Despite achieving tangible success in reducing the maternal mortality rate, Nepali women still suffer from myriad health problems, including pregnancy-related complications, uterus prolapse and malnutrition, among others. As most of the women live in the rural areas, they lack access to quality health services. A patriarchal socio-economic structure, abject poverty and lack of quality education have deprived them of a fair crack of a whip. These impediments have prevented them from having a decent social and health life.
A report of the Nepal Demographic Health Survey has pointed to other health hazards of women. Its findings listed unplanned pregnancy and unsafe abortion as a major health problem. Interestingly, the survey attributed this problem to the unmet need of contraceptives among the adolescents aged between 15 and 19 years. The more perplexing matter is that the unfriendly attitude of health service providers and ingrained social taboos have been blamed for this disappointing facet of reproductive health. Contraceptives, including the one used in emergency times, are considered to be easily accessible health items that can control up to 50 per cent unintended pregnancies if used properly and unhesitatingly. The irony is that the unmet need of contraceptives is about 24 per cent. Among the adolescents, the ratio of unmet need stands at 81 per cent. During the survey, many male and female adolescents were queried about the use of contraceptives, and they responded that the health workers harass them when they approach the health facility centres for the contraceptives. It is indeed bizarre that the health workers themselves discourage the visitors. It points to a faulty system that recruits health workforce sans broad knowledge and a receptive culture.
There has been phenomenal growth in the field of information and communications, literacy rate and education status of the people. Mushrooming FM radios and television stations, and ubiquitous print media have brought about an information revolution. Plus, an increase in the use of the Internet and smart phones has helped spread health messages to a cross section of people. But these positive gains, made in the field of communications, have not been well utilised to change the perception of people, especially the young, when it comes to applying family planning methods that are effective in controlling unwanted births. According to the survey, unintended pregnancies stand at 33 per cent among the newly married women. The health risk is even higher among the women aged between 15 and 24 years. In order to overcome this negative health scenario, bold and innovative approaches are needed. The government and health organisations should mobilise health volunteers on a massive scale to generate awareness about the use of contraceptives among the women of reproductive age. It is only with a conscious-raising drive that the people will be able to fight social taboos and misconceptions about their sexual life. The finding that health workers fail to encourage the clients to use contraceptives of both types - long-acting and short-acting - is a slap on the face of the Health Ministry, NGOs and INGOs working in the field of reproductive health. The government should now focus on producing trained health workers versed in medical and social knowledge. The foot doctors must know the social, culture, academic and economic backgrounds of the people before promoting the use of contraceptives among them.