Final Baseline Report
Total Page：16
File Type：pdf, Size：1020Kb
Final Baseline Report on Empowering women to access safe abortion service in Gorkha, Nepal Submitted to: Executive Director Population, Health and Development Group (PHD Group) Indraeni, Dhungakhani, Sanepa, Ring Road, Lalitpur Kathmandu +977-1-5184063 Submitted by Prof. Dr.GajaNandAgrawal – Team Leader Dr.Megha Raj Dhakal – Research Officer Qualitative Mr.PramijThapa – Research Officer Quantitative Metro Apartment, Kuleshwor Kathmandu, Nepal +977-015187341 Email:[email protected] December 20, 2018 i Acknowledgements We the research team comprising of Prof. Dr. Gaja Nand Agrawal – Team Leader, Dr. Megha Raj Dhakal – Research Officer Qualitative and Pramij Thapa – Research Officer Quantitative would like to express our sincere thanks to Dr. Yagya B. Karki, Project Team Leader, Empowering women to access safe abortion service in Gorkha, Nepal for his support and guidance for the successful completion of the baseline survey work. In the meantime we would also like to thank Mr. Khadaga B. Karki, Admin/Logistics Officer, PHD Group for his overall management when the field work was undertaken for data collection.We are grateful to Ms. Anchal Thapa, Project Assistant, PHD Group for refining the tools of the survey. We would also like to express our sincere thanks to Mr. Deepak Babu Kandel, Mayor, Palungtar Municipality, Mr. Raju Gurung, Mayor, Sirnachok rural municipality and Mr. Phadindra Dhital, Mayor, Ajirkot rural municipality for their for their valuable support and inputs while the baseline data was collected in their localities. Similarly, on behalf of PHD Group, we wish to thank local health facilities and the Family Welfare Division, Department of Health Services, Ministry of Health and Population, Teku, Kathmandu for their support in carrying out the baseline survey. We would also like to thank to the survey respondents for their valued time and patience in expressing their interest, understanding and the situation that they have been facing in the current situation. Research Team . ii STUDY TEAM MEMBERS Prof. Dr. Gaja Nand Agrawal - Team Leader Dr. Megha Raj Dhakal - Research Officer Qualitative Expert Mr. Pramij Thapa - Research Officer Quantitative Expert Field Supervisors Mr. Baburam Roka Mr. Sudip Roka Field Interviewers Ms. Kavita Bhatta Ms. Manju Thapa Ms. Sushmita BK Ms. Sabitri Dani Ms. Tara Sunar Ms. Niru Pulami iii Executive Summary Background Nepal made great strides in reducing maternal mortality ratio (MMR) of 596 prevalent in early 1990s to 239 by 2016. Nepal’s effort to liberalize abortion in 2002 is reported to be one of the main factors for this achievement. Despite legalization of abortion and expansion of maternal health services, it appears that women are not getting what they are supposed to get. Many are still dying during pregnancy or soon after giving birth and thus contributing to high maternal mortality. Only about 41% women are aware that abortion is legal and this knowledge is lower among older women (35% or less), women living in rural areas (36%), women with primary (33%) or no education (28%) and poor (38%) and very poor (30%) women. The 2016 NDHS 2016 shows that among women aware of legalization of abortion, much lower proportion (23%) of them know that pregnancy up to 12 weeks’ gestation can be legally aborted and this knowledge is the lowest (19%) among the teen age girls 15-19. Apparently very few women are accessing safe abortion service in the country; in 2016 it was estimated that only about 9% pregnancies ended in abortion and this low safe abortion rate and nearly stagnant contraceptive prevalence rate (about 50% from 2006-2016) do not support fast declining fertility trend. Nepal’s TFR declined from 4.1 in 2001 to 2.3 by 2016. It appears that women are taking recourse to unsafe abortion which is not reported or there isn’t any study that has captured this unfortunate plight of women contributing to high maternal mortality. In Nepal, son preference is high and discrimination against girls is persistent and these factors contribute to sex selection. Although sex selective abortion is strictly prohibited by law and punishable it is also possible that people may take advantage of liberal abortion to fulfil their wish. Also the situation of stagnant contraceptive prevalence but declining fertility in the last ten years indicates that women are using abortion as a family planning method. Nepal comprises of 125 caste/ethnic groups and many of these groups cherish their own cultural, social and religious values and beliefs which when it comes to male female relationship becomes complicated resulting in social conflict, violence and even deaths. This complex socio-cultural value system has its toll on females. Since the Fiscal Year 2016/17, safe abortion service is free but it appears that virtually no woman is aware of this provision. The objective of the baseline study is to establish the project baseline database that will serve as the basis for quantitative and qualitative assessment of progress towards achieving the defined outcomes and impacts of the project. The sample survey provides baseline indicators of WRA for the project areas. This will help establish SRHR and safe abortion indicators of these populations in working areas. Methodology The methodology included both qualitative and quantitative approaches such as qualitative approach including desk review; Focus Group Discussions (FGDs) with females aged 15-49 and Key Informant Interviews with school teachers, health facility in-charges and elected local body representatives. The quantitative approach included completion of household rosters of sample households and interview with women, men, adolescents and youth. The quantitative questionnaire was administered to 300 females and males aged 13-49. iv Findings From the 300 sample households demographic information was collected of all family members which numbered 1,259 individuals comprising of 47% males and 53% females, yielding a sex ratio of 89. No third gender was found in the sample area.About 26 per cent of the population is under age 15 and 6 per cent are above age 65. The mean age of household population is 29 years. The proportion of female headed households is estimated at 29 per cent overall and the corresponding figure for the country is 26 per cent. The average household size is 4.2 persons per household which is slightly lower than the national average household size was 4.9. Overall literacy rate (for population aged 5 years and above) is estimated at 86 per cent and it is higher among males (89%) than females (83%). In 2011, the overall national literacy rate was 66 per cent and among the males the literacy rate was 75 per cent and among the females it was 57 per cent. The mean years of schooling completed is7.2 years. Overall, 30 per cent population aged 10 and above was currently unmarried. By age 24, of all population, the proportion married is 46 per cent. Of the total 300 survey respondents, 240 were females and 60 were males. Respondents’ age ranges from age 13 to age 49. Of the total female respondents, 39 per cent belong to Janajati group followed by Dalit (24%), Chhetri (17%), Bahun (16%) and Newar (4%). Most respondents (39%) are engaged in agricultural occupation while 23 per cent are students and 14 per cent are housewives. Ten per cent respondents reported business as their main occupation, 4 per cent each engaged in service sector and wage labouring. Wage labouring is another important occupation especially for males as 18 per cent do wage labouring while among females it is about 5 per cent. According to female respondents, their family’s (household) average annual income was Rs. 340,821 and the corresponding amount reported by male respondents was more than double (Rs. 873,250). The average annual household income was highest (Rs. 867,968) in Siranchok rural municipality followed by Palungtar municipality (Rs. 293,695) and the lowest was found in Ajirkot rural municipality (Rs. 150,091). Overall, only about 64 per cent families have 12 months food security and the corresponding figures for Ajirkot rural municipality, Siranchok rural municipality and Palungtar municipality are respectively 15 per cent, 74 per cent and 78 per cent. Of the total survey respondents, 22 per cent were unmarried and 78 per cent were married and by sex more (80%) female respondents were married than male respondents (68%). Compared to male, only 16 per cent of females make important decision in the family while more males (43%) do so. Female respondents said decisions are made mostly (nearly 75%) by male members of the family such as husband, father/father-in-law, grandfather or any male member of the family. About 10 per cent female respondents said decisions are made by mother or mother-in- law. Thirty four per cent of married females said they decided themselves about their marriage while this proportion is much higher for male respondents (59%). Nearly three in four (71%) female respondents said that they have to ask someone in the family to spend the money they earn and this proportion is much lower for male respondents (31%). For 66 per cent of female respondents aged 13-49 years reproductive health is child bearing. Over half (55%) of females said that reproductive health is the development of reproductive organs. About 33 per cent females said becoming mentally matured is reproductive health. Good health of mother and child was mentioned by a quarter of female respondents. Use of FP methods for birth v spacing is RH for 21 percent female respondents. Male respondents emphasized mainly childrearing, development of reproductive organs, child care, good health of mother and child, becoming mentally mature, birth spacing by using FP methods, health care, reproductive hygiene, personal hygiene and female diseases to mean RH. During adolescence most (82%) girls experienced pain in the stomach and back while menstruating, heavy bleeding (51%), irregular menses (38%), emotional and mental problem (14%), felt shame to go to school when menstruating (11%), social stigma (7%), and 6 per cent each were embarrassed to see organs growing and lacked sufficient information.