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2024 trends
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What does the year 2024 hold for us?

As the new year begins, we take a look at the trends and challenges ahead for sexual and reproductive health and rights.
Young nepalese female farmer, IPPF, FPAN
story

| 25 July 2017

Reproductive health for Nepalese female farmers after the earthquake

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. They face east towards the rising sun, their facades bedecked in intricate wooden carvings patterns linked to the ancient Buddhist culture of the Tamang people. Today, most of these houses lie in ruin, emptying the heart of the village of people, with most moving to temporary shacks on Gatlang’s fringes. Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband, Nakul, 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’s house – or what remains of it – lies at the centre of old Gatlang, on a street of traditional houses that have either entirely collapsed or are uninhabitable due to cracks and structural damage. Piles of stone and wooden cross beams are strewn in what was once a thriving village street. Like many families here, Kopila and her husband and boys have moved into a small shack built from corrugated iron and plastic. This was meant to be a temporary solution, but two years later, they are still living in it, unable to afford the enormous cost of rebuilding their old home. “It needs lots of money,” she says. “I don’t know when we will have the money to build this home again.” FPAN provided emergency health support to families like Kopila’s in the weeks and months after the earthquake. Mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.  These days, Kopila gets regular advice from Pasang Tamang, the FPAN reproductive health female volunteer in the village. Kopila had suffered after the birth of her last child. “I didn’t menstruate for eight months, and then after that I started using the [contraceptive] injection,” she says. “But there were some side effects: I started menstruating twice a month.” She then went to a mobile health camp run by FPAN and started using the intrauterine coil. “After that, my menstruation went back to normal,” she says. In a village scarred by the earthquake, access to family planning has brought some much needed stability and relief to Kopila and her small family. “FPAN provide different services and knowledge: I have come to know that having more children can bring suffering, because it’s not enough to just feed children, they must be educated too” she says. “A small family is a happy family.”

Young nepalese female farmer, IPPF, FPAN
story

| 28 March 2024

Reproductive health for Nepalese female farmers after the earthquake

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. They face east towards the rising sun, their facades bedecked in intricate wooden carvings patterns linked to the ancient Buddhist culture of the Tamang people. Today, most of these houses lie in ruin, emptying the heart of the village of people, with most moving to temporary shacks on Gatlang’s fringes. Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband, Nakul, 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’s house – or what remains of it – lies at the centre of old Gatlang, on a street of traditional houses that have either entirely collapsed or are uninhabitable due to cracks and structural damage. Piles of stone and wooden cross beams are strewn in what was once a thriving village street. Like many families here, Kopila and her husband and boys have moved into a small shack built from corrugated iron and plastic. This was meant to be a temporary solution, but two years later, they are still living in it, unable to afford the enormous cost of rebuilding their old home. “It needs lots of money,” she says. “I don’t know when we will have the money to build this home again.” FPAN provided emergency health support to families like Kopila’s in the weeks and months after the earthquake. Mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.  These days, Kopila gets regular advice from Pasang Tamang, the FPAN reproductive health female volunteer in the village. Kopila had suffered after the birth of her last child. “I didn’t menstruate for eight months, and then after that I started using the [contraceptive] injection,” she says. “But there were some side effects: I started menstruating twice a month.” She then went to a mobile health camp run by FPAN and started using the intrauterine coil. “After that, my menstruation went back to normal,” she says. In a village scarred by the earthquake, access to family planning has brought some much needed stability and relief to Kopila and her small family. “FPAN provide different services and knowledge: I have come to know that having more children can bring suffering, because it’s not enough to just feed children, they must be educated too” she says. “A small family is a happy family.”

A student in Nepal is helped by IPPF, FPAN, after the earthquake
story

| 25 July 2017

A rescued student devotes her time to rebuilding her community

For 22-year-old student Anjal Auwal, April 25 began as an ordinary day. She had been up late the night, preparing for an exam. Tired after revising, she woke up late and went into the kitchen to eat. It was then that the earthquake struck. “When it struck and I saw the walls shaking and falling down, I collapsed,” Anjal says. “I knew nothing after that. It was just like a dream.” 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,” 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.” Hours later, Anjal heard her uncle’s voice from somewhere beyond the rubble that surrounded her. “I thought this is my chance, and I shouted again in the hope my uncle might hear me.” Eventually, five hours after being trapped, Anjal was pulled from the rubble, injured but alive. “My left side was not working, so my family took me to hospital,” she says. “But the hospital rejected me because they had such limited services. Eventually we found another hospital to care for me.” Anjal’s injuries were extensive. It took six months of medication, rest and rehabilitation for her hand and leg to recover. She also suffered digestion problems: whenever she ate, she would vomit, and the doctors became alarmed that her body was getting little nutrition.   Two years later, she has more or less recovered. “I still have a few problems with digestion, I have scars from the wounds and I occasionally gets pain in my hands, but things have improved a lot,” she says. Her sickness and long rehabilitation meant her studies were interrupted, but eventually she managed to take the exam and passed. Having time off has given her time to reflect on what she wants to do with her life. She’s now planning to volunteer for FPAN, after hearing about it from friends at school. “I haven’t so far because of my health problems,” she says. “But now I’m eager to join and to learn about sexual health and family planning. I’ve realised it’s very important.”

A student in Nepal is helped by IPPF, FPAN, after the earthquake
story

| 28 March 2024

A rescued student devotes her time to rebuilding her community

For 22-year-old student Anjal Auwal, April 25 began as an ordinary day. She had been up late the night, preparing for an exam. Tired after revising, she woke up late and went into the kitchen to eat. It was then that the earthquake struck. “When it struck and I saw the walls shaking and falling down, I collapsed,” Anjal says. “I knew nothing after that. It was just like a dream.” 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,” 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.” Hours later, Anjal heard her uncle’s voice from somewhere beyond the rubble that surrounded her. “I thought this is my chance, and I shouted again in the hope my uncle might hear me.” Eventually, five hours after being trapped, Anjal was pulled from the rubble, injured but alive. “My left side was not working, so my family took me to hospital,” she says. “But the hospital rejected me because they had such limited services. Eventually we found another hospital to care for me.” Anjal’s injuries were extensive. It took six months of medication, rest and rehabilitation for her hand and leg to recover. She also suffered digestion problems: whenever she ate, she would vomit, and the doctors became alarmed that her body was getting little nutrition.   Two years later, she has more or less recovered. “I still have a few problems with digestion, I have scars from the wounds and I occasionally gets pain in my hands, but things have improved a lot,” she says. Her sickness and long rehabilitation meant her studies were interrupted, but eventually she managed to take the exam and passed. Having time off has given her time to reflect on what she wants to do with her life. She’s now planning to volunteer for FPAN, after hearing about it from friends at school. “I haven’t so far because of my health problems,” she says. “But now I’m eager to join and to learn about sexual health and family planning. I’ve realised it’s very important.”

A mother rescued by IPPF in Nepal, FPAN, speaks to a clinician
story

| 25 July 2017

A mother in need volunteers to save others in the earthquake

“When the earthquake struck, I was on the sixth floor of my family’s house, with my son. For 15 or 20 minutes, I couldn’t do anything. I tried to open the door but I couldn’t: I was trapped.” Rita Chawal is 32 years old and married with a small son, who was four at the time of the earthquake. They lived together with 15 other members of her husband’s family in one of the tall, traditional houses that line the streets of Bhaktapur, an ancient temple city 15 kilometres from Kathmandu. The earthquake caused extensive damage to the city, bringing down old brick houses, shops and schools, and destroying some of the medieval temples in the network of squares that make up the city’s historic centre. The entire back of Rita’s house collapsed. “Eventually, we managed to come down from the sixth floor, but once we got to ground level, we saw that many houses had collapsed,” she says. “It was really terrifying seeing those scenes. Nevertheless, we managed to cross over the demolished buildings and get to the public football grounds, where we stayed together and lived in tents.” Sexual health and the menstrual needs of women and girls tend to be neglected by aid organisations in the aftermath of natural disasters. One problem is that WASH (Water, sanitation and hygiene) response tends to be coordinated and designed by men, who can more easily overlook women’s needs. This is why organisations like FPAN are so vital in frontline response after disasters. “After the earthquake, family planning services stopped for a few days,” Rita explains. “But after that there were health camps [run by FPAN] that distributed dignity kits and family planning devices. I received dignity kits [sanitary pads etc] from them.” Rita was so moved by the suffering around her and so inspired by the work of FPAN and other NGOs, that, after attending to her own and her family’s needs, she began working as a volunteer distributing dignity kits to women and girls living in tents. FPAN services are vital, both during emergency response and in normal life. Rita says the fact that FPAN community mobilisers and volunteers can mediate well between local people and the health services, and articulate their needs, makes them unique in Nepal. “The activities that FPAN are doing are really good,” she says. “I and the women in this community really want FPAN to continue their services because they are the best ones we get. We are really worried they might stop.”

A mother rescued by IPPF in Nepal, FPAN, speaks to a clinician
story

| 28 March 2024

A mother in need volunteers to save others in the earthquake

“When the earthquake struck, I was on the sixth floor of my family’s house, with my son. For 15 or 20 minutes, I couldn’t do anything. I tried to open the door but I couldn’t: I was trapped.” Rita Chawal is 32 years old and married with a small son, who was four at the time of the earthquake. They lived together with 15 other members of her husband’s family in one of the tall, traditional houses that line the streets of Bhaktapur, an ancient temple city 15 kilometres from Kathmandu. The earthquake caused extensive damage to the city, bringing down old brick houses, shops and schools, and destroying some of the medieval temples in the network of squares that make up the city’s historic centre. The entire back of Rita’s house collapsed. “Eventually, we managed to come down from the sixth floor, but once we got to ground level, we saw that many houses had collapsed,” she says. “It was really terrifying seeing those scenes. Nevertheless, we managed to cross over the demolished buildings and get to the public football grounds, where we stayed together and lived in tents.” Sexual health and the menstrual needs of women and girls tend to be neglected by aid organisations in the aftermath of natural disasters. One problem is that WASH (Water, sanitation and hygiene) response tends to be coordinated and designed by men, who can more easily overlook women’s needs. This is why organisations like FPAN are so vital in frontline response after disasters. “After the earthquake, family planning services stopped for a few days,” Rita explains. “But after that there were health camps [run by FPAN] that distributed dignity kits and family planning devices. I received dignity kits [sanitary pads etc] from them.” Rita was so moved by the suffering around her and so inspired by the work of FPAN and other NGOs, that, after attending to her own and her family’s needs, she began working as a volunteer distributing dignity kits to women and girls living in tents. FPAN services are vital, both during emergency response and in normal life. Rita says the fact that FPAN community mobilisers and volunteers can mediate well between local people and the health services, and articulate their needs, makes them unique in Nepal. “The activities that FPAN are doing are really good,” she says. “I and the women in this community really want FPAN to continue their services because they are the best ones we get. We are really worried they might stop.”

Young nepalese volunteer from IPPF in Nepal, FPAN
story

| 25 July 2017

Thousands of young volunteers join us after the earthquake

The April 2015 earthquake in Nepal brought death and devastation to thousands of people – from which many are still recovering. But there was one positive outcome: after the earthquake, thousands of young people came forward to support those affected as volunteers. For Rita Tukanbanjar, 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,” she says. The earthquake severely affected people’s access to healthcare, but women and girls were particularly vulnerable: living in tents can make menstrual hygiene difficult, and most aid agencies tend to neglect these needs and forget to factor them into relief efforts. “After the earthquake, lots of people were living in tents, as most of the houses had collapsed,” Rita says. “During that time, the girls, especially, were facing a lot of problems maintaining their menstrual hygiene. All the shops and services for menstrual hygiene were closed.” This makes FPAN’s work even more vital. The organisation stepped into the breach and organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. This was not only useful during the earthquake, but provided valuable knowledge for women and girls to use in normal life too, Rita says: “From that time on wards, women are still making their own sanitary pads.” In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons. Nepal is one of the poorest countries in the world with gross domestic product per capita of just $691 in 2014. In this largely patriarchal culture, the needs of women often come low down in a family’s priorities. “This is very important work and very useful,” Rita says. The women and girls also learned about how to protect themselves from sexual violence, which saw a surge in the weeks after the earthquake, with men preying on people living in tents and temporary shacks. Rita and her family lived in a tent for 20 days. “There was always the fear of getting abused,” she says. Eventually they managed to return home to live in the ruins of their house: “one part was undamaged so we covered it with a tent and managed to sleep there, on the ground floor.” Seeing the suffering the earthquake had caused, and the work FPAN and other organisations were doing to alleviate it, cemented Rita’s decision to begin volunteering. “After the earthquake, when things got back to normal, I joined FPAN.” She also completed her nursing degree, which had been interrupted by the disaster. “Since joining FPAN, I have been very busy creating awareness about sexual rights and all kinds of things, and running Friday sexual education classes in schools,” Rita says. “And since I have a nursing background, people often come to me with problems, and I give them suggestions and share my knowledge with them.” She also hopes to become a staff nurse for FPAN. “If that opportunity comes my way, then I would definitely love to do it,” she says.

Young nepalese volunteer from IPPF in Nepal, FPAN
story

| 28 March 2024

Thousands of young volunteers join us after the earthquake

The April 2015 earthquake in Nepal brought death and devastation to thousands of people – from which many are still recovering. But there was one positive outcome: after the earthquake, thousands of young people came forward to support those affected as volunteers. For Rita Tukanbanjar, 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,” she says. The earthquake severely affected people’s access to healthcare, but women and girls were particularly vulnerable: living in tents can make menstrual hygiene difficult, and most aid agencies tend to neglect these needs and forget to factor them into relief efforts. “After the earthquake, lots of people were living in tents, as most of the houses had collapsed,” Rita says. “During that time, the girls, especially, were facing a lot of problems maintaining their menstrual hygiene. All the shops and services for menstrual hygiene were closed.” This makes FPAN’s work even more vital. The organisation stepped into the breach and organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. This was not only useful during the earthquake, but provided valuable knowledge for women and girls to use in normal life too, Rita says: “From that time on wards, women are still making their own sanitary pads.” In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons. Nepal is one of the poorest countries in the world with gross domestic product per capita of just $691 in 2014. In this largely patriarchal culture, the needs of women often come low down in a family’s priorities. “This is very important work and very useful,” Rita says. The women and girls also learned about how to protect themselves from sexual violence, which saw a surge in the weeks after the earthquake, with men preying on people living in tents and temporary shacks. Rita and her family lived in a tent for 20 days. “There was always the fear of getting abused,” she says. Eventually they managed to return home to live in the ruins of their house: “one part was undamaged so we covered it with a tent and managed to sleep there, on the ground floor.” Seeing the suffering the earthquake had caused, and the work FPAN and other organisations were doing to alleviate it, cemented Rita’s decision to begin volunteering. “After the earthquake, when things got back to normal, I joined FPAN.” She also completed her nursing degree, which had been interrupted by the disaster. “Since joining FPAN, I have been very busy creating awareness about sexual rights and all kinds of things, and running Friday sexual education classes in schools,” Rita says. “And since I have a nursing background, people often come to me with problems, and I give them suggestions and share my knowledge with them.” She also hopes to become a staff nurse for FPAN. “If that opportunity comes my way, then I would definitely love to do it,” she says.

Family Planning FPAN
story

| 25 July 2017

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Family Planning FPAN
story

| 28 March 2024

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Portrait of Binu
story

| 05 July 2017

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Portrait of Binu
story

| 28 March 2024

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Young nepalese female farmer, IPPF, FPAN
story

| 25 July 2017

Reproductive health for Nepalese female farmers after the earthquake

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. They face east towards the rising sun, their facades bedecked in intricate wooden carvings patterns linked to the ancient Buddhist culture of the Tamang people. Today, most of these houses lie in ruin, emptying the heart of the village of people, with most moving to temporary shacks on Gatlang’s fringes. Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband, Nakul, 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’s house – or what remains of it – lies at the centre of old Gatlang, on a street of traditional houses that have either entirely collapsed or are uninhabitable due to cracks and structural damage. Piles of stone and wooden cross beams are strewn in what was once a thriving village street. Like many families here, Kopila and her husband and boys have moved into a small shack built from corrugated iron and plastic. This was meant to be a temporary solution, but two years later, they are still living in it, unable to afford the enormous cost of rebuilding their old home. “It needs lots of money,” she says. “I don’t know when we will have the money to build this home again.” FPAN provided emergency health support to families like Kopila’s in the weeks and months after the earthquake. Mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.  These days, Kopila gets regular advice from Pasang Tamang, the FPAN reproductive health female volunteer in the village. Kopila had suffered after the birth of her last child. “I didn’t menstruate for eight months, and then after that I started using the [contraceptive] injection,” she says. “But there were some side effects: I started menstruating twice a month.” She then went to a mobile health camp run by FPAN and started using the intrauterine coil. “After that, my menstruation went back to normal,” she says. In a village scarred by the earthquake, access to family planning has brought some much needed stability and relief to Kopila and her small family. “FPAN provide different services and knowledge: I have come to know that having more children can bring suffering, because it’s not enough to just feed children, they must be educated too” she says. “A small family is a happy family.”

Young nepalese female farmer, IPPF, FPAN
story

| 28 March 2024

Reproductive health for Nepalese female farmers after the earthquake

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. They face east towards the rising sun, their facades bedecked in intricate wooden carvings patterns linked to the ancient Buddhist culture of the Tamang people. Today, most of these houses lie in ruin, emptying the heart of the village of people, with most moving to temporary shacks on Gatlang’s fringes. Kopila Tamang is a 24-year-old farmer and mother to two young boys. Her husband, Nakul, 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’s house – or what remains of it – lies at the centre of old Gatlang, on a street of traditional houses that have either entirely collapsed or are uninhabitable due to cracks and structural damage. Piles of stone and wooden cross beams are strewn in what was once a thriving village street. Like many families here, Kopila and her husband and boys have moved into a small shack built from corrugated iron and plastic. This was meant to be a temporary solution, but two years later, they are still living in it, unable to afford the enormous cost of rebuilding their old home. “It needs lots of money,” she says. “I don’t know when we will have the money to build this home again.” FPAN provided emergency health support to families like Kopila’s in the weeks and months after the earthquake. Mobile health camps offered medicines, health check ups, dignity kits, family planning, antenatal checks and other vital services.  These days, Kopila gets regular advice from Pasang Tamang, the FPAN reproductive health female volunteer in the village. Kopila had suffered after the birth of her last child. “I didn’t menstruate for eight months, and then after that I started using the [contraceptive] injection,” she says. “But there were some side effects: I started menstruating twice a month.” She then went to a mobile health camp run by FPAN and started using the intrauterine coil. “After that, my menstruation went back to normal,” she says. In a village scarred by the earthquake, access to family planning has brought some much needed stability and relief to Kopila and her small family. “FPAN provide different services and knowledge: I have come to know that having more children can bring suffering, because it’s not enough to just feed children, they must be educated too” she says. “A small family is a happy family.”

A student in Nepal is helped by IPPF, FPAN, after the earthquake
story

| 25 July 2017

A rescued student devotes her time to rebuilding her community

For 22-year-old student Anjal Auwal, April 25 began as an ordinary day. She had been up late the night, preparing for an exam. Tired after revising, she woke up late and went into the kitchen to eat. It was then that the earthquake struck. “When it struck and I saw the walls shaking and falling down, I collapsed,” Anjal says. “I knew nothing after that. It was just like a dream.” 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,” 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.” Hours later, Anjal heard her uncle’s voice from somewhere beyond the rubble that surrounded her. “I thought this is my chance, and I shouted again in the hope my uncle might hear me.” Eventually, five hours after being trapped, Anjal was pulled from the rubble, injured but alive. “My left side was not working, so my family took me to hospital,” she says. “But the hospital rejected me because they had such limited services. Eventually we found another hospital to care for me.” Anjal’s injuries were extensive. It took six months of medication, rest and rehabilitation for her hand and leg to recover. She also suffered digestion problems: whenever she ate, she would vomit, and the doctors became alarmed that her body was getting little nutrition.   Two years later, she has more or less recovered. “I still have a few problems with digestion, I have scars from the wounds and I occasionally gets pain in my hands, but things have improved a lot,” she says. Her sickness and long rehabilitation meant her studies were interrupted, but eventually she managed to take the exam and passed. Having time off has given her time to reflect on what she wants to do with her life. She’s now planning to volunteer for FPAN, after hearing about it from friends at school. “I haven’t so far because of my health problems,” she says. “But now I’m eager to join and to learn about sexual health and family planning. I’ve realised it’s very important.”

A student in Nepal is helped by IPPF, FPAN, after the earthquake
story

| 28 March 2024

A rescued student devotes her time to rebuilding her community

For 22-year-old student Anjal Auwal, April 25 began as an ordinary day. She had been up late the night, preparing for an exam. Tired after revising, she woke up late and went into the kitchen to eat. It was then that the earthquake struck. “When it struck and I saw the walls shaking and falling down, I collapsed,” Anjal says. “I knew nothing after that. It was just like a dream.” 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,” 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.” Hours later, Anjal heard her uncle’s voice from somewhere beyond the rubble that surrounded her. “I thought this is my chance, and I shouted again in the hope my uncle might hear me.” Eventually, five hours after being trapped, Anjal was pulled from the rubble, injured but alive. “My left side was not working, so my family took me to hospital,” she says. “But the hospital rejected me because they had such limited services. Eventually we found another hospital to care for me.” Anjal’s injuries were extensive. It took six months of medication, rest and rehabilitation for her hand and leg to recover. She also suffered digestion problems: whenever she ate, she would vomit, and the doctors became alarmed that her body was getting little nutrition.   Two years later, she has more or less recovered. “I still have a few problems with digestion, I have scars from the wounds and I occasionally gets pain in my hands, but things have improved a lot,” she says. Her sickness and long rehabilitation meant her studies were interrupted, but eventually she managed to take the exam and passed. Having time off has given her time to reflect on what she wants to do with her life. She’s now planning to volunteer for FPAN, after hearing about it from friends at school. “I haven’t so far because of my health problems,” she says. “But now I’m eager to join and to learn about sexual health and family planning. I’ve realised it’s very important.”

A mother rescued by IPPF in Nepal, FPAN, speaks to a clinician
story

| 25 July 2017

A mother in need volunteers to save others in the earthquake

“When the earthquake struck, I was on the sixth floor of my family’s house, with my son. For 15 or 20 minutes, I couldn’t do anything. I tried to open the door but I couldn’t: I was trapped.” Rita Chawal is 32 years old and married with a small son, who was four at the time of the earthquake. They lived together with 15 other members of her husband’s family in one of the tall, traditional houses that line the streets of Bhaktapur, an ancient temple city 15 kilometres from Kathmandu. The earthquake caused extensive damage to the city, bringing down old brick houses, shops and schools, and destroying some of the medieval temples in the network of squares that make up the city’s historic centre. The entire back of Rita’s house collapsed. “Eventually, we managed to come down from the sixth floor, but once we got to ground level, we saw that many houses had collapsed,” she says. “It was really terrifying seeing those scenes. Nevertheless, we managed to cross over the demolished buildings and get to the public football grounds, where we stayed together and lived in tents.” Sexual health and the menstrual needs of women and girls tend to be neglected by aid organisations in the aftermath of natural disasters. One problem is that WASH (Water, sanitation and hygiene) response tends to be coordinated and designed by men, who can more easily overlook women’s needs. This is why organisations like FPAN are so vital in frontline response after disasters. “After the earthquake, family planning services stopped for a few days,” Rita explains. “But after that there were health camps [run by FPAN] that distributed dignity kits and family planning devices. I received dignity kits [sanitary pads etc] from them.” Rita was so moved by the suffering around her and so inspired by the work of FPAN and other NGOs, that, after attending to her own and her family’s needs, she began working as a volunteer distributing dignity kits to women and girls living in tents. FPAN services are vital, both during emergency response and in normal life. Rita says the fact that FPAN community mobilisers and volunteers can mediate well between local people and the health services, and articulate their needs, makes them unique in Nepal. “The activities that FPAN are doing are really good,” she says. “I and the women in this community really want FPAN to continue their services because they are the best ones we get. We are really worried they might stop.”

A mother rescued by IPPF in Nepal, FPAN, speaks to a clinician
story

| 28 March 2024

A mother in need volunteers to save others in the earthquake

“When the earthquake struck, I was on the sixth floor of my family’s house, with my son. For 15 or 20 minutes, I couldn’t do anything. I tried to open the door but I couldn’t: I was trapped.” Rita Chawal is 32 years old and married with a small son, who was four at the time of the earthquake. They lived together with 15 other members of her husband’s family in one of the tall, traditional houses that line the streets of Bhaktapur, an ancient temple city 15 kilometres from Kathmandu. The earthquake caused extensive damage to the city, bringing down old brick houses, shops and schools, and destroying some of the medieval temples in the network of squares that make up the city’s historic centre. The entire back of Rita’s house collapsed. “Eventually, we managed to come down from the sixth floor, but once we got to ground level, we saw that many houses had collapsed,” she says. “It was really terrifying seeing those scenes. Nevertheless, we managed to cross over the demolished buildings and get to the public football grounds, where we stayed together and lived in tents.” Sexual health and the menstrual needs of women and girls tend to be neglected by aid organisations in the aftermath of natural disasters. One problem is that WASH (Water, sanitation and hygiene) response tends to be coordinated and designed by men, who can more easily overlook women’s needs. This is why organisations like FPAN are so vital in frontline response after disasters. “After the earthquake, family planning services stopped for a few days,” Rita explains. “But after that there were health camps [run by FPAN] that distributed dignity kits and family planning devices. I received dignity kits [sanitary pads etc] from them.” Rita was so moved by the suffering around her and so inspired by the work of FPAN and other NGOs, that, after attending to her own and her family’s needs, she began working as a volunteer distributing dignity kits to women and girls living in tents. FPAN services are vital, both during emergency response and in normal life. Rita says the fact that FPAN community mobilisers and volunteers can mediate well between local people and the health services, and articulate their needs, makes them unique in Nepal. “The activities that FPAN are doing are really good,” she says. “I and the women in this community really want FPAN to continue their services because they are the best ones we get. We are really worried they might stop.”

Young nepalese volunteer from IPPF in Nepal, FPAN
story

| 25 July 2017

Thousands of young volunteers join us after the earthquake

The April 2015 earthquake in Nepal brought death and devastation to thousands of people – from which many are still recovering. But there was one positive outcome: after the earthquake, thousands of young people came forward to support those affected as volunteers. For Rita Tukanbanjar, 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,” she says. The earthquake severely affected people’s access to healthcare, but women and girls were particularly vulnerable: living in tents can make menstrual hygiene difficult, and most aid agencies tend to neglect these needs and forget to factor them into relief efforts. “After the earthquake, lots of people were living in tents, as most of the houses had collapsed,” Rita says. “During that time, the girls, especially, were facing a lot of problems maintaining their menstrual hygiene. All the shops and services for menstrual hygiene were closed.” This makes FPAN’s work even more vital. The organisation stepped into the breach and organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. This was not only useful during the earthquake, but provided valuable knowledge for women and girls to use in normal life too, Rita says: “From that time on wards, women are still making their own sanitary pads.” In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons. Nepal is one of the poorest countries in the world with gross domestic product per capita of just $691 in 2014. In this largely patriarchal culture, the needs of women often come low down in a family’s priorities. “This is very important work and very useful,” Rita says. The women and girls also learned about how to protect themselves from sexual violence, which saw a surge in the weeks after the earthquake, with men preying on people living in tents and temporary shacks. Rita and her family lived in a tent for 20 days. “There was always the fear of getting abused,” she says. Eventually they managed to return home to live in the ruins of their house: “one part was undamaged so we covered it with a tent and managed to sleep there, on the ground floor.” Seeing the suffering the earthquake had caused, and the work FPAN and other organisations were doing to alleviate it, cemented Rita’s decision to begin volunteering. “After the earthquake, when things got back to normal, I joined FPAN.” She also completed her nursing degree, which had been interrupted by the disaster. “Since joining FPAN, I have been very busy creating awareness about sexual rights and all kinds of things, and running Friday sexual education classes in schools,” Rita says. “And since I have a nursing background, people often come to me with problems, and I give them suggestions and share my knowledge with them.” She also hopes to become a staff nurse for FPAN. “If that opportunity comes my way, then I would definitely love to do it,” she says.

Young nepalese volunteer from IPPF in Nepal, FPAN
story

| 28 March 2024

Thousands of young volunteers join us after the earthquake

The April 2015 earthquake in Nepal brought death and devastation to thousands of people – from which many are still recovering. But there was one positive outcome: after the earthquake, thousands of young people came forward to support those affected as volunteers. For Rita Tukanbanjar, 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,” she says. The earthquake severely affected people’s access to healthcare, but women and girls were particularly vulnerable: living in tents can make menstrual hygiene difficult, and most aid agencies tend to neglect these needs and forget to factor them into relief efforts. “After the earthquake, lots of people were living in tents, as most of the houses had collapsed,” Rita says. “During that time, the girls, especially, were facing a lot of problems maintaining their menstrual hygiene. All the shops and services for menstrual hygiene were closed.” This makes FPAN’s work even more vital. The organisation stepped into the breach and organised classes on menstrual hygiene and taught women and girls how to make sanitary pads from scratch. This was not only useful during the earthquake, but provided valuable knowledge for women and girls to use in normal life too, Rita says: “From that time on wards, women are still making their own sanitary pads.” In an impoverished country like Nepal, many women and girls can simply not afford to buy sanitary pads and tampons. Nepal is one of the poorest countries in the world with gross domestic product per capita of just $691 in 2014. In this largely patriarchal culture, the needs of women often come low down in a family’s priorities. “This is very important work and very useful,” Rita says. The women and girls also learned about how to protect themselves from sexual violence, which saw a surge in the weeks after the earthquake, with men preying on people living in tents and temporary shacks. Rita and her family lived in a tent for 20 days. “There was always the fear of getting abused,” she says. Eventually they managed to return home to live in the ruins of their house: “one part was undamaged so we covered it with a tent and managed to sleep there, on the ground floor.” Seeing the suffering the earthquake had caused, and the work FPAN and other organisations were doing to alleviate it, cemented Rita’s decision to begin volunteering. “After the earthquake, when things got back to normal, I joined FPAN.” She also completed her nursing degree, which had been interrupted by the disaster. “Since joining FPAN, I have been very busy creating awareness about sexual rights and all kinds of things, and running Friday sexual education classes in schools,” Rita says. “And since I have a nursing background, people often come to me with problems, and I give them suggestions and share my knowledge with them.” She also hopes to become a staff nurse for FPAN. “If that opportunity comes my way, then I would definitely love to do it,” she says.

Family Planning FPAN
story

| 25 July 2017

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Family Planning FPAN
story

| 28 March 2024

Emergency rescue in Kathmandu Valley

For Sharad Kumar Argal, the weeks after April 25 are a time he will never forget. Sharad has been working for FPAN for twenty years, currently as Kathmandu Valley branch manager. When the earthquake struck, the Kathmandu Valley was among the worst affected area in the country. Thousands of people were killed, injured and displaced, and many of the valley’s houses, schools, buildings and historic temples were destroyed or damaged beyond repair. The 2015 earthquake has been a major test for the country, with bureaucracy and alleged abuse hampering reconstruction. But for FPAN, in the days after the quake struck, there was no time to waste. “The first thing we did was to identify the needs of the people,” Sharad says. “We realised people were being deprived of services,” with many clinics and hospitals damaged, closed or overwhelmed by patients. By the second day after the earthquake, we were conducting health camps. All the volunteers and staff came together and made a plan: we identified the most affected areas and went there with mobile services.” The teams divided their work into two categories: first and second level. During the first phase, they offered check ups for those injured and distributed essential items like oral rehydration, medicines, food and water. During the second phase, a few days later, they gave more comprehensive services: the team set up mobile labs to carry out blood tests, provided contraception and dignity kits [sanitary pads etc], and gave antenatal checks and psycho-social counselling. They also set up women- and child-friendly spaces, in partnership with the UN Population Fund and other NGOs. For women, safe spaces to spend time and access support were vital, particularly given how insecure and vulnerable their temporary accommodation was. “Children were very affected with trauma, as well as physically,” says Sharad. “We set up child-friendly spaces where children could come, spend time and play with toys. We even had a tutor to give them education, as well as counsellors.” Today, the work of the FPAN Valley branch office is still heavily affected by the earthquake. Their Bhaktapur clinic was completely destroyed and they now operate out of tiny room in the ancient heart of the city, surrounded by building sites and the sounds of cement mixers, while they await permission from government and community leaders to begin building a new centre. “Most of our service delivery points are still damaged,” says Sharad. “This is the main hindrance to giving services to the people: we want to provide services but due to the lack of space, we often can’t provide the services they want. This is one of the biggest impacts we are still facing.”

Portrait of Binu
story

| 05 July 2017

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal

Portrait of Binu
story

| 28 March 2024

How cultural traditions affect women’s health

High up in the mountains of central northern Nepal, not far from the Tibetan border, lies the district of Rasuwa. The people here are mainly ethnic Tamang and Sherpa, two indigenous groups with cultural traditions stretching back centuries. But these rich cultural traditions can come hand-in-hand with severe social problems, compounded by entrenched poverty and very low literacy rates. Binu Koraila is a health facility mentor for the Family Planning Association of Nepal (FPAN) in Rasuwa. "Stigma, myths and cultural practices can have a damaging effect on sexual health, family planning and women’s rights", she says. Misconceptions about contraception are widespread. “People think the intrauterine coil will go into the brain or will fall out. They think the contraceptive implant will penetrate into the muscles.” Funeral rites present another problem. “Men who want a vasectomy need permission from their parents,” she explains. “But it’s thought that men who have had vasectomies won’t be able to perform the rituals after their parent’s death: parents think that God won’t accept that, so they don’t allow men to have vasectomies.” The culture here is strongly patriarchal. Among the Tamang, marriage involves boys or men picking out young girls from their communities.Early and forced marriage is widespread among the Tamang. If chosen, the girls have no choice but to get married. “If a boy likes a girl, they can just snatch them and take them to their house,” Binu says. Some girls are as young as 13 years old. “The girls don’t know enough about family planning, so there is a lot of teenage pregnancy.” Early marriage and teenage pregnancy can create all kinds of physical, emotional, social and economic problems for girls and their families. For many, their bodies are not well developed enough for childbirth, and maternal mortality remains a major problem in Nepal, at 258 deaths per 100,000 live births, according to UNFPA data. Their large families also suffer because there is not enough food and money to go around. “Women are the worst affected,” Binu says. Parents and husbands keep strict control of women’s access to contraception. “If they want to use contraception, women tend to need consent from their parents or husbands. “I have seen cases where if a woman gets contraceptive implant services, they get beaten by their father-in-law and husband. One woman asked to have her implant removed because she had been beaten by her husband.” Binu’s role is to deliver sexual health and family planning advice and services to villages across Rasuwa district: “I go to remote places, where people are marginalised and don’t know about family planning.” She also trains government health workers on family planning, and mentors them after they return from training in Kathmandu to Rasuwa. As well as delivering health services, the FPAN team have been working hard to change perceptions. “Recently we had a health camp at Gatland,” she explains. "After two hours of counselling one client requested an IUD. After months there was a rumour in Gatlang that her coil had fallen out. The FPAN volunteer went to the woman’s house and asked if this was true. She said, ‘No, I’m really comfortable with that service.’ After that, the client went door to door and told others how happy she was with it and that they should take it at the next family planning camp. “After four or five months, we went back to the Gatlang camp and at that time another eight women took the IUD.” These numbers might seem small but they are far less so when viewed against the wall of stigma and myth that can obstruct contraception use here, as in so many rural areas of Nepal. The involvement of committed, passionate health mentors and volunteers is vital to show people how important it is to take sexual health and family planning seriously: the benefits are felt not just by women and their families, but by entire communities. Stories Read more stories from Nepal