REPRODUCTIVE HEALTH RIGHTS ARE HUMAN RIGHTS
There was a furor amongst denizens of Kathmandu just a few days back. On January 6, 2010, five fetuses in a plastic bag were fished out by a rag-picker from a dump by the side of Bishnumati River in Kathmandu. Kajal Kumari, who fished out the plastic back hoping for goods to be salvaged, was left screaming at the sight of human heads inside. This is just one of many incidents where fetuses have been found dumped, which raises the spectra of flourishing illegal abortions in the country.
According to the law introduced in the year 2002, abortion is allowed up to 12 weeks of pregnancy if it seriously endangers the mother’s mental or physical health, and up to 18th week in case of rape or incest. Despite legalizing abortion, lack of access to safe abortion facilities and the social stigma that is still attached to it have contributed to unsafe, illegal abortions.
Lack of such reproductive rights is one of the most important issue affecting women in Nepal. In addition to other problems that women face including domestic violence, workplace harassment, low familial and social status, poverty, patriarchal perspective, and illiteracy; inadequate reproductive health services pose a serious threat to their lives. Reproductive rights are human rights, and there are various rights that are directly impeded for women when reproductive rights are violated, like right to work and right to education.
Women in Nepal are deprived of basic health services. Even today, many women in Nepal give childbirth while working in the fields, and they stay at the cowshed during menstruation. They lack information about their rights, and have no knowledge of contraceptives. Additionally, widespread adherence to gender roles prevents girls and women from making decisions about their reproductive lives.
Although the Interim Constitution of Nepal along with International Conventions to which Nepal is signatory, guarantees reproductive rights to women, not much have changed for them. As per The Program for Action adopted at the International Conference for Population and Development (ICPD), reproductive health includes the capacity to enjoy a satisfactory and sexual life without risks and the freedom to decide whether or not to have children, when and how often. Similarly, the Convention on Elimination of All Forms of Discrimination against Women (1979) supports women’s rights to reproductive health information and services and to equity in reproductive decision-making and matters of sexual health. Despite Nepal being a signatory to both these international treaties, it has a long way to achieve the MDG of achieving a 90% attendance at birth by a trained personnel and reducing the maternal mortality ratio to 200 per 100,000 births by 2015.
As reported by World Health Organization (WHO), Asian mortality rates are highest in the world, with Nepal being on the top, with 740 deaths per 100,000 births, with 90 percent of these deaths concentrated among rural women. Only 10.2 % of rural women giving birth are attended by a skilled birth attendant, compared to 51.1% urban women. Additionally, direct causes like hemorrhage (which may result from complications of safe abortion and unsafe delivery practices), obstructed labor (esp. prevalent among young adolescent girls whose pelvises are not fully formed), pre-eclampsia, obstetric complications that are preventable cause 70.5% of maternal deaths. According to Global World Disaster Report prepared by International Federation of the Red Cross Society in the year 2006, the maternal death toll of one woman every 90 minutes makes Nepal the deadliest place in the world to give birth. Around 30,000 babies die before they complete even one month, one of the highest neonatal mortality in the world.
Antenatal care which is pre-requisite for risk detection and for the prevention and treatment of anemia is rarely availed by women in Nepal. Only 29.4 percent of Nepali women get the prescribed four antenatal visits. 32.6% of women of reproductive age in Nepal are anemic.
Uterine prolapsed is another severe problem encountered by Nepalese women. Although the problem is common worldwide, it strikes women in Nepal at a very young and is rarely treated. According to a population based survey carried out by UNFPA/WHO and the Institute of Medicine in the year 2006, more than 600,000 women suffer from uterine prolapsed of whom nearly 200,000 need immediate surgery.
Reproductive health services, life saving obstetric care should be made accessible to women. It is important that enough investment is done in the reproductive health since its long-term benefits encompass a healthy population, resulting in poverty reduction, improved quality of life, stabilized population growth, and sustainable development. The results of a healthy population are far reaching. Thus, the impact ripples across societies.
It is also important to incorporate adolescent sexual and reproductive health (ASRH) issues into the basic health-service delivery packages, and provide adolescent girls and young women with greater access to information, education, services, and resources that will empower them to make decisions about their sexual and reproductive health, including contraceptive use, safe abortion, birth spacing, pre and post-natal care, and management of pregnancy and childbirth-related complications. This is pertinent given the background that women in Nepal are under pressure to marry young and produce sons before they can property support or even understand childbirth. This is the reason that 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, resulting in 19% of maternal deaths from this age group.
Since husbands and mothers-in-law have a major say in the decision regarding women’s reproductive health, it would be imperative to train them and teach them the importance of availing reproductive health services, including prescribed antenatal care, obstetric care, deliveries through skilled birth attendants, and use of family planning to time and space births.
It is vital that governments around the world, including Nepal take corrective measures because unless questions of population, reproductive health, and gender equity are addressed, other MDGs, particularly eradication of extreme poverty and hunger cannot be attained.