Marie Stopes Nepal is a representative office of MSI Reproductive Choices, UK. MSI Reproductive Choices is a global sexual and reproductive health (SRH) service provider that works in close partnership with local NGOs throughout the world and provides partner NGOs with technical and managerial support.
MSI currently has partnerships in 37 countries in Asia, Africa, Europe and Latin America. Sunaulo Parivar Nepal (SPN) has been working as implementing partner for Marie Stopes Nepal to increase access to choices of reproductive health services through static centers, outreach and MS Ladies with a common mission of enabling people to have children by choice not chance.
Tushar Niroula has been the Executive Director at Sunaulo Parivar Nepal since 2014. He started by working in Marie Stopes managing centers, clinics, programs, etc. and is now leading the program. Marie Stopes has 22 clinics in 18 districts, and it supports Nepal government to conduct outreach programs and activities in order to meet its objective on sexual and reproductive health. Nepal Live Today recently caught up with him to discuss various aspects of reproductive health and the works carried out by his organization.
What is the current situation of reproductive, maternal, newborn and child health services in Nepal?
I think Nepal has moved very strongly and swiftly in terms of sexual and reproductive health. Initially when abortion was illegal you could see that maternal mortality rate was very high. Before 2002, the maternal mortality rate was around 500 out of a hundred thousand live births. But after Nepal legalized abortion services, MMR has dropped down. If you look at the current data, we are at 187 maternal mortality to hundred thousand life births. Even post COVID, we have made significant improvement in increasing access to medical abortion through our interim guidelines, which has allowed the nurses to provide services not only from clinics, they can also go to the client’s houses and provide SRH services.
In many cases, going to unsafe healthcare providers can result in life threatening complications. The provision of proper SRH services has helped people avoid unsafe healthcare providers. Marie Stopes is very much known to provide quality services within the country as well as internationally because of its stringent protocols and quality measures. Not only that, Marie Stopes also helps build the healthcare capacity of the government and provide technical and skill based support to the government in the SRH sector.
It is also vital to make sexual and reproductive services sustainable and self dependent so that lack of funding doesn’t make people stranded without essential services. This will ultimately bring down MMR and ensure the safety of mothers as well as the newborns.
Why is sexual and reproductive health education important in the context of a country like Nepal?
It’s essential to provide SRH services in developing countries like Nepal. In developing countries, there’s a lack of education and awareness, and people seeking SRH services would not know where or how to access it. This leads to lack of quality sexual and reproductive services to those who need it. Sexual and Reproductive Health service is essential, and something that we may need at any time. It is important to create awareness among clients within various communities and localities so that they have knowledge about the access, the legality of the services and how to receive quality services.
“It is vital to make sexual and reproductive services sustainable and self-dependent.”
According to statistics, more than 53 percent of sexually active women of the age 15 to 49 use various method of family planning, both modern and traditional. Among them, 43 percent use modern methods and 10 percent use traditional methods. We still have a low prevalence rate of family planning. The Contraceptive Prevalence Rate for Nepal is 43 percent for modern methods which is quite low and has been stagnant over the years. It’s really important to integrate information within communities in such a way that the younger generation understands the importance of SRH services.
In your view, what are the challenges faced by organizations like Marie Stopes in ensuring reproductive healthcare in Nepal?
In the last two decades, Nepal has come a long way in matters of SRH. We have seen a lot of changes in terms of policies, access and knowledge of SRH services. However, one of the challenges is that many people are still not aware of the legality of these services. People don’t know where to access quality services and are not able to make a decision on their own. Many people are not willing to make sexual and reproductive decisions on their own. They gravitate towards advice from fellow women instead of trained professionals. That’s why we are working towards prioritizing the “my body my choice” perspective.
We are working hard to enable women to make their own choices based on their own needs. Besides that, accessibility, legal issues and a lack of trained health professionals are still massive hurdles in rural areas.
How is Marie Stopes working towards achieving the SDG goal 3.7, which is ensuring universal access to sexual and reproductive healthcare services by 2030?
Recently we developed our 2030 strategy in alignment with SDG goals, and our goal is to eliminate unsafe abortion. There needs to be synergy and partnership between Marie Stopes and other SRH organizations as well as the government. We need to ensure that SRH services and programs are designed in such a way that it aligns with the government’s agenda of meeting the objectives of SDGs through innovative policies and trained resources. The interim guidelines that were introduced during COVID-19 to ensure access to SRH and other healthcare during restriction of travel is a great example of much needed progressive change in SRH.
How is Marie Stopes incorporating the intergenerational solidarity theme of youth day 2022?
It is a big priority for us to work with the youth as well. Through our programs we not only target people above the age of 20/25, but we work with adolescents and youth well. It’s very important that SRH education is provided at early stage, as it helps destigmatize sex education. Since we are moving into a digital era, it is getting harder to access accurate and reliable information regarding SRH because of informational overload. There can be a lot of false information on the internet, and we need to make sure that young people and adolescents receive their information from a reliable source.
“Many people are not willing to make sexual and reproductive decisions on their own. They are influenced by different factors and drivers of our patriarchal society, in the decision-making. They gravitate towards advice from fellow women instead of trained professionals.”
We also work closely with parents and teachers as they are the first line of contact with young people. We will be coordinating with the National Youth Conference organized by Nepal Youth Council for engaging with youth participants from all of seven provinces. We will be contributing for empowering youths through developing a pool of educators from all provinces, to include adolescent sexual reproductive health session to reach almost all government schools of all districts of seven provinces.
What can societal institutions like civil service institutions, civil societies or government do to destigmatize sexual and reproductive health?
It basically comes down to creating awareness and providing proper information regarding sexual and reproductive health. Due to the taboo nature of SRH, anyone seeking out services from any SRH clinic may be perceived as being sexually promiscuous or about to get an abortion. For this, we are working very closely with different sectors and different relevant stakeholders, such as Nepal Police and National Women Commission. We seek to work at district, provincial, municipal and grassroots levels.
What can other organizations like Marie Stopes do to incorporate aims such as Sustainable Development, youth participation and inclusiveness?
Most non-health sectors don’t talk about issues regarding health. SRH is not only linked to health, but also to socioeconomic aspects of life. That’s why issues regarding sexual and reproductive health should be everyone’s concern. Most health sectors are doing all that they can to help in sexual and reproductive awareness. There needs to be more contribution from various organizations from various fields, such as youth organizations, development organizations, women’s organizations etc. Collaboration and partnership is essential in ensuring inclusion of all groups, which will ultimately help achieve milestones like Sustainable Development Goals and Youth participation.
Finally, how can the general public access Sunaulo Pariwar for information related to SRH?
Sunaulo Parivar Nepal runs a toll free helpline branded as MERI SAATHI helpline- 1143. The helpline opening hours are from 7:00 am till 12:00 am. People can call at this number, ask questions and receive information.