xenoMED advisor reports for Lancet: Nepalese women under the shadow of.......

[Suvash]

We are proud to see our senior member, advisor and moderator Dr Sanjaya Dhakal at The Lancet.

World Report

Nepalese women under the shadow of domestic violence

Sanjaya Dhakal

Although Nepal's decade-long conflict has ended, every year, tens of thousands of women in the country still experience violence. In about 80% of cases, the perpetrator is not a stranger to the woman but a member of her own family. Sanjaya Dhakal reports from Kathmandu.

Despite rising political awareness, most women in Nepal are still subject to deeply entrenched discrimination, resulting in a scary situation where violence against them is commonplace.

Domestic violence against women, including beatings by husbands. dowry-related murders, and physical and psychological harassment by families is rampant in Nepal, one of the poorest countries in the world. “Of the total incidence of violence against women, domestic violence constitutes over 80%”, said Dhana Kumari Sunar, a member of the National Women's Commission (NWC). “Among the various causes of domestic violence, dowry-related hostilities, second marriage by husbands, assaults on women accused of being witches, and disputes involving properties top the list”, she added.

The central cell for women and children at Nepal's police headquarters has recorded 1100 cases of domestic violence against women in the past year. Since these reports consist of only the formal complaints lodged by women, officials concede that they are only the tip of the iceberg. As these violent episodes occur within family settings, often the women end up with no-one and nowhere to turn to in a society that is still overtly patriarchal.

The NWC—an umbrella national body formed to protect the rights of women—is in the process of compiling nationwide data on the numbers and nature of violence against women. “But we can safely say that tens of thousands of women suffer from domestic violence every year in the country”, Sunar said.

The women of Nepal who had fought alongside Nepalese men to restore democracy in their country 2 years ago, were roundly disappointed when the parliament they helped to restore also failed to take up their cause.

A bill to combat domestic violence against women, which has been lingering in Nepal's parliament for the past 13 years, could not be passed even in this year's parliamentary session, which ended last month.

The bill was an important piece of legislation that could have provided crucial support for Nepalese women. In the absence of such a law, the perpetrators of domestic violence often get off scot-free or only get a slap on the wrist—since in many cases the traditional patriarchy operates in a manner where husbands and senior family members are thought to possess the right to control women of the house.

Take the case of Hasun Idrisi—a woman from a city in western Nepal called Nepalgunj who was long harassed by her husband and in-laws for not bringing a big enough marriage dowry. 2 months ago, they poured kerosene on her body, set a fire nearby, and locked her up in a toilet. Luckily, her neighbours, who heard her shouts for help, managed to rush her to the hospital and she survived.

Manauti Saru was not so lucky. The 23-year-old woman from Nawalparasi district in south western Nepal was killed by her husband 2 weeks ago. A case has been registered against her husband—Sher Bahadur Saru, who is a constable at a local police station, and family members, who have been accused of hacking her to death amidst a domestic scuffle.

Almost every day, newspapers in the country report cases of domestic violence against women. The extent of this problem is shown by a report in the last week of January, in which four women were killed by their husbands or family members in the space of 1 week in Rupandehi and Nawalparasi—two districts in south-western Nepal. Three of the women were killed after dowry-related disputes, and the fourth was killed by her husband after a bitter domestic brawl. Ironically, these two districts had earlier been declared by local civil society organisations to be zones free of violence against women.

“Currently, even grave violence against women, such as sexual violence, marital rape, mental and physical torture are dealt with under the public offence act. The non-passage of the bill to control domestic violence, therefore, is very unfortunate”, said Sunar.

Women's rights activists have also complained about the tendency of law enforcement agencies to try to settle disputes without pressing charges against the perpetrators. “Often, police and local people try to settle the domestic dispute by pressing the women into accepting their ‘fate’ as the society is still dominated by Hindu patriarchy with its own set of strict codes—many of which are in conflict with basic rights for women”, said activist and former NWC chairperson Bandana Rana.

Women experienced conflict-related trauma in the decade-long conflict in Nepal. Between 1996 and 2006, when Nepal was in the throes of a violent insurgency, about 15000 people lost their lives—many of them women. Many more people were injured and displaced. Thousands of women were subjected to torture, assault, and rape by both sides of the warring factions. Around 300000 people—mostly women and children—were displaced from their native places due to conflict.

However, in recent times, conflict-related traumas such as rape and forced displacements have tapered off, but domestic violence continues to grow. “We have not seen the incidence of violence against women drop at all. Although the level of awareness among women regarding their rights has increased, sadly the situation has not improved so far as violence against them is concerned”, said Rana, who is also the vice president of Saathi—an organisation that runs a shelter home for abused women in Kathmandu.

Sita Gurung (name changed), from Bhojpur district in eastern Nepal, found shelter at Saathi. “My husband used to beat me every day. Unable to bear the beatings even at minor causes, I ran away from my house”, said Gurung.

Amidst this backdrop, Nepal's women's rights movement has been gaining strength. Consequently, the government has amended old laws that discriminated against women. The parliament has already declared that women should be guaranteed at least 33% representation in all areas of the state. But this policy has not helped to change the condition on the ground.

The social neglect experienced by women is shown by poor health indicators. The latest Demographic Health Survey shows that the maternal mortality rate per 100000 deliveries is 281. 81% of births still take place in the home.

Half a million children are out of school and more than 60% of them are girls. The overall literacy for women is 42·5%, compared with 65·1% for men, according to recently released government statistics.

Women have received the short end of the stick on the economic front as well. A report commissioned by the NWC revealed startling discrimination against women in terms of ownership of assets and properties. The report, which assessed the situation in 68 of 75 districts in Nepal, exposed the skewed nature of property distribution. It revealed that only 0·78% of houses were actually (legally) owned by women (about three women in 500 had houses in their names). Only 5·25% of women had land-ownership certificates in their name. Likewise, only 5·45% of women owned livestock.

About 17% of women had some kind of assets in their name such as ornaments, jewellery, property, or land. Only 16% of women had a regular income. And, only 8% of the civil-service and private-sector workforce is made up of women. “Because the women of Nepal suffer from various kinds of discrimination, they have landed in such a pathetic socioeconomic condition”, said Babita Basnet, a prominent women's rights activist in Nepal.

Over the past two decades, Nepal has gone through a series of political upheavals. In 1990, a street movement restored democracy in the country. In 1996, a violent insurgency was launched by Maoists but ended in 2006 after a peace pact. In all these movements, women took part prominently. But they were still unable to secure just participation in other areas of society and improve their socioeconomic status. Even now, women occupy less than 5% of leadership positions in the political parties.

Until such social factors are addressed and improve, the health and wellbeing of women in Nepal will continue to pay the price.

This was published in the Volume 371, number 9612 of The Lancet on 16th February 2008.

[Mati]

Waooooooooooo!!!

That's great!
You are really great Dr Sanjaya. Keep up the good work. Xenomed is really proud to have a dynamic and professional like you. In fact, Nepal herself.

I'm great to be together with the people like here.

You are in roll ---- I hope to read many in the future.

World Report

Maternal mortality falls in Nepal but inequalities exist

Sanjaya Dhakal

Available online 11 October 2007.

Although a recent survey has indicated a sharp fall in the maternal mortality ratio in Nepal, the decline is not evenly spread across the country. In poor communities and in rural regions, the maternal health situation has not improved. Sanjaya Dhakal reports from Kathmandu.

When officials and activists were busy celebrating a sharp fall in maternal mortality in Nepal, an impoverished woman from an under developed region in the far west of the country was making a heart-rending request to a social worker. Parvati wanted poison. Unable to bear the constant pain and discomfort due to severe uterine prolapse, Parvati had expressed her wish to die at the first opportunity she had to express her misery.

36-year-old Parvati comes from a marginalised Dalit (so-called untouchables) community. She was married at age 10 years to a man 20 years older. She had ten children—six of whom survived. 2 years ago, she gave birth to her last child but that delivery proved too much for her frail, weary, and undernourished body.

Uterine prolapse is often the result of difficult labour, frequent pregnancies, lack of antenatal care, and a rigorous working schedule. In less severe cases, the womb can be stabilised by inserting a rubber ring or pessary, but surgery is required in severe cases. 600 000 women all over Nepal need urgent medical care for uterine prolapse, according to the UN Population Fund.

Although Parvati lives in a fairly accessible place, each time she gave birth she was alone. She used rusty sickles to cut off the umbilical cord. The latest Demographic Health Survey (DHS) shows that 81% of births still take place in homes and the remainder in a health facility.

Against such a backdrop, the news of a sharp drop in maternal mortality ratio (MMR) over 10 years—which was marked by extreme instability, violent conflict, and a reduction of the state's presence from various rural areas—has been received with much scepticism.

Even senior government officials have expressed “pleasant surprise” over the dramatic fall in MMR. “Various reasons like increased awareness, expansion of health-care facilities, immunisation, and antenatal care may be behind this fall. As the fall has been very substantial, we are currently engaged in further analysis to find out the truth”, said Ram Hari Aryal, a joint secretary at the Ministry of Health and Population and chief of Population Division at the Ministry.

Bhogendra Dotel, senior officer at Family Health Division of the Ministry, added that improvement in family planning awareness, which is evident by the increase in the contraceptive prevalence rate from 39% to 48% in past 5 years, is largely responsible for the fall in MMR. “The average family size has decreased from 4·6 children (for every parent) in 1996, to 4·1 in 2001, to 3·1 in 2006. This means there have been fewer pregnancies and, by that extension, fewer deaths”, he said. However, he conceded that the prevalence of contraceptives and family planning awareness has increased much more in urban areas than in rural areas.

Former minister and a Member of Parliament representing the Doti district, Bhakta Bahadur Balayar, says, “The situation not only in Doti but also in other poor districts is similar. The improvement is coming very slowly in rural regions. The dramatic fall in MMR is possibly because of huge improvement in urban areas.”

The DHS shows considerable differences in maternal health indicators for women living in different parts of the country. It shows that although 85% of urban women received antenatal care from a skilled birth attendant, only 38% of rural women did so. Almost half (48%) of children in urban areas are born in a health facility, compared with 14% in rural areas.

It seems that Nepal will need to redouble its efforts in rural areas and among marginalised communities, such as Parvati's, to reduce the country's MMR further.

The Lancet

Volume 370, Issue 9595, 13 October 2007-19 October 2007, Page 1301




Best wishes,
mati

[bishnurath]

its really great
to have publications in Lancet a journal with one of the highest impact factors

Hats off Dr Sanjay !!!!
keep goin ahead.

all the best.