Nepal

Nepal, a landlocked kingdom between India and China, is home to 28.5 million people who comprise roughly 100 ethnic and caste groups and who speak more than 92 dialects. The country’s rugged terrain often prevents Nepali people from accessing health care; those who live in remote mountain villages are often a day’s walk from the nearest health facility. Compounding this, many women marry young—before the age of 18—and family pressure to have a child soon after marriage puts their lives in jeopardy as young women face an increased risk of pregnancy and childbirth complications.

It is within this context that EngenderHealth first began working with Nepal’s Ministry of Health in the 1980s. In the last two decades, family planning use has risen significantly, but there is still high unmet need for contraception and other reproductive and maternal health services. Today, EngenderHealth collaborates with the government and local partners to:

• Expand contraceptive choice
• Strengthen the quality of reproductive health care services
• Promote maternal health
• Increase access to postabortion care services
• Addressing the Unique Needs of Married Adolescents

 
Expanding Contraceptive Options
In Nepal, as in other developing countries, several factors limit access to and use of contraception, including a shortage of skilled and trained providers, inadequate commodities and supplies, and lack of accurate information about available methods. EngenderHealth works to:

• Increase the availability of a wide range of family planning
• Ensure the availability of family planning supplies
• Develop national medical standards for family planning (partnering with Nepal’s Ministry of Health and Population)
• Provide training, staffing, and supervisory support at clinics and hospitals
• Use mobile family planning clinics to reach clients in underserved areas
• Address the unique contraceptive needs of postpartum women, many of whom would like to use contraception but don’t have access
• Promote family planning in the private sector and among the country’s leaders and policymakers

 
Strengthening the Quality of Health Care Services
In Nepal, EngenderHealth helps train health care providers in a range of reproductive health services, such as HIV and AIDS prevention and treatment, and helps improve the quality of care clients receive. We use a variety of approaches, including performance improvement, COPE®, and infection prevention training. EngenderHealth collaborates with Nepal’s Ministry of Health to develop national medical standards and helps ensure health care professionals meet and maintain these standards.  

 
Promoting Maternal Health
EngenderHealth developed a training package to strengthen the skills of health providers offering care during pregnancy and childbirth—especially in preventing and treating postpartum hemorrhage, obstructed labor, and preeclampsia and eclampsia. This training is being expanded through several districts of the country. In addition, we started an initiative to prevent postpartum hemorrhage among women delivering at home through community-based distribution of the drug Misoprostol.

 
Increasing Access to Postabortion Care Services
EngenderHealth trains doctors and midwives at health centers to provide comprehensive postabortion care, including manual vacuum aspiration as well as counseling and referrals for other services. A priority is ensuring health care professionals maintain infection prevention practices. We also advocate for the integration of postabortion care into routine maternal care services.

 
Addressing the Unique Needs of Married Adolescents
Many married adolescent couples in Nepal lack adequate access to reproductive health information, counseling, and services. EngenderHealth led a reproductive health program for young married couples in the Southeastern part of Nepal’s terai region, a particularly conservative area where both early marriage and dowry payments are widely practiced. The program:

• Used the media to provide information on family planning, pregnancy, delivery, postnatal care, and prevention of HIV and sexually transmitted infections
• Educated communities about reproductive health issues and encourage support of young couples’ needs
• Trained peer educators to provide reproductive health information to their families and friends
• Worked with parents, in-laws, religious leaders, and other influential community members to support the reproductive health needs of young married couples

In the project’s districts, there is evidence that the attitudes of young people, community members, and health providers changed and the quality of health services for adolescents significantly improved. There are now more young women and men visiting health clinics, obtaining family planning and other services. The proportion of women making four or more prenatal visits to a doctor rose from 29% to 50%. And, the age of marriage in the area increased significantly from 14 to 16 years old.