Nepal

Landlocked between India and China, Nepal is a country of geographic and cultural wonders, including the Himalayan peaks, ancient temples and colourful marketplaces. Nepal is one of the poorest countries in South Asia with 1 in 2 people living in poverty. Worsening civil conflict and poverty are the major obstacles to development. More than 12,000 people, mainly civilians, have died during the ongoing conflict.

Conditions facing women and children in Nepal are amongst the worst in the world. Nepal is a patriarchal society with extreme gender discrimination that results in females having less access to education, facilities & decision-making arenas. This results in poverty, poor health & disempowerment. Government policies addressing gender discrimination do not affect ground level reality. The health system has little money; only 5.3% of GDP is spent on health.& less has been available since the start of the civil war. The civil war has led to the destruction of health facilities and infrastructure, flight of medical professionals, lack of attendance at work & of refresher training.  Since the start of the conflict, HIV and other STIs have been increasing rapidly mainly due to community fragmentation and migration; there is increased poverty and sexual violence.

Health of Women and Children

Maternal and infant mortality is high; 1 in 13 children die before the age of 5 mainly due to hypothermia, infectious diseases, and poor nutrition. Over 1 in 200 mothers die in childbirth, due to lack of antenatal care, no trained assistant at delivery, haemorrhage and infection. The situation is much worse in rural areas where 85% of the population live. The birth rate remains high and many women marry as young as 12. A strong cultural value is placed on having many children in rural areas, especially sons. Unsafe abortion is also common.

Sexual Health in Young People

Young people aged 10-24 years, account for almost one third of Nepal’s population. sexual activity commences at an early age for the majority of Nepali women, usually within the context of marriage. Sexual initiation for boys also occurs relatively early, often with older married women in the community and without protection, as well as with commercial sex workers. HIV and other sexually transmitted infections are increasing rapidly, mainly due to community fragmentation. This has added to the vulnerability of young people; evidence suggests that the epidemic is now spreading even to those not considered to be in high-risk groups.

Young women complain that menstrual taboos continue to be practiced, where they are isolated from their community at the start of their periods, and unable to participate in activities whilst menstruating. Those that marry young often have no access to contraception and become pregnant as young as 12; many of these women and their children die in childbirth.

Gender Discrimination

Traditionally, girls are seen as “visitors” in their families; one day they will leave to live with their husband so it is not worth investing in their future. This view still prevails in rural areas but in urban areas it is changing. Girls are at the bottom of the priority ladder, and this expresses itself in many ways. More females than males die under 5 years as males receive better food and are taken to the health post sooner that girls. Boys are more likely to be sent to school and therefore to be literate and able to compete in the job market. Thus in a poor family, the girls will be the ones to get sick first and less likely to get the resources they need.