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Nepal: by Grace Lesser & Kyla Pearce on Exposure
Constructed on the biggest faultlines in the world, Nepal is one of the world’s poorest countries. It is landlocked, between India and China, and mountainous, situated between the Himalayas and the plain of the Ganges river. The effects of the fault are evident in the changing contours of Nepal’s biggest tourist attraction: the 1,400 mile Himalayan mountain range is pushed up by about a centimeter each year by the constant collision of the India and Eurasia plates. Today, Nepal’s 27 million residents have a per capita GDP of under US$1. Despite political instability in the last two decades, Nepal achieved remarkable progress in reproductive health care, including family planning. Total fertility rates decreased from 6.4 to 3.4 between 1995 and 2005. Contraceptive prevalence increased twenty percentage points in the past twenty years. There are a number of factors that likely contributed to this success. First, family planning was well integrated into a national immunization program, meaning that every woman who seeks vaccinations for her young child also received counseling and access to contraceptive options. Second, the legalization and rollout of safe abortion services in 2002 contributed to a reduction in serious abortion-related mortality. Third, a massive social marketing campaign on smaller family size was distributed through radio and print publications. Still, a quarter of women still have an unmet need for contraceptives and corruption abounds. For example, there was a national stock-out of the highly effective contraceptive implant this year, simply because the Minister of Health didn’t approve of the supplier that the procurement committee had selected, and thus prohibited the importation. Nepal has also seen a slip in family planning use in the past decade. Indeed, the most recent Nepal Demographic Health Survey showed a notable decline in the contraceptive prevalence rate between 2006 and 2011. Theories explaining this trend point to the high proportion of spousal separation, an increased use of traditional methods, and the inherent challenge of continually delivering products to very remote areas and marginalized populations. And, that was all before the earthquakes. Nepal had made immense progress in strengthening its reproductive health system in the past several decades, but the earthquakes decimated this foundation. What happens next?