Late last year I returned to Chimling Village in Sindhupalchowk district, in Nepal, to follow up on maternal health issues. I was impressed and disappointed at the same time.
Late last year I returned to Chimling Village in Nepal’s Sindhupalchowk district to follow up on maternal health issues. I was impressed and disappointed at the same time.
I first visited the cluster of tiny cement houses at the top of a steep, rocky and rutted dirt road in March 2021. My goal was to trace an essential drug called misoprostol, which is used to stop bleeding after birth (also known as post-partum haemorrhage). There was a major shortage of the drug in 2020, so Nepal’s Ministry of Health had requested help from the international community.
Kathmandu-born epidemiologist Dr Lhamo Sherpa says that early in her career she began questioning the treatment of women in Nepal
Working at a community hospital in Bouddha, Kathmandu soon after graduating with a medical degree exposed Dr. Lhamo Sherpa to situations that made her reassess the lives being lived by women in Nepal. For example, “there was this childless couple who came for advice. After all the investigations, when I told him the price for in-vitro fertilization… the husband said that he could get another wife (instead) for 50,000 rupees.”
Maternal health in Rohingya refugee camps in Bangladesh continues to make gains despite huge logistical, financial and cultural impediments
Twenty years ago I visited what were commonly called ‘Bhutanese refugee camps’ in southeastern Nepal. (In fact, they were camps of tens of thousands of Nepali-origin people living in Bhutan who had been brutally evicted from that country, with the tacit assent of regional superpower India. But that’s another story.) The tiny bamboo huts where people had to make their new lives were laid out in regular grids on the beaten earth of Nepal’s Tarai or plains region.
So when I imagined the Rohingya refugee camps in Cox’s Bazar, Bangladesh, that image of rows upon rows of tidy, tiny, bamboo buildings came to mind. It couldn’t be further from the truth. The massive Rohingya camps (housing close to 900,000 people) are located on hilly terrain. Because the Bangladesh Government refuses to recognize the Rohingya — who fled similar ethnic cleansing in neighbouring Myanmar — as official refugees, their ‘homes’ are not uniform buildings but a collection of irregular huts covering the hills.
Revising Nepal’s rape law is a priority but reducing cases of this violent act requires a societal shift
Almost one year ago, in January 2021, the Government of Nepal updated the country’s rape law. The changes were incomplete, partly because agreed revisions like widening the definition to include men and boys as victims were deleted at the last minute, but it was an improvement.
Changes that were agreed included increasing jail time for those found guilty and criminalizing any attempts to ‘settle’ a rape case outside of the courts, which is a regular occurrence.
A lifesaving drug cannot fix the sorts of systemic maternal health issues that I saw on a trip to one village
Almost exactly one year ago Nepal’s health department called an urgent meeting of its partners working in maternal health to ask if any of them could supply misoprostol, a drug used to stop excessive bleeding after childbirth. The Covid-19 lockdown had strangled supply and women in rural Nepal were reportedly dying for lack of the drug.
It took nearly six months for a 1-year supply of misoprostol to arrive via the UN Population Fund and an international non-profit, One Heart Worldwide (OHW), again as a result of the pandemic battering global supply chains. I read about this emergency and wanted to track the pills to their end users—women living in Nepal’s villages who were likely to give birth at home without a skilled birth attendant.
I’ve been reading about social determinants of health for some years now, but I had to see this phenomenon in practice before I truly ‘got it’.
It’s one thing to understand an issue or fact intellectually, another to experience it first-hand. That’s been made clear to me twice recently concerning health care here in Nepal and what are sometimes called ‘social determinants of health.’
One of my current projects is reporting about malnutrition during Covid-19. I contacted the Nutrition Home close to Kathmandu hoping to speak to the guardian of a child who had been admitted because they were malnourished.
Advocates for women were excited late in 2020 when they heard that changes were coming to Nepal’s rape law, which has long been criticized as ineffective. For example, youth activists who had met with the attorney general and other lawmakers were energized and excited by the process, as reported on my podcast, Nepal Now.
But when the ordinance containing the revisions was signed by the president, not all of the rumoured improvements were there. Left out was removal of the statute of limitations that says a rape charge must be filed within one year and broadening of the scope of victims of rape to include men, boys and persons of other genders.
Child marriage has risen in many countries since the world started locking down earlier this year. In fact, the UN Population Fund (UNFPA) is predicting that if conditions don’t change, the pandemic will contribute to an additional 13 million marriages of children (mostly under 18) in the next decade.
The causes of child marriage are many and complex — economic, social and cultural. In Nepal, girls are often seen as a burden: raised by their parents only to be sent away to live with their husband’s family, and on top of that a girl is usually expected to carry with her a dowry for the groom’s family, which can amount to a huge amount of cash and goods, big enough to put her family in debt for many years.
A report published online in the journal The Lancet Global Health this week revealed that the COVID-19 pandemic has caused 50% fewer women in Nepal than usual to give birth in hospitals, resulting in higher risks for premature births, stillborn deliveries and newborn deaths.
The study, conducted in nine hospitals across Nepal found that the stillbirth rate at hospitals and birthing centres increased from 14 per 1,000 before the lockdown to 21, and the neonatal mortality increased from 13 per 1,000 livebirths to 40.