Women left vulnerable to unwanted pregnancies and HIV after floods in Nepal

Reproductive health should be central part of climate change adaptation, say activists who argue women are left particularly vulnerable after floods and natural disasters
<p>During disasters, poorer women’s reproductive health vulnerability increases, while access to services decreases. Women sell vegetables in the Palace forecourt in Kathmandu. Photo Credit: Manipadma Jena</p>

During disasters, poorer women’s reproductive health vulnerability increases, while access to services decreases. Women sell vegetables in the Palace forecourt in Kathmandu. Photo Credit: Manipadma Jena

The massive floods and landslides that hit western Nepal in August affected over 90,000 people and washed away 12,000 homes. The surging water also took with it means of protection against unwanted pregnancies and HIV infections for thousands of married couples and migrant returnees.

“If we get pregnant you will be responsible, scold women who come to me for daily contraceptive pills,” said 35-year-old Ram Kali Choudhary, a reproductive health community peer educator for nine villages of Bardiya district in the mid-western region of Nepal, close to India’s border and 16-hours drive from Kathmandu.

“But what can I do, the waist-high flood water stayed for three days not only carried away my stock of contraceptives, the main clinic in Gularia town also lost their supplies to flood waters. Replacements arrived 20 days later, but during this period 50% of married couples were completely unprotected,” Ram Kali added.

Under normal conditions the situation in Bardiya is cause for concern, said Ram Kali; the average fertility rate among Nepal’s poorest women is 4.1 children, but 5 to 8 children are usual for these couples. While abortion is legal, most women are not aware of this. Consequently, many women risk unsafe abortions when unwanted pregnancies occur.

“Floods not only lead to unwanted pregnancies, menstruating girls and women caught in waist-deep water and damp clothes for days together run a high risk of catching urinary infections,” Navin Thapa, acting director general of the Family Planning Association of Nepal told

“The risk of women contracting HIV infections rises during natural disasters when male migrants return home to be with their families and condoms cannot be accessed,” Thapa said. “HIV and AIDS incidence in Nepal of late is seeing a jump among migrant labour groups”, he added. Male out- migration from rural Nepal where 85% of people live has been growing since the late 1990s, coinciding with the Maoist insurgency.

During disasters, poorer women’s vulnerability increases, while access to reproductive health services becomes more difficult.

“However, to be frank, we have no specific projects to handle reproductive health services during disasters,” Thapa said.

kathamandu women
Ram Kali Choudhary, a reproductive health peer educator in Bardiya district narrates the difficulties her community women faced when floods carried away her stock of contraceptives (Photo Credit: Manipadma Jena)

Reproductive health and natural disasters
Nepal faces a growing threat from natural disasters; floods, landslides, soil and river bank erosion, earthquakes and occasional glacier bursts are becoming more frequent and intense. Experts say the country’s rugged and geologically active terrain, poorly planned land use and the increasingly concentrated monsoon rains due to climate change are largely responsible.

Over the past 40 years (1971-2007) floods and landslides alone caused over 8,000 deaths, affected over 4 million people, damaged 0.25 million hectares of farm and forest land and resulted in economic losses of about US$100 million.

Natural disasters tend to have a disproportionate impact on the poor, who mainly live on steep landslide-prone hills or in low-lying flood-prone areas, and who lack the resources to recover when their poorly-made homes collapse and their meager belongings are lost.

Frequent natural disasters present a major obstacle for Nepal as it tries to break out of its Least Developed Country (LDC) status and achieve the Millennium Development Goals (MDGs) by 2015, including targets for women’s empowerment and access to reproductive health services.

In the Gender Inequality Index (GII) in the UN Human Development Report 2014, Nepal has fallen steeply from 98th in 2013 to 145th out of 187 countries. The index is calculated by combining data on maternal mortality, number of adolescent mothers, education levels, women’s share of seats in parliament among other factors.

NGOs have begun to acknowledge and take action to address the links between climate variability, natural disasters and stalled human development. For example, in 2013 World Wildlife Fund for Nature (WWF) – Nepal began the Hariyo Ban (healthy forests) project in two climate fragile regions. The project integrates biodiversity conservation and sustainable management of forest resources led by women’s groups, with education about reproductive health and women’s empowerment.

But civil society members say this is too little too late. Climate disasters, they say, may be affecting women and girls in insidious ways we do not yet understand

Natural disasters linked to child marriages

A 2013 report from World Vision, ‘Untying the Knot – Exploring Early Marriages in Fragile States’, provides evidence that “fragility is a key contributing factor to higher rates of early marriage,” based on research with local communities.

Insecurity, distress and fear breaks up protective community networks makes early marriage seem like a refuge for many families wanting to safeguard their daughters and their family “honour”, the research claims.

According to a research by the International Centre for Research on Women (ICRW), after decades of civil war, the 2004 tsunami in Sri Lanka pushed desperate families to marry off their young to relieve economic strife. Girls were forced into early marriage with tsunami widowers, primarily to receive state subsidies and benefits for marrying and starting a family. In Bangladesh, nearly two-thirds of children married under 18 were married in the months following cyclone Sidr in 2007. Similar trends are cited for Afghanistan, the Sahel, Somaliland, and northern Uganda.

Most of the 25 countries with the highest rates of early marriage are considered fragile states or at high risk of natural disasters, the World Vision research says.

Half of all girls living in least developed countries marry before their eighteenth birthday, while 1 in 9 girls marry before they turn 15. Almost half of the world’s child spouses live in South Asia.

Child marriages in Nepal have fallen by 20% between 2006 and 2011, according to the UN Population Fund. However gender activist Sushmita Choudhury of the International Planned Parenthood Federation (IPPF), South Asia Region, warned “the impact of more frequent and more intense climate events could reverse the positive trend if girls are not educated and get a voice as soon as possible,” speaking at a consultation on the post-2015 development agenda in Kathmandu in September

If present trends continue,  even without counting the impact of natural disasters, the number of girls under 18 marrying every year will grow by 14% from 14.2 million in 2010 to 15.1 million by 2030, according to the UN.

“There is a major gap within existing policy interventions which have so far failed to recognise the role of fragility as a major driver of early marriage,” the World Vision report cautions.

Reproductive health key to development

“The key to climate change adaptation is resilient, secure and empowered people. These aims can only be achieved with access to sexual and reproductive health services,” said Sushmita Choudhury.

The activists gathered in Kathmandu all agreed the Sustainable Development Goals – the new global targets that will replace the millennium development goals (MDGs), which reach their deadline at the end of next year – must include a target “to achieve sexual and reproductive health and rights for all by 2030, including access to information, education, services particularly for adolescents and youth.”

Sexual and reproductive health was a contentious topic in the UN consultations about the post-2015 development goals in New York in July, with several countries refusing to include “sexual rights”, according to Ranja Sengupta of the Malaysia based non-profit Third World Network.

Last month, the UN appointed working group proposed 17 goals and 169 targets to the general assembly. The proposed goals cover the broad themes of the MDGs – ending poverty and hunger, and improving health, education and gender equality – but also include specific goals to reduce inequality, make cities safe, address climate change and promote peaceful societies.

Which of these remain in the final list of SDGs will be decided in September 2015, but NGOs are putting up a stiff fight not just to keep sexual and reproductive health rights in the final list but expand its purview.