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.
Filmmaker Deepak Rauniyar says his role is to examine the society he grew up in (south-eastern Nepal), not to make movies that entertain. That said, the director recently told the Nepal Now podcast that his upcoming film he will try to deliver his social commentary wrapped up in the genre of a police thriller.
Researching this article for The New Humanitarian it became clearer than ever that the status of maternal health in Nepal is cloudy at the best of times since accurate data is unavailable. In the COVID-19 pandemic, it’s really a guess.
Researching this article for The New Humanitarian it became clearer than ever that the status of maternal health in Nepal is cloudy at the best of times since accurate data is unavailable. In the COVID-19 pandemic, it’s really a guess: everyone assumes it’s getting worse but no one is sure. The local office of the UN Population Fund (UNFPA) was supposed to start an assessment with the Government of Nepal late in June but it has yet to begin. Read on:
As home births rise in Nepal, so do fears for maternal health
Home births are rising in Nepal as fewer pregnant women visit hospitals, fuelling fears that the coronavirus pandemic could reverse years of progress on maternal health in the South Asian nation.
The government says less than half of pregnancies are now taking place in health facilities, compared with about 70 percent before coronavirus lockdowns began in March. A separate survey of health facilities across Nepal, conducted by the UN Population Fund (UNFPA) in April, found that visits by pregnant women had dropped as much as 50 percent.
In June, Nirmala Joshi, 24, walked two hours to her nearest hospital in Baitadi, a mountainous district in Nepal’s remote far west, for her first prenatal check-up.
It was startling to learn that Nepal Prime Minister KP Oli admitted in Parliament on Tuesday that Nepal’s two coronavirus deaths to date represent a failure of his government. This raises the question: when will a leader apologise for the more than 1,200 women who die every year giving birth?
When will a Nepali leader apologise for the 1,200-plus women who die giving birth yearly?
The headline of this story refers to Nepal Prime Minister KP Oli, who a couple of weeks ago admitted in Parliament that his government had failed to prevent COVID-19 deaths. (As I write this Nepal has four COVID deaths). When the article was published on the Nepali Times website the headline was changed, removing that point. Regardless, too many women, and other Nepalis, continue dying because of the broken health system.
It shouldn’t be surprising that Nepal’s first COVID-19 death was that of a new mother. It was startling to learn that Prime Minister Oli admitted in Parliament on Tuesday that Nepal’s two coronavirus deaths to date represent a failure of his government. This raises the question: when will a leader apologise for the more than 1,200 women who die every year giving birth? Continue reading “‘We have failed’ new mothers”
If the current trend doesn’t change it will take the poorest Nepali families 50 years longer than the wealthiest ones to reach the target for the number of newborn deaths per capita. As the Covid-19 pandemic is leading to discussion about what kind of societies we want to live in, Nepal’s growing inequality should also be on the table. Read my latest article for Nepali Times.
The overall trend in neo-natal deaths is positive, but the poorest families will lag behind further as inequality grows
According to a recent journal article, it will be 2067 before newborn deaths among the poorest Nepalis have fallen enough to reach the global target set for 2030. That target, of 12 or fewer deaths per 1,000 live births, was attained by the wealthiest in Nepal four years ago, but the impact of COVID-19 may increase inequality and make it even more difficult for the country to reduce infant mortality.
If the pandemic shutdown is an opportunity to reimagine our societies, what should Nepal make of the widening gap in newborn deaths? Yes, overall trends are improving — both maternal and newborn health have made major gains in recent decades — but the poorest families are still lagging behind.
Chhaupadi is the traditional practice in parts of rural western Nepal of segregating women and girls outdoors when they have their periods. In the past decade, more than a dozen women have been killed while staying in a chhau (shed), some from a snakebite, others after lighting a fire to say warm then suffocating in a windowless building. Women and girls in sheds are also at risk of sexual assault.
In recent years there has been increasing focus on chhaupadi, including various attempts to end it, such as demolishing sheds, criminalising the practice and threatening to withhold social security payments from anyone involved in the practice. I wrote the article below for Nepali Times after learning that one hospital in the region has had great success in getting its community nurses to discontinue chhaupadi.
Tipping point on menstrual banishment in Nepal
It is easy to be cynical about recent reports of actions taken to end chhaupadi, the traditional practice in parts of western Nepal of segregating menstruating women.
This article was published in Nepali Times on Friday. I found the arguments difficult to follow, but I think the main point is that even when support appears to be available to assist women to adapt to challenges, like the impacts of climate change, they still lose some of their power as they are forced to adapt.
Given that programmes are being developed to assist those hardest-hit by climate change — mostly in low-income countries — that finding is important. Please read on!
Women in Asia and Africa hardest hit by climate change have a tough time adapting to the climate emergency, even with support from family or the state, finds a new study. The results raise questions for global agreements designed to help people adapt to the climate emergency, it adds.