Reproductive Health
Investments in reproductive health save and improve lives, slow the spread of HIV and AIDS and encourage gender equity, equality, and women's empowerment. Long-term benefits of a healthy population include poverty reduction, improved quality of life, stabilized population growth and sustainable development. The results of a healthy population are far-reaching. The impact ripples across societies.
Situation Assessment
Access to health services in Nepal is limited due to remote mountainous areas, poor infrastructure, lack of sufficient and qualified health personnel, and socio-cultural and language barriers especially among excluded groups. The conflict had a serious impact on health-services delivery. Women's lack of access to health care, information and education contributed to high levels of female mortality and morbidity. Nepal has a high rate of adolescent pregnancies and roughly 20% of adolescent girls are pregnant or are mothers with at least one child. About half of them do not receive adequate obstetric care. 19% of maternal deaths occur among this age group.
Many other health and social issues are related to adolescent pregnancies and early marriages. A widespread adherence to traditional gender roles and some harmful cultural beliefs and practices prevent girls and women from making decisions about their reproductive lives and exercising their reproductive rights, effectively limiting the reproductive health care they receive. Due to early child bearing, the educational and employment opportunities of women are greatly reduced. While the number of in-school and out-of-school education programmes that incorporate basic reproductive health issues as part of overall life skills and HIV peer education are increasing, current coverage remains limited. Adolescent sexual and reproductive health (ASRH) issues have not yet been incorporated into the basic health-service delivery packages. There is also limited capacity amongst teachers and health providers to provide necessary youth-friendly information, services and counseling. Nearly all Nepalese women and men know at least one method of contraception and there is marked increase in the use of contraceptives. Nevertheless, there is a considerable scope for increased use of family planning (FP).
A severe problem encountered by numbers of Nepalese women is uterine prolapse, a medical term for the maternal illness where the pelvic organ, the uterus, the rectum or the bladder protrudes into the vagina. In severe cases the uterus falls out of the vagina. Although the problem is common worldwide, it strikes women in Nepal at a young age, and is rarely treated. Its prevalence among women in reproductive age exceeds 10 percent and is as high as 24 percent among women between the age of 45 and 49 years old. According to a population based survey carried out by UNFPA/World Health Organization and the Institute of Medicine Tribhuvan University in 2006 all together more than 600,000 women are found having uterine prolapse and of them nearly 200,000 are in immediate need of surgery. Uterine prolapse is related to poverty and associated factors of discrimination against women, the denial of their human and reproductive rights, unequal gender relationships, and as a consequence of sexual and gender based violence and low level of maternity care. Ill treatment by mothers-in-law and husbands during pregnancy, chronic under-nutrition, early marriage and pregnancy, repeated pregnancy, difficulties during child birth, lack of skilled birth attendance, heavy manual work and sexual relationships just after child birth increase the prevalence of uterine prolapse.
Formerly a low prevalence country, Nepal has now entered the 'concentrated' epidemic phase, which means that HIV infection in one or more sub groups is significantly higher. A 2005 study estimates 70,000 people in the adult population (15-49 years) are living with HIV in the country. There is lack of correct knowledge about HIV and AIDS prevention. Sexual transmission is the major transmission mode in Nepal and the majority of the 'Most at Risk Population' (intravenous drug users, commercial sex workers, migrants, men who have sex with men) are young people. Although the knowledge on HIV and AIDS has gone up significantly among young people, studies have shown that they do not have adequate information and skills to protect themselves against HIV and AIDS or access to services that are friendly to them. Another key vulnerable population to HIV infection is women. Poverty, gender inequality, biological factors, violence, conflict and socioeconomic factors have further exacerbated women's vulnerability. In the West and Far West of Nepal, feminization of HIV and AIDS is becoming prominent with HIV positive migrant spouses returning from India, particularly following the peace process.
Nepal 2007 Estimations of HIV Infections: Key Messages - National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, 8th April 2008
Our response
Reproductive health is at the core of UNFPA activities. The Fund's Reproductive Health Programme in Nepal contributes to increasing utilization of quality reproductive health services by women, men and young people and awareness of reproductive health risks and benefits of behavioral changes regarding safe-sex and reproductive health practices. The programme concentrates on policy issues and strengthening of capacity at the central level and on improving the provision and equitable utilization of quality reproductive health services at the district level by men, women and adolescents, including socially excluded groups. UNFPA's holistic approach to reproductive health care includes:
- Access to a range of safe and affordable modern contraceptive methods and counseling;
- Maternal and neonatal health care;
- Prevention and management of HIV and AIDS among high risk groups, including other sexually transmitted infections;
- Support to strengthen national response to AIDS;
- Adolescents sexual and reproductive health care and awareness;
- Advocacy for promoting reproductive health, gender equality and women's empowerment;
- Medical and psychological assistance for gender based violence survivors;
- Care for complications of abortion;
- Specific measures to address in systematic way uterine prolapse prevention and treatment;
- Prevention and care for reproductive health of elderly;
- Reproductive health commodity security and quality;
- Improvement in capacity of local communities especially among excluded groups, to participate in local-level planning, monitoring and evaluation of quality reproductive health services.
Through its Reproductive Health Programme, UNFPA assists the Department of Health Services in strengthening the promotion and delivery of reproductive health services and management and training capacity of the department. UNFPA also contributes to increasing access and exposure of men, women and adolescents to the Ministry of Health and Population's information, education and communication activities; and to ensuring provision of reproductive health and safe motherhood comprehensive packages through the health service delivery network at the grassroots level.
UNFPA supports the Government of Nepal in achieving the goals and objectives of the
International Conference on Population and Development (ICPD 1994). The Nepalese Government has adopted several policy measures to make reproductive health services available to all Nepalese citizens through the primary health care system. The Fund further supports the Government in achieving the outputs of the Nepal Health Sector Programme - Implementation Plan and the
Millennium Development Goals. UNFPA is committed to contribute to a long term support for the prevention and control of uterine prolapse as well as in short term it is continuing support for prevention efforts and surgical operations for women suffering from uterine prolapse. UNFPA is advocating for prevention and control of uterine prolapse by developing communication materials, carrying out Reproductive Health Mobile Camps and conducting surgical uterine prolapse treatments with its funding assistance as well as mobilizing support from European Commission Humanitarian Aid department and from the Government of Japanand and the Government of Denmark. To date more than 1200 surgical operations were assisted by UNFPA and including ring pessary insertions for a large number of women who do not qualify for surgery.
Attaining the goals of sustainable and equitable development requires that individuals are able to exercise control over their sexual and reproductive lives. This includes the rights to decide the number, timing and spacing of children, the right to voluntarily marry and establish a family, and the right to the highest attainable standard of quality of service and living, among others. UNFPA is also active in promoting and protecting
reproductive rights during humanitarian response efforts and institutionalizing them during post-conflict reconstruction, rehabilitation and peace-building, as called for by UN Security Council Resolution 1325.
Read more about the UNFPA work in the area of Reproductive Health:
