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1
Scenario at the State Level
Nepal has shown commitment
to international human right
instruments by ratifying major
conventions.1
Endorsing ICPD
was a groundbreaking process at
the State level ensuring women’s
de jure sexual, reproductive and
health rights which got immersed
in the dominant development
and human right discourse. It is
this aspect which needs strategic
check by women’s organization to
make it de facto. With the Interim
Constitution of Nepal (2007)
asserting “Every woman shall
have the right to reproductive
health and other reproductive
matters” 20 (2), the government
again showed commitment to
ensure sexual and reproductive
health rights.
1	 Nepal ratified ICESCR, ICCPR,
CAT,CEDAW, CERD, CRC ,CRPD, and
endorsed ICPD (PoA),BPfA & MDGs.
The purpose of this brief is to highlight the
status of sexual and reproductive health
rights of women in Nepal, discuss the gaps
and challenges in the policies to address
the ground realities of women with sexual
and reproductive needs and to ensure their
rights. As the brief includes the ‘voices’
of grassroot women and stakeholders, it
is expected to demand accountability and
changes in direction where it is urgently
neededandsuggestchangesorstrengthening
as necessary at different levels, including
the upcoming International Conference on
Population and Development. (ICPD)+20.
Sexual and Reproductive Health
and Rights of Women in Nepal
(SRHR)
Policy Brief- no. 1 www.worecnepal.org
Population Perspective Plan (PPP) 2010-2031
has been formulated with a multidisciplinary
approach to integrate population aspects
with economic and social mostly focusing on
poverty reduction, gender mainstreaming,
and social inclusion. The plan also attempts
to address Nepal’s commitments in endorsing
plans of action related to population issues in
various international forums, particularly the
1994 International Conference on Population
Development and the 2000-2015 MDGs.
Ministry of Health and Population, 2010.
2
What is Sexual and
Reproductive Health Right
(SRHR)?
SRHR incorporates the rights of all
people, regardless of age, gender and
other characteristics, to make choices
regarding their own sexuality and
reproduction, provided that their
rights do not infringe on the rights of
others. Thus, it promotes reproductive
decision-making; freedom from forced
abortion; access to information and
Of the Sixteen health policies which were
introduced in the 1991–2011 period, the
following are mostly relevant to impact
women’s health:
National AIDS Policy, 1995 (updated in 2011)
National Mental Health Policy, 1995
National Safe Motherhood Policy, 1998
National Nutritional Policy and Strategies, 2004
National Safe Abortion Policy, 2006
National Skilled Birth Attendants Policy, 2006
Policy on Quality Health Services, 2007
Free Essential Health Care Policy, 2008
Free Delivery Policy, 2009
Review of National Health Policy 1991, MOHP.
REPRODUCTIVE HEALTH is the
absolute physical, mental and social
well being related to the reproductive
system throughout the life cycle.
REPRODUCTIVE RIGHTS are
those of couples and individuals to
freely decide the timing, number
and spacing of their children, and
to access information and care in
all matters related to reproduction
and sexuality.
SEXUAL HEALTH is a state of
physical, mental and social well being
in relation to sexuality throughout the
life cycle.
SEXUAL RIGHTS includes the
right to not be subjected to sexual
violence.
Adapted from ICPD Plan of Action
appropriate reproductive education;
freedom from harmful traditional
practices and gender based violence
andfreedomtoexpressone’ssexuality.
Sincesexualrightsenteredmainstream
human rights discourse in the early
1990s, it has tried to broaden the
understanding of traditional human
rights covenants to include sexuality-
related issues; conceptualize sexual
and reproductive health and rights;
and articulate sexual autonomy and
3
the right to pleasure.2
“Autonomy is
intimately and intrinsically connected
with many fundamental human
rights, such as liberty, dignity, privacy,
security of the person, and bodily
integrity.”3
It asserts the right of a
woman to make decisions concerning
her fertility and sexuality free of
coercion and violence. The notion of
choice, consent and confidentiality
gets highlighted through reference to
autonomy. The most widespread and
institutionalized component has been
the health and reproductive rights
based articulations of sexuality.
Sexual and reproductive
health problems continue to
affect the lives of women in
Nepal.
Although it is important to move
beyond the health oriented focus of
SRHR, it should not be minimized
as unimportant but should be
supplemented further with socio-
political analysis of power structures.
Following facts need to be noted.
2	 Sexual Rights and Social Movements in
India, Working Paper 2006, p.6.
3	 Carmel Shalev, Rights to Sexual and
Reproductive Health - the ICPD and the
Convention on the Elimination of All
Forms of Discrimination against Women.
Paper presented at the International
Conference on Reproductive Health,
India, March 1998.
•	 Girls in the age group 15-19(29%)
whoarealreadyinformalmarriage
lack access to critical information
on SRHR and related services.4
•	 Unmet need for family planning
for girls in the age group 15-19 is
42% and for 20-24 age group is
37%.5
•	 25% of women of reproductive age
in Nepal experience unplanned
4	 Government of Nepal, Ministry Of Health
And Population, Population Division,
Nepal Demographic and Health Survey,
2011, p.65.
5	 Nepal Demographic and Health Survey,
2011, p.104.
Women’s Health Negligence
I have been suffering from obstetric
fistula for almost a year but never
shared this problem with others.
I was ashamed to tell them. My
health problem started after I became
pregnant at 18 years of age. I was
in labor pain for 5 days before being
taken to a hospital only to find
out it was a still birth. My second
pregnancy also ended similarly with
me going into labor for six days
at home before being taken to the
hospital. (Pabitra Nepal, 40 years,
Udayapur, Source: WOREC Nepal.)
4
of women nationally.12
•	 Unplanned pregnancies expose
women to the risk of unsafe
abortion. Unsafe abortion is the
cause of up to 20-27% of maternal
deaths in hospitals which is
significantly higher than the
global average of 13% despite the
legalization of abortion in 2002.13
•	 Suicide accounted for 10% of
deaths among women of the
reproductive groups (15-49) in
1998 which increased to 16% in
2008/09.14
12	 Institute of Medicine, 2006. Nepal
Demographic and Health Survey (DHS),
2011,p.143.
13	 Advocating Accountability: Status Report
on Maternal Health and Young People’s
Sexual and Reproductive Health and
Rights in South Asia (Nepal), 2010.p.55.
14	 Pathak LK,Malla D,Pradhan A,Rajlawat
R. Maternal Mortality and Morbidity
Study(MMMS, 1998);Pradhan A, Suvedi
BK, Barnett S, Sharma S, Puri M,Poudel
P, Rai Chitrakar S, Pratap NKC, Hulton
L, Maternal Mortality and Morbidity
Study(MMMS, 2008/09).Family Health
Division, Department of Health Services,
Ministry of Health and Population,
Government of Nepal, Kathmandu, Nepal;
Pradhan A, Poudel P, Thomas D, Barnett
S. A review of the evidence: suicide among
women in Nepal. Options consultancy
services Ltd, UKaid and UNFPA, 2011,
p.10.
pregnancies.6
•	 47% of girls who first had sex
before the age 15 were forced
against their will.7
•	 Only 29% of women have ever
heard of emergency contraception
and only 0.1 percent have actually
used it. 8
•	 17 % of girls in the age group 15-
19 have already had a birth or are
pregnant with their first child.9
•	 18% of women in the reproductive
age are undernourished (BMI <
18.5 kg/m2) and 35 % in the age
group 15-49 are anemic, nutritional
deficiencies such as anemia is often
exacerbated during pregnancy.10
•	 Although maternal mortality
ratio (MMR) in Nepal decreased
between 1996 and 2006, from 539
to 281 deaths per 100,000 births, it
is still very high.11
•	 Uterine prolapse affects about 10%
6	 Ibid.90.
7	 Ibid.239.
8	 Ibid.94.
9	 Ibid.83.
10	 Ibid.184.
11	 Ministry of Health and Population
[MOHP], New ERA, and Macro
International Inc., 2007.Nepal DHS
2011,p.119.
5
of disease prevention or violence.
Similarly, it should be articulated
to incorporate aspects of “choice,
pleasure, and dignity, as well as
diverse understandings of the body,
desires, and sexual preferences.”15
Additionally, it must be discussed
within a broad spectrum of issues
that shape access to resources,
opportunities and options for
economic activity, livelihoods, and
survival. Women’s access to resources,
opportunities and mobility are
sanctioned through gender-biasness,
social restrictions and their sexuality
is controlled in the name of chastity.
15	 Sexual Rights and Social Movements in
India, Working Paper 2006.
•	 Data collection at the national level
for rape cases are missing. The
data from WOREC Nepal gives
a glimpse of this issue. The data
collected from 14th
April-15 July,
2013 report a total of 149 cases of
rape and 4 cases of attempted rape.
Sexuality and Rights
The experience of women working
beyond the socially acceptable sectors
has shown that they are threatened
by both the law enforcement officers
as well as local people while asserting
their right to work. Further, their
issues get sidelined whenever they
raise their ‘voice’. The story is no
different for women laborers or
domestic workers.
Sexuality needs to be understood
in the context of power and social
relationships and not just in terms
Rape of 5 year old girl
5 year old girl was raped by a 50
year old man in Siraha. The girl
survived with internal injuries but
in spite of being referred to Dharan
hospital, the family could not afford
to take her for further treatment.
(WOREC, Nepal)
Women and Poverty
Cases involving mother killing
self and her children have been a
common occurrence in Nepal. One
such incident involved a woman
with a lump in her breast. The family
of the woman was very poor to even
have two meals a day. They wouldn’t
imagine about the treatment for the
disease. So while husband was out,
wife murdered her son and hung
herself. The main reason behind most
of these incidents is poverty.
(eKantipur July,2013)
6
The deeply rooted silence around
sexual rights needs to change. At the
practice level of asserting SRHR,
it should be underscored that the
consequences of claiming rights in the
name of sexuality should not further
marginalize the minorities.16
It should
create a ‘space’ for them to demand
their sexual rights in a just and fair
way.
Poverty, Food Security and
SRHR
SRHR issues are overshadowed by
persistent poverty and women with
unmet basic need specially their food
security. The issue of food security
affects the well being of women to
16	 Lesbian, Gay, Bisexual, Transgender,
Intersex and Queer (LGBTIQ), differently-
abled, single women, widows, migrants,
sex worker, entertainment workers etc.
the extent of having control over their
bodies.17
To address the linkage of food
17	 Dr. Renu Rajbhandari, WOREC Nepal
- Nepal Narrative of the on the linkages
between poverty, food security and sexual
and reproductive health and rights in
Nepal and the Asia-Pacific region, Asian-
Pacific Resource & Research Centre for
Women (ARROW),2012.
Women and security
I went to file a case against sexual
harassment and torture from my
neighbor in a local police station.
Instead of registering my case,
the sub inspector called me the
following day only to rape me. He
gave me Rs. 50 to remain silent
about the incident. Where am I
safe? (Kabita, 17 years, Biratnagar)
WOREC, Nepal.
7
security18
and poverty in line with
SRHR, there should be proper
linkage with policy makers to move
in an integrated way with various
ministries like agriculture, health
and women’s ministries for a holistic
change. Efforts on addressing women
and poverty have largely been based
on micro-finance projects to help
women to earn a livelihood. The
focus is not sufficient to adequately
address women in poverty and to
18	 The three pillars of food security –i.e.
“Food security is built on three pillars:
Food availability: sufficient quantities of
food available on a consistent basis, Food
access: having sufficient resources to
obtain appropriate foods for a nutritious
diet”, Food use: appropriate use based on
knowledge of basic nutrition and care,
as well as adequate water and sanitation.
World Health Organization. (2012). Food
Security. Trade, foreign policy, diplomacy
and health.
fundamentally understand the root
causes that deprive women’s well
being in the first place. Unless the root
causes are addressed to ensure better
access to health and food, women’s
conditions cannot be improved.
Future focus for ICPD beyond
2014 19
Social and structural change is needed
to facilitate the implementation of the
SRHR policies. The real change will
not happen if we don’t change the
way society thinks about women's
body, work and sexuality. Therefore,
there is a need to speak clearly about
sexual rights as the issue has been
silenced even in “progressive and
politically correct spaces.”
19	 Based on the discussion with the civil
society groups.
Sexual and reproductive problems of post-menopausal woman
I am a 58 years old post- menopausal
woman who has undergone surgery
for uterine prolapse. I have several
stitches and am suffering from terrible
pain. I was forced against my will for
sexual intercourse by my husband
despite my pain. I am really afraid that
my husband will force to have sexual
intercourse again. I am residing at
my maternal home and cannot dare
to go home soon. I wish there were
programs that supported women like
me and involved male counterparts
and not just adolescents regarding
sexual and reproductive health. Rama
(name changed), 58 years, Siraha.
8
SRHR can be a strategic tool of
challenging social norms that
discriminate individuals who ascribe
to different sexual behavior and
practices than that of the predominant
one.Asmentionedearlier,itcancreate
a platform where alliances can be
made with various groups that have
been vulnerable to abuse because of
their identities. The future focus on
SRHR should be able to create spaces
for conversations to impact broader
structures of power.
The impact of poverty is
predominantly structural in nature
which denies women access to
and control over resources and
opportunities and as well as control
over their bodies. Thus, SRHR
should assure women's right to food,
security and justice. Similarly, SRHR
in general needs to be analyzed in a
broad context and dealt with through
multi-sectoral approaches. The
recent trend of the free market policies
has impacted women's livelihood,
health care and other issues related
to their basic rights. This needs
to be thoroughly researched and
addressed. The increasing trend of
youth migration has added burden to
the already heavy chores of women
and increased vulnerability of women
migrantstolabor&sexualexploitation
and consequently stigma.
It has also impacted the lives of most
women and their children who are
subjected to huge psychological and
emotional problems. To overcome
these issues, clear, concrete and
effective policies should be devised
to curb the detrimental social
consequences of migration. Thus, the
present need is to ensure policies that
guarantee women their right to work,
living wage that is adequate for their
livelihood and well being.
Incorporation of the above
raised issues in the future
initiative beyond ICPD +20
and State accountability to
their commitments is needed
to address the short-comings
at the practice level of
implementation of SRHR. The
Government must recommit
themselves to achieving the
9
goals by addressing the gaps and
strengthening the loop-holes. Since
ICPD beyond 2014 is an opportunity
to influence the future of SRHR of
women, the ‘voices’ in this brief should
define what needs to be done to deliver
what it actually promises. Similarly,
it becomes equally important to
thoroughly investigate to find out the
evidences of what has actually worked
and where; and what challenges still
surface in the lives of women with
regard to their SRHR.
Recommendations to the
Government
Nepal is nearing the election for
Constituent Assembly which is the
right time for the Government to
make changes to gaps in policies and
programs with regard to SRHR of
women. The new Constitution should
address the issues related to structural
changes, right to food sovereignty and
security, right to livelihood security,
sexual and reproductive rights , right
to bodily integrity, freedom from all
forms of violence , equality of women
and their inclusion at all levels in the
policy making processes. The political
parties should make this commitment
including ending all forms impunity
to ensure SRHR in their election
manifesto and abide by this while
drafting the new constitution. Along
with these, below are some specific
recommendations:
•	 Ensure access, availability,
affordability, adequacy
and quality of sexual and
reproductive health services
and create conducive
environment for accessing
these services.
	 A safe, accessible and quality
reproductive health service
sufficient to meet the needs
of women throughout their
life- cycle is needed.20
There
should be comprehensive, non
discriminatory reproductive
20	 Safe abortion, maternal health services
pre-natal care, emergency obstetric care,
safe delivery and post-natal care, skilled
birth attendants and comprehensive
reproductive health services capable
of addressing women's reproductive
morbidity including post menopausal
concerns, uterine prolapse, obstetric
fistula, maternity leave etc.
10
and sexual health care services
within favorable environment for
the youth.
•	 State should move beyond
‘project based approach’ and
ensure accountability.
	 State should move beyond
‘project based approach’ and
incorporate human rights
dimensions/perspectives in the
reproductive health initiatives.
True human rights accountability
must be supplemented with
access to remedies for sexual and
reproductive rights violations and
complain mechanism established
by the Government.
•	 Ensure appropriate reproductive
and sexual education,
information and services to
women of all age and groups.
	 The State must ensure that the
reproductive and sexual health
information and services reach
women of all ages and groups.21
•	 Ensure coordination at all levels.
21	 (children, adolescent, post menopausal,
elderly).Similarly, it should ensure SRHR
of LGBTIQ, differently-abled, single
women, widows, migrants, sex worker,
entertainment workers etc.
	Government should create
effective coordination mechanism
to deliver appropriate sexual
and reproductive health care
to all women and adolescents.
Coordination structure
needs to include civil society
members; specially women right
organizations and prioritize
activities to address structural
inequalities which marginalize
women.
•	 Ensure measures to end impunity
against VAW.
	 VAW is the cause and
consequences of denial of
reproductive and sexual health
rights of women. To address
the increasing number of rape
among women, it is essential to
focus on programs like large scale
media campaign for behavioral
change and mass sensitization.
The practice of commodification
of women bodies and negative
stereotyping must end. Likewise,
the current law against rape and
the investigation procedure needs
immediate revision. Furthermore,
the current law on domestic
violence needs to be revised due
to its ineffectiveness of addressing
the intensity of the problems of
11
women. Another urgent need is
to create the fast track court to
ensure speedy justice to women.
Hence, it must be addressed
through integrated approach
while providing women and girls
with effective protection, access
to justice and at the same time
creating favorable environment
for women to move away from
any forms of violence.
•	 SRHR needs to be dealt with
through multi-sectoral approach.
	 Gender analysis of poverty is
needed to address the economic,
structural and root causes that
deprive women in the first
place. Similarly, women's right
to natural resources, land and
employment needs to be ensured.
Further, to address practical
needs such as food security, food
sovereignty and poverty in line
with SRHR, proper linkage and
comprehensive planning needs
to be established with different
ministries such as agriculture,
health, women’s ministries etc.
•	 Ensure support and security
to the Women Human Right
Defenders(WHRDs)
	 Femalecommunityhealthworkers
and women health workers play
a major role in providing care
and information on reproductive
and sexual health and rights.
As these rights are considered a
taboo, these women as well as the
Women Human Right Defenders
(WHRDS) who advocate for these
rights get constantly threatened,
harassed and abused. This needs
to be acknowledged with proper
support mechanism by the State.
To effectively provide protection
and security to the WHRDs,
security guideline and policies
need to be implemented. The State
should also take reasonable steps
with ‘due diligence’ to prevent the
human rights violations and carry
out investigations as necessary.
Recommendations to UN and
other donor agencies
•	 Establish more partnership with
women rights organizations
to effectively address SRHR.
Women’s empowerment (Social,
Economic, and Political) should
move parallel to SRHR initiatives.
Unless SRHR is assured all other
human rights (civil and political,
economic and social) have limited
power to advance the well-being
of women and vice-versa.
12
•	 Integrate VAW in women’s
reproductive and sexual health
policies and programs and ensure
adequate resources for their
implementation.
•	 Emphasize sexual and
reproductive health and rights
related issues through right-
based policy frameworks and
support civil society organizations
to monitor government’s
commitment on SRHR.
•	 UN agencies should adhere to the
UN guidelines on Human right
defenders and outcome document
of CSW (2013)22
which emphasizes
22	 CommissionontheStatusofWomenFifty-
seventh session 4 – 15 March, 2013. Agreed
conclusions: (z) “Support and protect
those who are committed to eliminating
violence against women, including women
human rights defenders in this regard,
who face particular risks of violence.” (p.9).
Similarly, the UN Declaration on Human
Rights Defenders adopted by the UN
General Assembly on 9 December 1998
lays out the basic principles that must be
fully respected by all governments in order
to ensure that human rights defenders can
carry out their work freely and without
fear of reprisals.
on the special needs and concerns
of WHRDs.
Commitments from the civil
society groups
Women and young people face
huge social and economic barriers
to sexual and reproductive health.
Improving services is not enough.
Sexual and reproductive health has
major social, economic, political and
legal determinants and consequences
that needs to be addressed in a multi
sectoral way. Therefore the civil
society,shouldcommittocoordinating
with different stakeholders to support
in their endeavors and to assure
women their fundamental rights with
emphasis on SRHR. To materialize
the policy level commitments at the
practice level, it is vital that there is
a strong coordination mechanism
and commitments in the part of all
stakeholders to ensure SRHR and
address the ground realities and
specific SRHR issues.
Published by:
WOREC Nepal
P.O. Box: 13233, Kathmandu, Nepal,
Tel: 977-1-5006373 Fax: 977-1-5006271
Email: ics@worecnepal.org,
URL: www.worecnepal.org
Supported by:
Asian-Pacific Resource &
Research Centre for Women
Kuala Lumpur, Malaysia
URL: www.arrow.org.my
www.facebook.com/worecnepal.org www.youtube.com/theworec
WOREC_9-2013

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Sexual and Reproductive Health and Rights of Women in Nepal (SRHR)

  • 1. 1 Scenario at the State Level Nepal has shown commitment to international human right instruments by ratifying major conventions.1 Endorsing ICPD was a groundbreaking process at the State level ensuring women’s de jure sexual, reproductive and health rights which got immersed in the dominant development and human right discourse. It is this aspect which needs strategic check by women’s organization to make it de facto. With the Interim Constitution of Nepal (2007) asserting “Every woman shall have the right to reproductive health and other reproductive matters” 20 (2), the government again showed commitment to ensure sexual and reproductive health rights. 1 Nepal ratified ICESCR, ICCPR, CAT,CEDAW, CERD, CRC ,CRPD, and endorsed ICPD (PoA),BPfA & MDGs. The purpose of this brief is to highlight the status of sexual and reproductive health rights of women in Nepal, discuss the gaps and challenges in the policies to address the ground realities of women with sexual and reproductive needs and to ensure their rights. As the brief includes the ‘voices’ of grassroot women and stakeholders, it is expected to demand accountability and changes in direction where it is urgently neededandsuggestchangesorstrengthening as necessary at different levels, including the upcoming International Conference on Population and Development. (ICPD)+20. Sexual and Reproductive Health and Rights of Women in Nepal (SRHR) Policy Brief- no. 1 www.worecnepal.org Population Perspective Plan (PPP) 2010-2031 has been formulated with a multidisciplinary approach to integrate population aspects with economic and social mostly focusing on poverty reduction, gender mainstreaming, and social inclusion. The plan also attempts to address Nepal’s commitments in endorsing plans of action related to population issues in various international forums, particularly the 1994 International Conference on Population Development and the 2000-2015 MDGs. Ministry of Health and Population, 2010.
  • 2. 2 What is Sexual and Reproductive Health Right (SRHR)? SRHR incorporates the rights of all people, regardless of age, gender and other characteristics, to make choices regarding their own sexuality and reproduction, provided that their rights do not infringe on the rights of others. Thus, it promotes reproductive decision-making; freedom from forced abortion; access to information and Of the Sixteen health policies which were introduced in the 1991–2011 period, the following are mostly relevant to impact women’s health: National AIDS Policy, 1995 (updated in 2011) National Mental Health Policy, 1995 National Safe Motherhood Policy, 1998 National Nutritional Policy and Strategies, 2004 National Safe Abortion Policy, 2006 National Skilled Birth Attendants Policy, 2006 Policy on Quality Health Services, 2007 Free Essential Health Care Policy, 2008 Free Delivery Policy, 2009 Review of National Health Policy 1991, MOHP. REPRODUCTIVE HEALTH is the absolute physical, mental and social well being related to the reproductive system throughout the life cycle. REPRODUCTIVE RIGHTS are those of couples and individuals to freely decide the timing, number and spacing of their children, and to access information and care in all matters related to reproduction and sexuality. SEXUAL HEALTH is a state of physical, mental and social well being in relation to sexuality throughout the life cycle. SEXUAL RIGHTS includes the right to not be subjected to sexual violence. Adapted from ICPD Plan of Action appropriate reproductive education; freedom from harmful traditional practices and gender based violence andfreedomtoexpressone’ssexuality. Sincesexualrightsenteredmainstream human rights discourse in the early 1990s, it has tried to broaden the understanding of traditional human rights covenants to include sexuality- related issues; conceptualize sexual and reproductive health and rights; and articulate sexual autonomy and
  • 3. 3 the right to pleasure.2 “Autonomy is intimately and intrinsically connected with many fundamental human rights, such as liberty, dignity, privacy, security of the person, and bodily integrity.”3 It asserts the right of a woman to make decisions concerning her fertility and sexuality free of coercion and violence. The notion of choice, consent and confidentiality gets highlighted through reference to autonomy. The most widespread and institutionalized component has been the health and reproductive rights based articulations of sexuality. Sexual and reproductive health problems continue to affect the lives of women in Nepal. Although it is important to move beyond the health oriented focus of SRHR, it should not be minimized as unimportant but should be supplemented further with socio- political analysis of power structures. Following facts need to be noted. 2 Sexual Rights and Social Movements in India, Working Paper 2006, p.6. 3 Carmel Shalev, Rights to Sexual and Reproductive Health - the ICPD and the Convention on the Elimination of All Forms of Discrimination against Women. Paper presented at the International Conference on Reproductive Health, India, March 1998. • Girls in the age group 15-19(29%) whoarealreadyinformalmarriage lack access to critical information on SRHR and related services.4 • Unmet need for family planning for girls in the age group 15-19 is 42% and for 20-24 age group is 37%.5 • 25% of women of reproductive age in Nepal experience unplanned 4 Government of Nepal, Ministry Of Health And Population, Population Division, Nepal Demographic and Health Survey, 2011, p.65. 5 Nepal Demographic and Health Survey, 2011, p.104. Women’s Health Negligence I have been suffering from obstetric fistula for almost a year but never shared this problem with others. I was ashamed to tell them. My health problem started after I became pregnant at 18 years of age. I was in labor pain for 5 days before being taken to a hospital only to find out it was a still birth. My second pregnancy also ended similarly with me going into labor for six days at home before being taken to the hospital. (Pabitra Nepal, 40 years, Udayapur, Source: WOREC Nepal.)
  • 4. 4 of women nationally.12 • Unplanned pregnancies expose women to the risk of unsafe abortion. Unsafe abortion is the cause of up to 20-27% of maternal deaths in hospitals which is significantly higher than the global average of 13% despite the legalization of abortion in 2002.13 • Suicide accounted for 10% of deaths among women of the reproductive groups (15-49) in 1998 which increased to 16% in 2008/09.14 12 Institute of Medicine, 2006. Nepal Demographic and Health Survey (DHS), 2011,p.143. 13 Advocating Accountability: Status Report on Maternal Health and Young People’s Sexual and Reproductive Health and Rights in South Asia (Nepal), 2010.p.55. 14 Pathak LK,Malla D,Pradhan A,Rajlawat R. Maternal Mortality and Morbidity Study(MMMS, 1998);Pradhan A, Suvedi BK, Barnett S, Sharma S, Puri M,Poudel P, Rai Chitrakar S, Pratap NKC, Hulton L, Maternal Mortality and Morbidity Study(MMMS, 2008/09).Family Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal; Pradhan A, Poudel P, Thomas D, Barnett S. A review of the evidence: suicide among women in Nepal. Options consultancy services Ltd, UKaid and UNFPA, 2011, p.10. pregnancies.6 • 47% of girls who first had sex before the age 15 were forced against their will.7 • Only 29% of women have ever heard of emergency contraception and only 0.1 percent have actually used it. 8 • 17 % of girls in the age group 15- 19 have already had a birth or are pregnant with their first child.9 • 18% of women in the reproductive age are undernourished (BMI < 18.5 kg/m2) and 35 % in the age group 15-49 are anemic, nutritional deficiencies such as anemia is often exacerbated during pregnancy.10 • Although maternal mortality ratio (MMR) in Nepal decreased between 1996 and 2006, from 539 to 281 deaths per 100,000 births, it is still very high.11 • Uterine prolapse affects about 10% 6 Ibid.90. 7 Ibid.239. 8 Ibid.94. 9 Ibid.83. 10 Ibid.184. 11 Ministry of Health and Population [MOHP], New ERA, and Macro International Inc., 2007.Nepal DHS 2011,p.119.
  • 5. 5 of disease prevention or violence. Similarly, it should be articulated to incorporate aspects of “choice, pleasure, and dignity, as well as diverse understandings of the body, desires, and sexual preferences.”15 Additionally, it must be discussed within a broad spectrum of issues that shape access to resources, opportunities and options for economic activity, livelihoods, and survival. Women’s access to resources, opportunities and mobility are sanctioned through gender-biasness, social restrictions and their sexuality is controlled in the name of chastity. 15 Sexual Rights and Social Movements in India, Working Paper 2006. • Data collection at the national level for rape cases are missing. The data from WOREC Nepal gives a glimpse of this issue. The data collected from 14th April-15 July, 2013 report a total of 149 cases of rape and 4 cases of attempted rape. Sexuality and Rights The experience of women working beyond the socially acceptable sectors has shown that they are threatened by both the law enforcement officers as well as local people while asserting their right to work. Further, their issues get sidelined whenever they raise their ‘voice’. The story is no different for women laborers or domestic workers. Sexuality needs to be understood in the context of power and social relationships and not just in terms Rape of 5 year old girl 5 year old girl was raped by a 50 year old man in Siraha. The girl survived with internal injuries but in spite of being referred to Dharan hospital, the family could not afford to take her for further treatment. (WOREC, Nepal) Women and Poverty Cases involving mother killing self and her children have been a common occurrence in Nepal. One such incident involved a woman with a lump in her breast. The family of the woman was very poor to even have two meals a day. They wouldn’t imagine about the treatment for the disease. So while husband was out, wife murdered her son and hung herself. The main reason behind most of these incidents is poverty. (eKantipur July,2013)
  • 6. 6 The deeply rooted silence around sexual rights needs to change. At the practice level of asserting SRHR, it should be underscored that the consequences of claiming rights in the name of sexuality should not further marginalize the minorities.16 It should create a ‘space’ for them to demand their sexual rights in a just and fair way. Poverty, Food Security and SRHR SRHR issues are overshadowed by persistent poverty and women with unmet basic need specially their food security. The issue of food security affects the well being of women to 16 Lesbian, Gay, Bisexual, Transgender, Intersex and Queer (LGBTIQ), differently- abled, single women, widows, migrants, sex worker, entertainment workers etc. the extent of having control over their bodies.17 To address the linkage of food 17 Dr. Renu Rajbhandari, WOREC Nepal - Nepal Narrative of the on the linkages between poverty, food security and sexual and reproductive health and rights in Nepal and the Asia-Pacific region, Asian- Pacific Resource & Research Centre for Women (ARROW),2012. Women and security I went to file a case against sexual harassment and torture from my neighbor in a local police station. Instead of registering my case, the sub inspector called me the following day only to rape me. He gave me Rs. 50 to remain silent about the incident. Where am I safe? (Kabita, 17 years, Biratnagar) WOREC, Nepal.
  • 7. 7 security18 and poverty in line with SRHR, there should be proper linkage with policy makers to move in an integrated way with various ministries like agriculture, health and women’s ministries for a holistic change. Efforts on addressing women and poverty have largely been based on micro-finance projects to help women to earn a livelihood. The focus is not sufficient to adequately address women in poverty and to 18 The three pillars of food security –i.e. “Food security is built on three pillars: Food availability: sufficient quantities of food available on a consistent basis, Food access: having sufficient resources to obtain appropriate foods for a nutritious diet”, Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation. World Health Organization. (2012). Food Security. Trade, foreign policy, diplomacy and health. fundamentally understand the root causes that deprive women’s well being in the first place. Unless the root causes are addressed to ensure better access to health and food, women’s conditions cannot be improved. Future focus for ICPD beyond 2014 19 Social and structural change is needed to facilitate the implementation of the SRHR policies. The real change will not happen if we don’t change the way society thinks about women's body, work and sexuality. Therefore, there is a need to speak clearly about sexual rights as the issue has been silenced even in “progressive and politically correct spaces.” 19 Based on the discussion with the civil society groups. Sexual and reproductive problems of post-menopausal woman I am a 58 years old post- menopausal woman who has undergone surgery for uterine prolapse. I have several stitches and am suffering from terrible pain. I was forced against my will for sexual intercourse by my husband despite my pain. I am really afraid that my husband will force to have sexual intercourse again. I am residing at my maternal home and cannot dare to go home soon. I wish there were programs that supported women like me and involved male counterparts and not just adolescents regarding sexual and reproductive health. Rama (name changed), 58 years, Siraha.
  • 8. 8 SRHR can be a strategic tool of challenging social norms that discriminate individuals who ascribe to different sexual behavior and practices than that of the predominant one.Asmentionedearlier,itcancreate a platform where alliances can be made with various groups that have been vulnerable to abuse because of their identities. The future focus on SRHR should be able to create spaces for conversations to impact broader structures of power. The impact of poverty is predominantly structural in nature which denies women access to and control over resources and opportunities and as well as control over their bodies. Thus, SRHR should assure women's right to food, security and justice. Similarly, SRHR in general needs to be analyzed in a broad context and dealt with through multi-sectoral approaches. The recent trend of the free market policies has impacted women's livelihood, health care and other issues related to their basic rights. This needs to be thoroughly researched and addressed. The increasing trend of youth migration has added burden to the already heavy chores of women and increased vulnerability of women migrantstolabor&sexualexploitation and consequently stigma. It has also impacted the lives of most women and their children who are subjected to huge psychological and emotional problems. To overcome these issues, clear, concrete and effective policies should be devised to curb the detrimental social consequences of migration. Thus, the present need is to ensure policies that guarantee women their right to work, living wage that is adequate for their livelihood and well being. Incorporation of the above raised issues in the future initiative beyond ICPD +20 and State accountability to their commitments is needed to address the short-comings at the practice level of implementation of SRHR. The Government must recommit themselves to achieving the
  • 9. 9 goals by addressing the gaps and strengthening the loop-holes. Since ICPD beyond 2014 is an opportunity to influence the future of SRHR of women, the ‘voices’ in this brief should define what needs to be done to deliver what it actually promises. Similarly, it becomes equally important to thoroughly investigate to find out the evidences of what has actually worked and where; and what challenges still surface in the lives of women with regard to their SRHR. Recommendations to the Government Nepal is nearing the election for Constituent Assembly which is the right time for the Government to make changes to gaps in policies and programs with regard to SRHR of women. The new Constitution should address the issues related to structural changes, right to food sovereignty and security, right to livelihood security, sexual and reproductive rights , right to bodily integrity, freedom from all forms of violence , equality of women and their inclusion at all levels in the policy making processes. The political parties should make this commitment including ending all forms impunity to ensure SRHR in their election manifesto and abide by this while drafting the new constitution. Along with these, below are some specific recommendations: • Ensure access, availability, affordability, adequacy and quality of sexual and reproductive health services and create conducive environment for accessing these services. A safe, accessible and quality reproductive health service sufficient to meet the needs of women throughout their life- cycle is needed.20 There should be comprehensive, non discriminatory reproductive 20 Safe abortion, maternal health services pre-natal care, emergency obstetric care, safe delivery and post-natal care, skilled birth attendants and comprehensive reproductive health services capable of addressing women's reproductive morbidity including post menopausal concerns, uterine prolapse, obstetric fistula, maternity leave etc.
  • 10. 10 and sexual health care services within favorable environment for the youth. • State should move beyond ‘project based approach’ and ensure accountability. State should move beyond ‘project based approach’ and incorporate human rights dimensions/perspectives in the reproductive health initiatives. True human rights accountability must be supplemented with access to remedies for sexual and reproductive rights violations and complain mechanism established by the Government. • Ensure appropriate reproductive and sexual education, information and services to women of all age and groups. The State must ensure that the reproductive and sexual health information and services reach women of all ages and groups.21 • Ensure coordination at all levels. 21 (children, adolescent, post menopausal, elderly).Similarly, it should ensure SRHR of LGBTIQ, differently-abled, single women, widows, migrants, sex worker, entertainment workers etc. Government should create effective coordination mechanism to deliver appropriate sexual and reproductive health care to all women and adolescents. Coordination structure needs to include civil society members; specially women right organizations and prioritize activities to address structural inequalities which marginalize women. • Ensure measures to end impunity against VAW. VAW is the cause and consequences of denial of reproductive and sexual health rights of women. To address the increasing number of rape among women, it is essential to focus on programs like large scale media campaign for behavioral change and mass sensitization. The practice of commodification of women bodies and negative stereotyping must end. Likewise, the current law against rape and the investigation procedure needs immediate revision. Furthermore, the current law on domestic violence needs to be revised due to its ineffectiveness of addressing the intensity of the problems of
  • 11. 11 women. Another urgent need is to create the fast track court to ensure speedy justice to women. Hence, it must be addressed through integrated approach while providing women and girls with effective protection, access to justice and at the same time creating favorable environment for women to move away from any forms of violence. • SRHR needs to be dealt with through multi-sectoral approach. Gender analysis of poverty is needed to address the economic, structural and root causes that deprive women in the first place. Similarly, women's right to natural resources, land and employment needs to be ensured. Further, to address practical needs such as food security, food sovereignty and poverty in line with SRHR, proper linkage and comprehensive planning needs to be established with different ministries such as agriculture, health, women’s ministries etc. • Ensure support and security to the Women Human Right Defenders(WHRDs) Femalecommunityhealthworkers and women health workers play a major role in providing care and information on reproductive and sexual health and rights. As these rights are considered a taboo, these women as well as the Women Human Right Defenders (WHRDS) who advocate for these rights get constantly threatened, harassed and abused. This needs to be acknowledged with proper support mechanism by the State. To effectively provide protection and security to the WHRDs, security guideline and policies need to be implemented. The State should also take reasonable steps with ‘due diligence’ to prevent the human rights violations and carry out investigations as necessary. Recommendations to UN and other donor agencies • Establish more partnership with women rights organizations to effectively address SRHR. Women’s empowerment (Social, Economic, and Political) should move parallel to SRHR initiatives. Unless SRHR is assured all other human rights (civil and political, economic and social) have limited power to advance the well-being of women and vice-versa.
  • 12. 12 • Integrate VAW in women’s reproductive and sexual health policies and programs and ensure adequate resources for their implementation. • Emphasize sexual and reproductive health and rights related issues through right- based policy frameworks and support civil society organizations to monitor government’s commitment on SRHR. • UN agencies should adhere to the UN guidelines on Human right defenders and outcome document of CSW (2013)22 which emphasizes 22 CommissionontheStatusofWomenFifty- seventh session 4 – 15 March, 2013. Agreed conclusions: (z) “Support and protect those who are committed to eliminating violence against women, including women human rights defenders in this regard, who face particular risks of violence.” (p.9). Similarly, the UN Declaration on Human Rights Defenders adopted by the UN General Assembly on 9 December 1998 lays out the basic principles that must be fully respected by all governments in order to ensure that human rights defenders can carry out their work freely and without fear of reprisals. on the special needs and concerns of WHRDs. Commitments from the civil society groups Women and young people face huge social and economic barriers to sexual and reproductive health. Improving services is not enough. Sexual and reproductive health has major social, economic, political and legal determinants and consequences that needs to be addressed in a multi sectoral way. Therefore the civil society,shouldcommittocoordinating with different stakeholders to support in their endeavors and to assure women their fundamental rights with emphasis on SRHR. To materialize the policy level commitments at the practice level, it is vital that there is a strong coordination mechanism and commitments in the part of all stakeholders to ensure SRHR and address the ground realities and specific SRHR issues. Published by: WOREC Nepal P.O. Box: 13233, Kathmandu, Nepal, Tel: 977-1-5006373 Fax: 977-1-5006271 Email: ics@worecnepal.org, URL: www.worecnepal.org Supported by: Asian-Pacific Resource & Research Centre for Women Kuala Lumpur, Malaysia URL: www.arrow.org.my www.facebook.com/worecnepal.org www.youtube.com/theworec WOREC_9-2013