By Prativa Subedi

REPRODUCTIVE Health in an important aspect of women’s health Pregnancy, child bearing, family planning, and dealing with unsafe abortion and sexually transmitted disease are key aspects of reproductive health. One third of the illness among women aged 15-44 is related to pregnancy, child birth abortion and sexually transmitted disease and its mental depression. Reproductive health programme should respond to the reproductive health problems and men’s involvement is very important. In our country one of the most frequent and problems of women is dislocation and prolapsed of the uterus. Although illness specific to females are not limited to pregnancy and childbirth, health care services and information should not be limited to the time of child bearing and child rearing.

Most babies are born at home, either with the help of midwives of experiences members of the household. Average Nepali woman gives birth to 6 children. Women spend most of their time caring for others, whether it is children or other members of the family as mothers, mothers-in-law, daughters-in-law. In many villages women come and approach development workers and health assistants to say that they do not want many babies, Because of the lack of family planning facilities and social norm it is not that easy for women to decide on their own.

Family Planning and maternal health services started in Nepal during the third periodical plan (1965-1970). At that time information part was focussed and later maternal and child health was emphasised. The National Health Policy (1991) seeks to reach reproductive health services and family planning up to the village level through health institutions. In each VDCs 3199 sub health posts were supposed to be established and 205 Primary Health Care Centres in each electoral constituency. Some International and National Non-governmental Organisations are also working to improve the health status. But health facilities have not improved and reached to villages.

Marriages are usually arranged for the convenience of the parents. Sometimes they are not even real marriages, as in the case of a teenage girl being ‘married’ to a 9-year-old boy because his family needed a servant to work in the house and fields and could not afford to pay for the one.

In our villages 40 per cent of the first bear their first child between the ages of 15 and 19 which means that the baby will probably be of low birth weight. If another infant is born before the child in the lap is two years there is a 50 per cent possibility of the infant’s death.

Unseen and unexpressed is the mental suffering of the woman who has lost a child Ratna Maya Giri a 42 year old leader of a women’s group in Dolakha District had given birth to eleven children. The first one lived, but all the others except the last two died. She never understood how they had died, and thinks that if she had known what she knows now those eight children would still be alive. Now she is a community health volunteer. She had fallen into a deep depression after her eighth child, daughter died.

She wandered away from the village in a daze, convinced that she must have committed some terrible sin to deserve such a punishment. Holding the dead child in her arms she walked up a steep rocky cliff, telling herself that it was either the sin of the child or her own fault had killed it and if she was the sinner she should die along with the child. She climbed all the way up never losing her footing and reached the top unhurt. After really thinking about it she realised she wasn’t to blame, and only then was she able to return, home, exhausted but convinced that it must not have been all her fault after all.

Now a days maternity related illnesses are regarded as the most serious, although the problems of malnutrition and anemia also take their toll on women’s health.

Each year 500,000 mothers throughout the world die of problems related to childbirth in our country 85 out of every 1,000 women die during childbirth. According to a family planning survey the desire to have a son by women without children was found to be 86 per cent and 100 per cent of women who already had three girls desired for a son. Those with one son wanted another son in 90 per cent of the cases. Many women have their own unique concepts of human anatomy. For example, if asked to describe sterilization of a woman the villagers say that the uterus has been turned upside down. Whatever means of family planning may be adopted, it is necessary to have an idea as to what its bodily effects are. It is important to know about the structure of their body and how it functions.

In the developing countries 20 per cent of the population is seriously affected by malnutrition, 50 per cent do not have access to pure drinking water, and 60 per cent do not have access to health care facilities. Poverty and ignorance are at the root of poor health. The main cause for the deplorable condition of women’s health are social and traditional customs and burden of the work is always heavier on women. Men and male children have much more access to resources than woman and female children.

In the past, nursing and health services were considered as belonging exclusively to women, but in the last few years men have also begun to take up nursing training. Even if there is a special significance of women in the society, we should encourage the participation of men also in family health care. Women could use their own knowledge and skill of only they had more self confidence and accurate information. This could be enhanced through training courses in basic first aid, nutrition and health care. Health problems should not be taken in isolation only gender sensitive integrated programme can improve health and reproductive health of women.