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Government Efforts and Personal Opinion Explain the Medicalization of Pregnancy and Childbirth Through Time in Lower Mustang, Nepal Ruth Baker SIT Study Abroad

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Government Efforts and Personal Opinion Explain the Medicalization of Pregnancy and Childbirth Through Time in Lower Mustang, Nepal Ruth Baker SIT Study Abroad SIT Graduate Institute/SIT Study Abroad SIT Digital Collections Independent Study Project (ISP) Collection SIT Study Abroad Fall 12-1-2014 Government Efforts and Personal Opinion Explain the Medicalization of Pregnancy and Childbirth Through Time in Lower Mustang, Nepal Ruth Baker SIT Study Abroad Follow this and additional works at: https://digitalcollections.sit.edu/isp_collection Part of the Asian Studies Commons, Health Services Research Commons, Maternal and Child Health Commons, Maternal, Child Health and Neonatal Nursing Commons, Obstetrics and Gynecology Commons, and the Women's Health Commons Recommended Citation Baker, Ruth, "Government Efforts and Personal Opinion Explain the Medicalization of Pregnancy and Childbirth Through Time in Lower Mustang, Nepal" (2014). Independent Study Project (ISP) Collection. 1966. https://digitalcollections.sit.edu/isp_collection/1966 This Article is brought to you for free and open access by the SIT Study Abroad at SIT Digital Collections. It has been accepted for inclusion in Independent Study Project (ISP) Collection by an authorized administrator of SIT Digital Collections. For more information, please contact [email protected]. Government Efforts and Personal Opinion Explain the Medicalization of Pregnancy and Childbirth Through Time in Lower Mustang, Nepal Baker, Ruth Academic Director: Onians, Isabelle Senior Faculty Advisor: Decleer, Hubert Project Advisor: Marsden, Cailin Bates College Environmental Studies: Ecology Asia, Nepal, Lower Mustang Submitted in partial fulfillment of the requirements for Nepal: Tibetan and Himalayan Peoples, SIT Study Abroad, Fall 2014 Kagbeni, Mustang, Nepal ABSTRACT The way that women approach pregnancy and childbirth in rural Nepal has seen an amazing change in the past twenty to thirty years. The medicalization of this entire process, from pre- to post-natal care, comes with government efforts for the increased education of women about family planning, nutrition, hygiene, and the proposed benefits of institutional versus in-home delivery. In 9 villages of Lower Mustang, interviews conducted with Government Health Post workers, Female Health Volunteers, and women of different ages sought to discern personal experience and opinion about pregnancy and childbirth from the perspective of both local women and those with medical training. Today in Mustang, almost all deliveries take place with the help of trained professionals in some type of medical institution, while the elder generation sees weakness in the inability of younger women to deal with the pain in the same way they did for multiple in-home deliveries. Additionally, interviews included questions to gain basic knowledge about the general work of Mustangi Health Posts, in order to better understand their equipment and capability for dealing with patients. This study looks at accessibility of health care, opinions on delivery location, government involvement and incentive in the pregnancy process, and mothers’ personal anecdotes regarding their own experiences and the changes they have witnessed in maternal and infant health through time in Mustang. ACKNOWLEDGMENTS This work would not have been possible without the support of the entire staff at SIT Nepal: Tibetan and Himalayan Peoples as well as the personal efforts of many individuals. I attribute much of my success to my incredible interpreter and guide, Yangjin Bista. Her innumerable friends and family in Mustang and her ability to make personal connections with complete strangers allowed for amazing breadth and depth in my interviews. I cannot thank her enough for being both a motivator and a friend. Thank you to my grounding advisor Cailin, who served as both inspiration and an incredible knowledge base for all of my research. To Rinzi la, without whom we may not have ever gotten on the bus or plane to bring us to our destination. To Isabelle, Nazneen, and Hubert, thank you for your unfaltering support and excitement in my topic, which helped me to pursue what I really hoped to from the start. To my parents for their medical knowledge, research ideas, and generous emotional and financial support. To Annika for being the perfect travel companion, and for making all the cold days and nights less lonely. To our guesthouse proprietors, who somehow always cut us a deal and treated us like family. To all of the amazing mothers, nurses and health assistants who were so generous in giving me their time and willing to share anything and everything. My research would not have been possible without the amazing compassion and friendliness of the Mustangi people. And to the Annapurna range, for being my inspiration and my sanity, home to incredibly self sufficient people and some of the best views in the world, thank you for bringing to this most incredible destination. 1 TABLE OF CONTENTS I. Abstract …………………………………………………………………………………………………1 II. Acknowledgements…………………………………………………………………………………1 III. Introduction.………………………………………………………………………………..…..……..3 IV. Health Facilities………………………………………………………………………………………4 a. District Hospital………………………………………………………………………...…4 b. Health Posts…………………………………………………………………………………6 i. Thini………………………………………………………………………………….6 ii. Marpha…………………………………………………………...…………………7 iii. Kagbeni……………………………………………………………...……………...8 iv. Jharkot.……….………………………………………………………………….….9 v. Jhong…………………………………………………………………………………10 V. Government Programs a. Safe Motherhood…………………………………………………………………………..11 b. Suaahara………………………………………………………………………………………12 VI. Health Practitioners………………………………………………………………………………...13 a. Patients of Different Backgrounds ………………………………………………...14 b. Hopes for the Future…………………………………………………………….…...…..15 c. Changes Over Time……………………………………………………………………….16 VII. Female Health Volunteers……………………………………………………………….….……18 VIII. Mothers……………………………………………………………………………………………..……21 a. Birth Control and Family Planning…………………………………………………22 b. Delivery………………………………………………………………………………………..23 c. Changes Over Time ………………………………………………………………………26 IX. Conclusion………………………………………………………………………………………………28 X. Methods………………………………………………………………………………………………….30 XI. Interview Questions………………………………………………………………………….….….31 XII. Sources Cited a. Interviewees…………………………………………………………………………………34 b. Scholarly Sources………………………………………………………………….………35 XIII. Ideas for further research…………………………………….……………………………..……37 2 INTRODUCTION The district of Mustang, located in the Western Development Region of Nepal, is nestled into the beautiful landscape of the Himalayas. The district capitol, Jomsom, is accessible via airplane and bus or jeep from the closest major city, Pokhara. The Annapurna Conservation Area, which overlays much of the district, makes Mustang a very popular trekking area. Upon arrival in Jomsom, one is greeted by a plethora of hotels and restaurants with English signs that line the main road outside the airport. Often at first glance it is likely that one will see more “westerners” than locals (at least in the high season). While much of Lower Mustang (the southern part of the district) is in fact dominated by “western” people during the trekking season, there are many villages slightly off the beaten path where one can find a more authentic atmosphere, rather than one dominated by a tourist economy. Still, in the 10 villages I visited in my 18 days in Mustang, I was never turned away for an interview (other than for lack of time), and more often than not offered bottomless cups of Tibetan tea and endless stories. This population speaks Tibetan dialects, practices forms of Tibetan Buddhism and often identify politically and historically with the people of Tibet.1 The people of Mustang, Tibetan-oid in their culture and language, are incredibly hard working, humble, generous, and welcoming of complete strangers. Through their kindness, I was lucky enough to speak with 26 individuals about their experience with and opinion of pregnancy and childbirth. Through these conversations, my aim was to better understand how maternal and infant health has evolved in this section of rural Nepal, how most women choose to go about this process today, and what facilities and support systems are available to them. November in Mustang sees both the warming sun and the biting cold, the latter causing much of the population to go south for the winter, most often retreating to Pokhara or Kathmandu. Those who can’t afford to make the trip to warmer ground or stay back to look after animals, elders, households, etcetera, own stacks of fleece blankets enough to cover an entire wall floor to ceiling. The area is also known as a temporary home to migrant laborers who come from other parts of the country to work as farm hands or construction workers. This community, often less economically independent than most Mustangi locals, make up a significant amount of the population and are seen by health post workers in some places as the most common patients. Although each Village Development Committee (VDC) in Mustang has its own health post, some VDCs are so spread out that even travelling to one’s local post can be a trek. Each VDC has nine wards. In some cases a single village is large enough to consist of 3 or 4 wards in itself, but in many cases, multiple smaller villages make up a VDC, each one consisting of 1 or 2 wards. In a government effort to make health education more widespread, each ward is home to a Female Health Volunteer (FHV) who has basic training from local health workers and is a resource to the people of her ward. The health post is located in the largest or most central ward
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