electricity generation and connectivity to uplift the remote rural areas of Nepal.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d.jpg" data-media-id="editor_2" data-image-id="20251024081024_188ab121dc3cf2816ee71a72cb3687493eda37ab99ecc04802d647c8c9b4cd2d" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Tarakhola Furniture Factory"> <figcaption>Subedi's staff at the Tarakhola Furniture Factory.</figcaption> </figure>  Subedi’s furniture factory gets its electricity from the nearby Tarakhola Hydropower, a company set up eight years ago with financial and technical support from UNDP’s Renewable Energy for Rural Livelihood (RERL) project. &nbsp; “The project completely transformed living standards in this village,” says municipality chair Dhan Bahadur BK. “It has helped create jobs locally, there is now money to invest in education and healthcare. Households can pay their electricity fees electronically through smart billing.”&nbsp; After working with the government on rural electrification, UNDP is focussed on using that power for local employment creation. A women’s group, for example, has bought an electric-powered potato processing machine that can produce chips.&nbsp; “We are 12 of us mothers, daughters, daughters-in-law who process, package and market the potato that we grow ourselves, and it has raised our income,” says Sukmaya Roka, 57, who chairs the group.  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751.jpg" data-media-id="editor_3" data-image-id="20251024071044_70b22418699178bcdd0abb0aa308796980ecd29634bcda6ff113a7624e709751" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Sukamaya Roka"> <figcaption>Sukamaya Roka, 57, chair of Sipa Aalu Chips Utpadan Samuha from Tarakhola Rural Municipality, Baglung. </figcaption> </figure>  Today, 6.1 million households in Nepal (92.2% of total) have electricity in their homes, up from 17.9% 30 years ago. Access to electricity has not just brought lights to homes, but improved everything from productivity, quality of education, healthcare and phone connectivity.&nbsp; “To see what electricity and roads can do, just look at our municipality,” says chair Dhan Bahadur BK, “citizens have become more self-reliant, more aware of the outside world.”&nbsp; NETTLES INTO CASH&nbsp; Just a little bit of training, resource backup and local empowerment can uplift the living standards of Nepalis. The progress made in harvesting abundantly-available allo (nettles) and turning it into household products is an example. When a landslide swept away his home and farm in a flood 40 years ago, Buddhi Purja of Parbat became destitute. But he took part in a government training program supported by UNDP and Australia to harvest the wild nettles that grew on mountain slopes and turn the fabric into bags.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce.jpg" data-media-id="editor_4" data-image-id="20251024071048_56c440c478dffbc13911369b6f4133baf658cc3667773cdb44b7c40e006463ce" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Rhitu Saugat Handicraft"> <figcaption>A worker at Rhitu Saugat Handicraft making a bag out of nettles.</figcaption> </figure>  “After the landslide, we had to go hungry if we did not get a day job,” Purja recalls, “but after this training we have found that we can turn nettles into cash.” His allo bags are now hanging in tourist shops in Pokhara Lakeside and Thamel.&nbsp; The idea that nettles can be processed into useful fabric has not spread across the country, and new ecologically conscious consumers in Europe and elsewhere now import Made in Nepal nettle products.&nbsp; Purja started out with an investment of Rs500,000, and had a Rs20 million business that employed 25 workers. The Covid crisis in 2020 affected the sales, but Purja has recovered from it, sent his daughter off to study abroad, and is thinking of diversifying his product range.&nbsp;  <figure> <img src="https://publisher-publish.s3.eu-central-1.amazonaws.com/pb-nepalitimes/swp/asv65r/media/20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9.jpg" data-media-id="editor_5" data-image-id="20251024071044_ab6d15abcbb9a643e12a384f4bc488b7e210a8c95303fbe1b2f77716d26eede9" data-rendition-name="original" width="1500" height="1000" loading="lazy" alt="Buddi Purja"> <figcaption>Buddi Purja, proprietor of Rhitu Saugat Handicraft in Pokhara.</figcaption> </figure>  While UNDP’s project has made successful businessmen out of people like Purja, nationwide it has created 187,000 jobs in rural medium-scale industries. Much of what has worked in Nepal has been at the community level with decentralised projects like these that use the entrepreneurship of people like Buddhi Purja, Navaraj Subedi, and Sukmaya Roka. It is tantalising to imagine how much more progress Nepal would have made if their work could be replicated nationside and upscaled to the state-level.