Women of reproductive age are a highly vulnerable group: they are discriminated against due to gender and rendered more vulnerable by the physical risks of reproduction. The mortality rate among women of reproductive age is high, at 174 deaths per 100,000 women. Suicide is the leading cause of death for this population (16%), followed by accidents (9%), pregnancy (8%), and tuberculosis (5%).
There are different causes for the high mortality and morbidity rates of women of reproductive age. The most immediate cause is the limited availability of key reproductive health services. Not only are such services limited in general, but there are significant differences in access depending on age, location, ecological zone, educational status, wealth, caste and ethnicity.
In terms of family planning, the use of modern contraception among women of reproductive age increased from 26% in 1996 to 43% in 2011. The rate of increase was higher in rural than urban areas, and higher among uneducated women than among educated ones, demonstrating a narrowing in inequity. In terms of delivery in health facilities, the overall figure in 2011 was 35%, but again there are big discrepancies: 19% for women in the Mountains and 16%for women in the Western Mountains; 19%for women with no education and 11% for women in the lowest wealth quintile; 31% among rural women.
A key underlying cause for the low utilization of health services is the health system itself. The cost of services is prohibitive for many poor women. Skilled health professionals are scarce, and retaining staff in rural and remote areas is a major challenge. Infrastructure, equipment and medical and other supplies are also often missing. A second cluster of underlying causes relates to the lack of women’s empowerment. Some women do not access services where these are available because they are not informed about them. Early marriage and childbirth, in particular in the Central and Mid-Western Tarai and Far Western Hills, increase the risks of maternal mortality and morbidity. Malnutrition leads to poor pregnancy outcomes for both the mother and the newborn child. Finally, the preference for a son makes some women of reproductive age more vulnerable. Gender based violence and a lack of control over resources and decision-making power make it more difficult for women to access services when needed.
The National Health Policy of 1991 sought ‘to upgrade the health standards of the majority of the rural population by strengthening the primary healthcare system and making effective healthcare services readily available at the local level.’ Safe abortion was legalized in 2002, with first trimester abortion services available in all 75 districts through government and non-government facilities. The second five-year Nepal Health Sector Programme 2010–2015 (NHSP II) also seeks to address the constraints to increasing access and utilization of essential healthcare services. Family planning, safe motherhood and newborn health services are priorities within the NHSP II. Nutrition interventions have been scaled up to address major micronutrient deficiencies among women and children.
Over the coming five years the UN in Nepal support the Government in targeting the inequity in maternal, newborn and child health and HIV outcomes, and increase the capacity of national health institutions and service providers to plan, implement and monitor quality sexual and reproductive health services. The UN will support women of reproductive age who choose to in demanding quality sexual and reproductive health services.