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A ten-year-long civil war in Nepal left around 15,000 people dead and displaced over 100,000 others. Often women and children were targeted with many falling victim to assault and abuse. Although the conflict officially ended in late 2006, the violence against women continues.
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| OVERVIEW |
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The Programme
RHIYA Nepal partnered with 7 NGOs in 19 districts to improve the sexual and reproductive health of young people and adolescents in Nepal. Young people between the ages of 10 24 were targeted, in particular vulnerable groups such as drug users, low caste (Dalits), rural poor and victims of gender-based violence (GBV).
The key strategy in Nepal was to mobilize the community in support of ASRH information and services for these traditionally underserved groups. There was also a strong capacity building effort to improve the skills of health workers, teachers and community leaders. All NGOs took the lead on key certain aspects of the programme, advocacy, training and curriculum, youth-friendly services etc. Collaboration between the partners and linkages with other organizations was an important part of the success of RHIYA Nepal and the sustainability of many of the RHIYA interventions.
Peer education, radio programmes, street drama and community outreach were the main ways the projects reached out to young people. The Programme created spaces for young people through 55 Youth Information Centres and Youth Friendly Corners. Clinical services and counseling were made available to young people. During the course of the programme 80,000 consultations were conducted.
Source: Madhus Marriage Story
The Achievements
RHIYA Nepal has had very positive effects on young peoples sexual and reproductive health knowledge and behaviour. Results from the Baseline Endline survey show that across RHIYA project areas; almost all indicators showed a sharp increase. The changes have been especially striking for the most vulnerable groups (the less educated and the poor), confirming that RHIYA has contributed to greater equality across socio-economic groups in project areas. Comparisons between participants and non-participants consistently show that those who have participated have improved knowledge.
RHIYA Nepal has also been successful in reaching out to vulnerable groups. One NGO has begun to tackle the issues of GBV, integrating GBV into SRH services and raising community awareness on this secretive issue. This ground breaking work is captured in a short documentary entitled XXXXXXX. Strategies and approaches to reach drug users, sex workers and low caste communities are discussed in a Thematic paper on Vulnerable Groups in the RHIYA Final publication A Catalyst for Change
It is also important to acknowledge the scale of the RHIYA achievements in the midst of a major civil conflict. RHIYAs culturally sensitive approach, working with communities on both sides of the conflict allowed the programme to continue and contributed to the positive impact shown by the Baseline/Endline survey. ASRH Programming in Conflict Situations is the topic of a Thematic Paper in the RHIYA Final Publication A Catalyst for Change
The Way Forward
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| PROFILE |
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History / Culture: The first Kingdom of Nepal was born in 1768. Its history dealt with hostility with the British East India Company, which finally recognized its independence in 1923. More recently, Nepal entered into a fragile Peace process in 2006, after ten years of conflict between Nepalese authorities and a Maoist insurrection. The main religion is Hinduism (over 80%). Buddhism (12%) and Islam (4%) are also practiced.
Geography: Nepal, landlocked and mountainous, is squeezed between China and India. Mythical cross-road of the Salt and Silk routes, Nepal is the heartland of the Himalayas. Nepal is home of 8 of the highest 10 peaks in the world, including Everest.
Population / Demography: Nepal is inhabited by approximately 27 million people of which 40% live below the poverty line. Nearly 80% of the population is rural. Overall population density appears low, but this is misleading. Nearly half the population (48%) lives in the Terai region, along the border with India, where agricultural land is most productive. Here population densities reach 570 people per square kilometer. Though there have been some improvements in maternal and child health, mortality rates are high, especially in remote regions in the Himalaya. Reproductive health services, including family planning, remain rudimentary in many areas. Health posts are under-staffed and lack medical supplies. Only one-third of married women are using a modern method of family planning, most of them in urban areas.
Economy / Productivity: The majority of Nepalese is scratching out a precarious living from small hardscrabble farm plots, or hiring out as agricultural laborers. The land holding pattern works against poverty alleviation. 40% of rural households work only 9% of agricultural land, while the top 6% control one-third of all crop and grazing land. Consequently, poverty is endemic, especially in rural areas: 31% of the total population lives below the poverty line ($1 per day), while half the population is “underemployed”. The GDP per Capita is $294.
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| BACKGROUND |
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Characteristics of Youth and Adolescent Population: There are about 8 million young people aged 10-24 in Nepal. According to the population census of 2001, about 40% of the Nepalese population is under 15 years of age and an additional 19.4% is between 15-24 years old. Nepalese population is therefore very young as the mean age is just 20 years (UNFPA). These rates can be seen as a consequence of early (forced) marriage and related early sexual activities. Girls and women, especially in mountainous regions, have a very low status compared to males; they are very dependent on their parents and then their husbands’ decisions.
Education / Socio Economic Development: Gender disparity is evident in the enrolment for primary level education, with boy at 88.7% and girls at 76.8%. This is lower and lower at the secondary level: 44.7% for boys and 35.8% for girls. Moreover, despite efforts made to improve the quality of education, primary education remains weak. Besides, illiteracy or lack of education among girls and women also seem to be related to early marriages and pregnancies. Political instability over the past years remains a threat for socio-economic development, especially for young people who migrate for better life conditions. Because of poverty, large rates of young people indeed migrate to big cities in search for employment, especially in garment and textile factories, but become vulnerable to sex trafficking and abuses, and therefore to SRH issues.
Health and Knowledge on Sexuality and Reproductive Health: Reproductive health indicators are poor: 90% of all births still happen at home and maternal mortality is estimated over 500 per 100,000 live births. Overall, 24% of the female adolescents aged 15-19 years are already mothers or pregnant with their first child. Women do not have the power to influence condom use. SHR is not discussed openly, and parents feel too embarrassed to discuss SRH with their children. Adolescents and youth, because of the lack of knowledge and information are vulnerable. They lack life skills to negotiate with their partners and make informed decisions about reproductive health behaviour. They also have limited knowledge on SRH rights issues and hygiene. HIV prevalence is less than 1% in the general adult population, but more than 5% in high risk marginalized groups, mainly young people: seasonal labour migrants, commercial sex workers and their clients and injecting drug users.
Traditional Values and Attitudes / Marriage: Nepal is a patriarchal society and female virginity is highly valued and is a prerequisite for marriage. 86% of the population is Hindu. Hinduism plays a role in the social status of women. Women’s sexual roles are defined by their relationship with men and also their position in society. There is a social taboo about menstruation as women are often isolated during their menstruation and should avoid contact with males (UNESCO). In some parts of Nepal such as Deuki and Badani, there is belief that if young girls are given to temples for prostitution, parents will go to heaven (UNESCO). The practice of early arranged marriage (about 44% of women aged 15-19 years are already married) is the major factor accounting for high proportion of teenagers who have begun child bearing, particularly in their late teens (MOH 2002). Men may have extramarital relationships; women are expected to be faithful.
Actions: Health and education programmes have been less affected by the conflict than other Government systems and development programmes. By maintaining neutrality and low profile, RHIYA NGOs were able to continue to implement projects in zones with a high Maoist presence. The conflict has reduced the frequency of supervision visits to the field, but overall RHIYA has managed to maintain the pace of implementation
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