Advocate Deepesh Shrestha, FWLD
Advocate Nabin Kumar Shrestha, FWLD
It’s been 25 years since the adaptation of the Beijing Declaration and Platform for Action (BPFA) in 1995, which reflects a new international commitment to the goals of equality, development and peace for all women everywhere. In March 2020, the UN Commission on the Status of Women (CSW) is going to undertake a review of progress made by the states in the implementation of the BPFA in 64th Session. The Beijing Review provides an important opportunity for women to examine their respective governments’ efforts and those of the other non- state actors in implementing the BPFA. It is also an opportunity for holding leaders and governments accountable for their commitments made for women’s empowerment, gender equality and the promotion of women’s human rights under the BPFA.
The National Network for Beijing Review Nepal (NNBN) which constitutes of over 70 leading NGOs working to protect and promote Women’s Human Rights in Nepal has submitted the NGOs (parallel) report of Nepal on the Beijing +25 reviews and Forum for Women, Law and Development (FWLD) has been coordinating all the process as a Secretariat of the Network. The report consists the present status, progress achieved, persistent and emerging challenges along with conclusion and recommendation in 12 Beijing critical areas of concern.
For the benefit of women on their health, Nepal has reiterated its commitment to achieve Universal Access to SRHR (Sexual and Reproductive Health and Rights) as outlined in the targets 3.7 and 5.6 of Sustainable Development Goals. The Constitution of Nepal has affirmed that, “Every woman shall have right to Safe Motherhood and Reproductive Health” and has ensured basic health rights under the right relating to health.
The report highlights the progress achieved by Nepal which includes, Maternal Mortality Ratio (MMR) decreased from 539 maternal deaths per 100,000 live births to 239 maternal deaths per 100,000 live births between 1996 and 2016. The report shows major achievements like, legalization of abortion in 2002 and promulgation of Safe Motherhood and Reproductive Health Right Act, 2018. Also, the Procedure Guideline on Safe Abortion Service Program was revised to implement free abortion services in 2016. The report also shows implementation of National Safe Motherhood Program; launch of Birth Preparedness Package and Maternal Neo-natal Health Activities at community level, Rural Ultrasound Program, Aama and the New Born Program and providing incentives to mothers having completed four antenatal care visits in health facilities, free institutional delivery incentives for health care workers, free sick new born care. The report highlighted new programs like Reproductive Health Morbidity Prevention and Management Program, Management of Pelvic Organ Prolapse, Cervical Cancer Screening and Prevention Training, Obstetric Fistula Management, Emergency Referral Fund and the Nyano Jhola Program.
Furthermore, the report also emphasizes on one of the remarkable outcomes of 2018/19 i.e. prioritization of Universal Health Coverage where the government increased their budget on healthcare by NPR. 24.64 billion (US$ 228 million). The Nepal Health Sector Plan has focused on improving the health service delivery. The Government of Nepal has implemented “Multi-sector Nutritional Plan 2013- 2017 (MSNP) that targets teen aged girls, pregnant women and breast feeding mothers of low income groups. Likewise, the Ministry of Health introduced “Operational Guidelines for Gender Equality and Social Inclusion Mainstreaming in the Health Sector” in 2013 and also institutionalized the GESI unit. It has also been implementing “National Female Community Health Volunteer (FCHV) Program” to improve access to quality health services.
Similarly, the Country Criminal Code, 2017 has criminalized Chhaupadi and discrimination and exclusion based on menstruation period. The Public Health Service Act, 2018 ensures right to obtain quality health service to every citizen in an easy and convenient manner and guarantees free basic health services to every citizen. Furthermore, report shows training and awareness on Menstrual Health Management (MHM) are provided in some district.
However, the report also emphasizes some persistent and emerging challenges such as unequal power relation between men and women in negotiating safer sex resulting high maternal mortality ratio. The report shows lack of availability of full range of contraceptive devices in the health facilities which bring high unmet need among adolescent. Only 15% married adolescent use modern contraceptives and 19% have unwanted pregnancy. The report shows that only 41% women know about legalization of abortion and still 58% women go for clandestine abortion. Also, due to conditional decriminalization of abortion, women still are prosecuted and imprisoned in abortion related offences.
Likewise, the report also highlights on less health facilities that addresses health needs of most marginalized women and girls taking life cycle and an inter-sectional approach. Although, women account to more than 50% of the health worker there still prevalent unpaid and underpaid female community health workers.
The report concludes by stating that although many transformative reproductive health policies are in place in Nepal, the implementation level is weak and there remain multiple levels of barriers to access full range of available sexual and reproductive health services. Furthermore, the report also puts out some recommendations which includes, prioritizing and adopting life cycle approach to health design and delivery while addressing the health needs of the most marginalized women and girls taking an inter-sectional approach to leaving no one behind; all types of safe abortion services up to second trimester services should be included in Basic Health Care package; ensure availability of gender sensitive trained health care force that can address the inter linkage of different dimensions of health; ensure proper referral mechanism and promote empowerment programs that address gender inequality and adopt a gender transformative approach to national health workforce planning, making gender analysis integral to labor market analysis.