Continuing contraception services and women's health in the wake of disaster, Nepal

The earthquake destroyed entire villages credits: IPPF/Jon Spaull/2017

Just before midday on Saturday 25 April 2015, a 7.8 magnitude earthquake shook Nepal, causing massive devastation and loss of life. It was the worst natural disaster to strike the country for 80 years – and one the country is still recovering from. Three million people were displaced, 22,000 were injured and 9,000 people lost their lives. According to UNDP, 800,000 homes, were damaged or destroyed. A Nepalese government assessment in 2015 estimated the cost of damage, loss and reconstruction to be $14.6 billion – around three quarters of the country’s entire gross domestic product for 2015

The stories of survivors are harrowing. Twenty-two-year-old Anjana Suwal spent five hours trapped in the rubble of her family’s house. “I was thinking to myself: this is going to be the end of my life: I won’t survive,” she says. “I could hear sounds from outside and I began shouting and shouting, but no one heard me. My throat began to get sore and eventually I couldn’t make any more sounds: I felt so hopeless.”

Others speak of their desperate searches to find their children, alongside bittersweet gratitude that the earthquake had occurred on a Saturday rather than an ordinary school day, when the loss of life could have been far higher.

The effect on healthcare and family planning was severe. Clinics and hospitals were destroyed and those that survived quickly became overcrowded and had turn away hundreds of injured patients. Millions of people were forced from their homes into tents, often many miles from their usual clinics and family planning centres. Women, girls and orphans were particularly vulnerable: living in tents exposed them to sexual violence, while menstrual hygiene and basic cleanliness in the searing April heat became a struggle.

“There was always the fear of getting abused,” says FPAN volunteer Rita Tukanbanjar, who spent 20 days living in a tent after the earthquake.

Hitting the ground running

When the earthquake struck, FPAN lost no time in taking action. The first job was to do a needs assessment. Then, within 48 hours, FPAN had set up mobile health camps across the country, providing family planning services as well as general health check ups.

  • Two years after the earthquake that struck Nepal in April 2015, the village of Gatlang in the country’s mountainous north still lies in partial ruin. The houses here are built from enormous slabs of local stone, carved windows and doors, and roofs of stacked wooden planks.
    Two years after the earthquake that struck Nepal in April 2015, the village of Gatlang in the country’s mountainous north still lies in partial ruin. The houses here are built from enormous slabs of local stone, carved windows and doors, and roofs of stacked wooden planks.
  • In the days after the quake struck, FPAN wasted no time. “The first thing we did was to identify the needs of the people,” says branch manager Sharad. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. "All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.”
    In the days after the quake struck, FPAN wasted no time. “The first thing we did was to identify the needs of the people,” says branch manager Sharad. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. "All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.”
  • Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband works as a lorry driver and is often away. “When the earthquake struck, I was working in the fields,” she says. “If I had been at home, I would have died.”
    Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband works as a lorry driver and is often away. “When the earthquake struck, I was working in the fields,” she says. “If I had been at home, I would have died.”
  • Devendra is the district project coordinator at the Rasuwa branch. "FPAN conducted a three-month mobile camp providing healthcare, family planning services and medical supplies. The health camp really helped people get the services.”
    Devendra is the district project coordinator at the Rasuwa branch. "FPAN conducted a three-month mobile camp providing healthcare, family planning services and medical supplies. The health camp really helped people get the services.”
  • Pasang lives in Gatlang, high up in the mountains of northern Nepal, 15 km from the Tibetan border. “After the earthquake, there were so many problems. So many homes were destroyed. People are still living in temporary homes because they’re unable to rebuild their homes.”  Pregnant women fared particularly badly: “They were unable to access nutritious food or find a warm place. They really suffered.”
    Pasang lives in Gatlang, high up in the mountains of northern Nepal, 15 km from the Tibetan border. “After the earthquake, there were so many problems. So many homes were destroyed. People are still living in temporary homes because they’re unable to rebuild their homes.” Pregnant women fared particularly badly: “They were unable to access nutritious food or find a warm place. They really suffered.”
  • Volunteers like Pasang perform a crucial function in a region where literacy levels and a strongly patriarchal culture mean that women marry young and have to get consent from their husbands before using contraception. In this remote community, direct contact with a volunteer who can offer advice and guidance orally, and talk to women about their broader health needs, is absolutely vital.
    Volunteers like Pasang perform a crucial function in a region where literacy levels and a strongly patriarchal culture mean that women marry young and have to get consent from their husbands before using contraception. In this remote community, direct contact with a volunteer who can offer advice and guidance orally, and talk to women about their broader health needs, is absolutely vital.
  • FPAN's team ran classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons.
    FPAN's team ran classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons.
  • Like many villages in Nepal they are hard to reach in remote mountainous regions.
    Like many villages in Nepal they are hard to reach in remote mountainous regions.
  • FPAN organized mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.
    FPAN organized mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.
  • Houses are still too dangerous to live in following the earthquakes' widespread devastation. The effect on houses and buildings was catastrophic; many who lost their homes are still living in corrugated iron shacks.
    Houses are still too dangerous to live in following the earthquakes' widespread devastation. The effect on houses and buildings was catastrophic; many who lost their homes are still living in corrugated iron shacks.
  • Muna lives with her husband and two children in Bakultar, a rambling village of mud houses, tea shacks and vegetable, miles off a main road, at the end of a long dirt track in Kavre district.  When the earthquake struck, she and her family were cleaning the cowshed.  “It was so scary,” she says. “The children were not at home: we were so worried about the children and went looking for them. They were also looking for us.”
    Muna lives with her husband and two children in Bakultar, a rambling village of mud houses, tea shacks and vegetable, miles off a main road, at the end of a long dirt track in Kavre district. When the earthquake struck, she and her family were cleaning the cowshed. “It was so scary,” she says. “The children were not at home: we were so worried about the children and went looking for them. They were also looking for us.”
  • Anjal, a business student from Bhaktapur, spent five hours trapped in the rubble of her family’s house. They lived in one of the traditional mud and wooden houses that line the streets of this ancient temple city. Some of the mud walls and wooden support structure fell on Anjal’s legs and arms, trapping her.  “I was thinking to myself: this is going to be the end of my life: I won’t survive.”
    Anjal, a business student from Bhaktapur, spent five hours trapped in the rubble of her family’s house. They lived in one of the traditional mud and wooden houses that line the streets of this ancient temple city. Some of the mud walls and wooden support structure fell on Anjal’s legs and arms, trapping her. “I was thinking to myself: this is going to be the end of my life: I won’t survive.”
  • For Rita, a twenty-two-year-old nurse from Bhaktapur in the Kathmandu Valley, the earthquake was an eye-opening ordeal: it gave her first-hand experience of the different ways that natural disasters can affect people, particularly women and girls.  “After the earthquake, FPAN was organising menstrual hygiene classes for affected people, and I took part in these.”
    For Rita, a twenty-two-year-old nurse from Bhaktapur in the Kathmandu Valley, the earthquake was an eye-opening ordeal: it gave her first-hand experience of the different ways that natural disasters can affect people, particularly women and girls. “After the earthquake, FPAN was organising menstrual hygiene classes for affected people, and I took part in these.”

The team offered essential items like oral rehydration, medicines, food and water. They also distributed contraception and dignity kits, provided women with antenatal checks, and set up blood-testing labs and psycho-social counselling services. Women- and children-friendly spaces provided a haven for the most vulnerable to retreat to in safety.

The organisation also organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. “During that time, girls were facing a lot of problems maintaining their menstrual hygiene,” explains FPAN volunteer Rita Tukanbanjar. “All the shops and services for menstrual hygiene were closed.”

FPAN’s classes provided a vital service to women and girls, as well as valuable knowledge for life after the emergency response.

Up in the mountains of Rasuwa, close to the border with Tibet, FPAN ran a three-month mobile health camp, providing basic healthcare and family planning services.

Equipped for future disasters

FPAN, like Nepal, still has visible earthquake damage. “Most of our service delivery points in the Kathmandu Valley are still damaged,” says Sharad Kumar Argal.

But amid the tragedy and loss of the earthquake, the impressive and efficient emergency response it galvanised has left FPAN in a much stronger position, should another natural disaster strike Nepal. It also mobilised a huge number of young people to help: many of these volunteers are still working for FPAN, delivering vital sexuality education and community home-based care services.