Bishnu Nepal/ RSS

KATHMANDU: An officer at the Family Planning Association of Nepal (FPAN), Kathmandu Valley Branch, recently received a call from an unknown woman requesting the removal of her intellectually disabled daughter’s uterus.

The woman said, “She keeps asking us to arrange for her marriage. Whenever she sees a man, she becomes attracted to him. Please remove her uterus so we can avoid unnecessary tension.”

Officer Sharad Kumar Aryal immediately responded firmly, “No, no ma’am. I am sending a ‘friend teacher’ or ‘champion’ from our branch to meet you for counselling. We will make further decisions based on their recommendations.”

The champion, trained in counselling on sexual and reproductive health services, comprehensive sexuality education, menstrual hygiene, and other essential health needs for persons with disabilities, visited the woman and her daughter.

According to the champion, the girl clearly expressed her desire to get married, have children, and talk freely with boys, but said her mother stood against all her wishes.

During the counselling session, the champion explained various dimensions of sexual and reproductive health, the rights and needs of persons with disabilities, and related concerns. Ultimately, the team ‘convinced’ the mother that removing her daughter’s uterus was not recommended and was unnecessary.

Contraceptives are not disability-friendly

Girls with disabilities also menstruate. But during their menstruation, do they have access to menstrual pads and proper hygiene? Are they aware of menstrual management, or do their caregivers support them adequately?

Aryal said, “Experiences shared by adolescent girls with disabilities either during their clinic visits or at special health camps designed for them show clearly that parents and caregivers lack awareness of comprehensive sexuality education.”

Persons with disabilities also desire marriage and children. But is it easy for them? This question deserves serious attention. According to the latest census, two percent or around 700,000 people of Nepal’s population have some form of disability.

Access to contraceptives remains extremely limited for them. Only oral pills appear relatively disability-friendly.

On top of that, persons with disabilities face major barriers in accessing health facilities. Health infrastructure, services, and medicines are not easily accessible for them. As per the latest demographic survey, only two percent of persons with disabilities have access to health institutions.

Speaking at a programme organized on Tuesday to review the project “Disability-Friendly Sexual and Reproductive Health Services and Education,” Aryal highlighted the many struggles faced by persons with disabilities, their parents, and their caregivers. He urged the state to take education and health issues concerning persons with disabilities seriously.

The FPAN, with financial and technical support from the Government of Finland, is implementing the “Disability-Friendly Sexual and Reproductive Health Services and Education” project within the Kathmandu Valley.

The project aims to ensure access to sexual and reproductive health services and education for persons with disabilities. It conducts separate health camps, orientations, awareness programmes, comprehensive sexuality education sessions, and collaborates with stakeholders to promote disability-inclusive education at the school level.

Presenting the project’s activities, Project Coordinator Bibek Risal said that continuous advocacy is underway to promote disability-friendly health services and inclusive education.

“We are providing sexual and reproductive health services to the disabled people through the health camps and the clinic run by the FPAN,” he said.

According to him, the project, which was implemented in 2019, has so far provided services to 10,000 individuals with disabilities.

Sandhya Shrestha, who has a visual impairment, said, “People with disabilities also menstruate; they have desire to talk to boys, get married, and have children. Neither parents nor caretakers truly understand the desires and wishes of a person with a disability. We face obstacles and problems at every step in our life.”

Shrestha, a central member of the FPAN and also a ‘champion’, complained that health institutions and services are not disability-friendly for accessing sexual and reproductive health services.

Disabled-friendly services are there, but service recipients lack access and info

At the programme, Dr Satish Bista, Chief Senior Public Health Administrator of the District Public Health Office in Kathmandu, informed that the process of entering services received by persons with disabilities from health service institutions under the Ministry of Health and Population into the central information and data system has already begun. He added that there is still limited accessibility for persons with disabilities in areas such as health institutions, services, and free medicines.

Dr Khageshwar Gelal, Chief of the District Public Health Office Lalitpur, stated that health workers, including specialist doctors, need knowledge on how to communicate with and address the health problems of persons with disabilities, and that it is necessary to make the health structure and services disabled-friendly.

He said, “There are still people in society who believe that persons with disabilities need means for family planning and ask such questions.”

Head of the Family Planning and Reproductive Health Section of the Family Welfare Division, stated that although there are policy provisions for disability-friendly safe and reproductive health services, there are problems in their practical implementation.

“There are services for persons with disabilities, but lack of access and information created problems. This must be ended and information should be made disabled-friendly. Comprehensive sexuality education should be made mandatory again in school curricula,” he said.

Director of the Curriculum Development Centre, Dinanath Gautam, informed that the government has a policy to make school-level curricula inclusive and urged relevant stakeholders to provide the necessary support for this.

Dr Praveen Shakya, Executive Director of FPAN, discussed the need to ensure the sexual and reproductive health rights of persons with disabilities, stating that this has become a public health, economic, social and political issue.
“Among the priority areas of the Family Planning Association of Nepal is to assist the government in ensuring the sexual and reproductive health rights of persons with disabilities,” he added.

President of the National Federation of the Disabled Nepal, Devidatta Acharya, said, “Health institutions and services are not disability-friendly. Such individuals are deprived of sexual and reproductive health services. The policies that exist are limited to paper. Comprehensive sexuality education must be made compulsory in school curricula. Words that impact the self-esteem of persons with disabilities must be removed from privately published curricula.”

Kaladhar Adhikari, Chairman of Blind Youth Association Nepal (BYAN), an organisation advocating for the rights of visually impaired people, stated that persons with disabilities lack access to sexual and reproductive health services and that broader sexual education is necessary.

Prabhakar Shrestha and Suresh Pradhan, among others, suggested that stakeholders pay attention to ensuring easy access to sexual and reproductive health services for persons with disabilities and recommended making comprehensive sexuality education mandatory at the school level to highlight its importance.