Reproductive health and education services are scarce in rural Nepal. This results in low contraceptive use, high levels of birth complications and increased cases of sexually transmitted infections and HIV/AIDS. Can community-based programmes address the dual need for health and education services?

In the northern Bardiya District, a project run by the Family Planning Association of Nepal (FPAN) tackled cultural barriers to sexual and reproductive health and attempted to reduce ill-health suffered by women and children. Can such programmes improve the literacy of rural poor women and increase their awareness and participation in family planning?

The project ran for nearly four years. The aims included providing family planning services for 6000 married women aged 15-49 years, improving child health, raising female literacy levels from 17.2 percent, increasing income, developing skills, and improving water and sanitation facilities. It was also hoped to involve men in some activities and include women from the substantial ethnic Tharu population. An evaluation of the project just before its completion found:

• Use of contraceptives has risen from 17.6 percent to 40 percent in three years. The greatest increases are for modern contraceptive implants and injections. There has not been a marked increase in condom use.
• The uptake of primary health care services has been low. Some women do not see the need to visit the clinic if they are well. Others are intimidated by the all-male clinic staff.
• Child immunisation rates are high, but it is unrealistic to expect them to reach 100 percent.
• It is difficult to find enough teachers for literacy classes. Courses need to be longer than six months for literacy skills to be maintained.
• Tharu women make up 50 percent of those attending the project’s health clinic and they particularly appreciate the literacy classes. However, they are not successfully involved in decision-making.
• Skills training does not increase the economic status of women, but it boosts their self-confidence. They are more eloquent and better able to express their needs.

To sustain and build upon the achievements of the programme, there is a need to:

• involve men more fully whilst helping women to improve their status in society
• incorporate the supply of condoms into general women’s groups
• develop more formal cooperation between the different elements of the project, such as the clinics and the women’s groups
• work more closely with the village development committee, central government and other agencies so that the infrastructure will remain when the FPAN leaves the area.

Source(s):
‘Community based distribution project, Babai, Bardiya District, Nepal’ End of project evaluation report, by M. Gibbon (2000)

Funded by: European Union

id21 Research Highlight: 26 January 2001

Further Information:
Marion Gibbon
Guy’s, King’s and St Thomas’ School of Medicine
Department of General Practice and Primary Care
Weston Education Centre
10 Cutcombe Road
London
SE5 9RJ
UK

Tel: +44 (0) 207 848 5673
Fax: +44 (0) 207 848 5686
Contact the contributor: marion.gibbon@kcl.ac.uk

Guy's, King's and St. Thomas' School of Medicine, UK

Other related links:
Refer to the International Planned Parenthood Federation for information on reproductive health.

Search the UNFPA site for more information on reproductive health issues.

See the Population Council site for research on various aspects of reproductive health.

Take a look at this issue of International Health Matters on sexual and reproductive health.

The Global Reproductive Health Forum hosts on-line discussion on reproductive health issues.

The International Women's Health Coalition provides resources on women's health issues.