Nepal

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Nepal, a landlocked kingdom between India and China, is home to Himalayan peaks as well as 26 million people who comprise roughly 100 ethnic and caste groups and who speak more than 92 dialects.  Nepal is divided into three distinct zones - mountains, hills, and plains – and the often difficult terrain presents obstacles accessing health care for the Nepali people. Those who live in remote mountain villages are often a day's walk from health care services. Compounding this, many women marry young – under the age of 18 – and the family pressure to have a first child soon after marriage means an increased risk of complications during pregnancy and birth due to mothers’ young age. 

It is within this context that EngenderHealth first begin work with Nepal’s Ministry of Health in the 1980s.  Today, we collaborate with the government and local partners to:

 
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. Through the ACQUIRE Project, funded by USAID, EngenderHealth works with the Nepali government to:

  • Raise awareness of and access to long-acting contraceptive methods such as intrauterine devices (IUDs) and implants;
  • Develop national plans to ensure the availability of family planning and reproductive health supplies;
  • Provide training, staffing, and supervisory support at clinics and hospitals;
  • Use mobile family planning clinics to reach clients in underserved areas.

 
Addressing the Unique Needs of Married Adolescents
Many married adolescent couples lack adequate access to reproductive health information, counseling, and services. In  2005 EngenderHealth launched a reproductive health program for married adolescent couples in two districts: Dhanusha and Parsa. The program aims to:

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

 
Involving Men As Partners®
In Nepal, EngenderHealth’s Men As Partners (MAP) program launched a four-site initiative in 2002, and was the first intervention of its kind in the country. Today, MAP has expanded to 50 sites in Bara and Nawalparasi districts. The program, which includes a series of workshops, peer-education initiatives, and media outreach, aims to:

  • Challenge men’s attitudes and behaviors that compromise their own health and safety, as well as the health and safety of women and children;
  • Encourage men to become actively involved in fighting gender-based violence and the HIV and AIDS epidemic.

 
Increasing Access to Postabortion Care Services
To ensure that women have access to postabortion care, EngenderHealth has trained doctors and midwives at health centers to provide comprehensive postabortion care services, including counseling, referral, and infection prevention. We also advocate for integration of postabortion care into routine maternal care services.

 
Strengthening the Quality of Health Care Services
Throughout Nepal, EngenderHealth uses a variety of quality improvement approaches, including performance improvement, COPE®, training in infection prevention, and more, to ensure the quality of health care services. In addition, we helped found the Quality Assurance Working Group—an informal committee active in 17 districts.

 
Promoting Maternal and Newborn Health
In 2005, EngenderHealth and its partners initiated a community-based maternal and newborn care program in three districts: Banke, Jhapa, and Kanchanpur. By promoting community-based interventions, the program aims to:

  • Increase awareness among pregnant women and their families about danger signs during the prenatal, delivery, and postnatal periods;
  • Encourage delivery with skilled birth attendants;
  • Educate health workers and traditional birth attendants to recognize the danger signs of obstetric emergencies;
  • Improve provider skills in basic and emergency obstetric care;
  • Upgrade equipment at health facilities at clinics.