Let's Talk About Nepalese Perspective on Reproductive Health!
When you sit it down to talk about Sexual health with people, which of the following situations have you faced?
Have they changed the topic suddenly?😣
Have they shut you down?🤐
Have they scolded you for being shameless talking about “these things” openly?🤬😤
Have they hesitated, turned red from mortification or fled away?😱😡🏃♂️
Have they hushed you up, or whispered fearing others might hear?🤫🙉
Have you been lectured on and fed with orthodox habits and standards far divorced from scientific facts, you are left reeling and more confused at the end?😵🤯
Or have you been welcomed, openly discussing the topic, sharing experiences, and answering curiosities an clearing confusions freely providing understandable valid reasons for every query?😄🤗
If you are familiar with the last one, you have been luckier then the rest of us.
On third session and the fourth day of “Let’s Talk: Let’s Get Embarrassed” we deliberated on the overall social perspectives on reproductive health in Nepal. This time, our goal was for our participants to understand the perspective of the people they are surrounded with on the issues of sexual and reproductive health.
Miss Swastika Dangal welcomed our resource person for the day Dr. Sabina Basaula who gave us an interactive session on Nepalese perspective on reproductive and sexual health.
Dr. Sabina Basaula receives MBBS from Chitwan Medical College. She is currently working in Manmohan Hospital, Thamel.According to WHO, Health is
And what are the aspects that concern reproductive health?
(Source:https://netstorage-legit.akamaized.net/images/vllkyt5qsa74s4lh9.jpg?imwidth=1200&impolicy=default-amp)
According to WHO,
An interpretation of this can be that:
men and women should be informed of methods of birth control,
have access to safe, effective, affordable and acceptable methods of birth control,
provide safe ways of abortion, if they wish to do so,
also have access to appropriate health education programs to emphasize on the importance of women to go safely through pregnancy and childbirth giving the couples the best chance of having a healthy offspring.
What do you think of the Social Perspective?
Social Perspective :
What factors affect Social Perspective?
Physical Environment:
Social aspects are affected greatly by geographical differences as well as other infrastructural differences. Kathmanduites may have different opinions on sexual and reproductive health than those living in Himalayan regions because Kathmandu has better facilities in both health and education than in Himalayan regions. In addition, because there are less infrastructures and machinery, the daily work is completed by manpower in hilly and Himalayan regions. And more children means more manpower.
Demography:
Population and it's sudden increase or decrease also impacts people's opinions. For example, large increase in population may call for consideration of family planning options. However, the concept of “small family, happy family” is mostly limited to cities. Thus can be seen by the fact that people in villages have huge families.
Cultural Factors:
There is an immediate connection of cultural beliefs in formation of people's attitude towards any issue. The traditional and sometimes orthodox views has shaped up the deep-rooted beliefs that are impenetrable. For example, people consider children a boon from God and forbid any family planning options whatsoever.
Another example: From time immemorial, all the religious scriptures has portrayed marriages only between a man and a woman. Wherefore, there is no assumption of same sex marriage. Such presumption of no romantic relationships between non binary genders, and nescience on their existence at all originates due to histories of similar stories. Perhaps because of this, the knowledge of existence of different genders does not legitimize their acceptance.
Psychological Factors:
An individual's thoughts also heavily impacts the social perspective. For example, an educational session such as this might impact your ideology on sexual health.
But the thing is, these educational materials just limit to books. It’s not used practically. Students study for exams then close their books and go back to the same unscientific ways of life.
Political Factors:
Politics plays a huge role in sexual and reproductive health. Whether people can obtain their sexual and reproductive rights is entirely dependent on political sways of the ideologies that holds power in the country. Safe abortion, contraception, rights of LGBTIQ+ and their hard earned access could be threatened anytime by political changes in the country.
What is reproductive health in Nepal limited to?
The word sex is a taboo and the act behind closed doors and switched off lights.
Parents and children hesitate to talk about it openly. There's no chance a child gets the “birds and the bees” education from their parents.
Sexual health education is limited to books.
The notions such as that sexual intercourse only happens after marriage and that it is only for Male satisfaction has yet to be eradicated.
And mostly,
“Dui santan ishwar ko bardan" translates to “ Two children are the blessings from God.”
What are the reasons for such perceptions?
As has been highlighted before, all the theories remain theories and are limited inside the books or just to exams, and people convert to old habits when it comes to practice. Societal pressure to an individual also plays its role. The dogma of no sex before marriage though proved untrue remains unchanged due to deep-rooted societal values and questions of “moral".
People fear that they would not fit-in with their modern and unconventional (in that setting) thoughts. Some years ago, people who advocated for non binary genders were considered weird, due to which any one convinced by them would not dare to come out due to fear that they would seem strange and their beliefs odd one out from the crowd.
Science clashes with orthodox beliefs which is not digestible to some.
Having one girl child would not be enough because in our culture girls are meant to be ‘sent away to others’ after marriage and there would be no one to care for the parents in old age. In addition, son would contribute to increasing ‘bansa' or lineage.
Question: Has Nepal recognized transgender marriage?
Dr Basaula: No, it has not been legalized. It has been halted in the administrative process. In Thamel, near where I work, transgender people are forced to come out at the dark of the night. There are many challenges they face in their daily life.
When to think of Social change?
New needs in the society could create a way for changes to happen. For example the need for the rights of LGBTIQA+ is a required advancement in society.
Any dissatisfaction with the status quo pushes for changes to occur. The bitterness of non binary gender identities having to live a closeted from society could change into a movement demanding their rights as is happening all around the world.
All the knowledge accumulated in the society over the years could prompt for a change. All the scientific knowledge up to this 21st century should move the society in a progressive path of change. Post natal care, safe abortion, family planning, test tube baby etc. are scientifically advanced now. People should have easy access to them.
How to change?
》Be practical rather than being a puppet. Learn and make your own opinion. Keep an open mind and critical eyes. Analyze things.
》Rules that requires modification should be advocated to be changed. Demands and needs changes according to time. We should speak for the rules that fit those changes.
》Share your ideas and learn from others. Keep an open mind to new knowledge.
》Try and live as your own self. Do not live in a shadow of your parents or society. Your gender and identity is created by yourself.
Question: Is pre-marriage abortion legal in Nepal?
Dr Basaula: Abortion is legal in Nepal. There is no such condition as marriage or pre-marriage. There are other conditions. (You will find them below in topic 'Some laws'.)
Question: Is underage sex legal in Nepal?
Dr Basaula: It is illegal because that will be sexual contact with a minor. So sex between minors is also illegal even if it is consensual.
Question: What are the consequences of underage sex?
Dr Basaula: The sexual organs will not have been developed below the age of 18. There is high chances of tear in reproductive organs. And females bear most of the physical consequences than the males. As there is high chance of vaginal tear, some children could go to shock because of a lot of bleeding.
Addition: Under age sex, even with consent, has been termed as a rape. The punishments vary according to age. Different age groups have different punishments. Punishment can be imprisonment as well as fine. Minors are taken to juvenile reform homes to serve their imprisonment term.
Question: Is watching porn before the age of 18 right?
Dr Basaula: It depends. Watching porn increases sexual arousal. That’s the main reason right? Many movies also come with the tag of R-18 meaning that it is not for anyone below the age of 18. That's why, porn should be avoided by children below the age of 18. It will increase sexual curiosity, which will lead to a desire to test it out and any sexual intercourse below the age of 18, even with consent, will be considered as rape. It is better if you watch porn after the age of 18.
Question: In your opinion, are rape cases increasing due to watching porn?
Dr Basaula: Well it depends on how people take it. They say watching porn increases the urge to have sex. This may direct them to the wrong path due to the curiosity of enacting those scenes. More so for people with sexophilia. Watching porn might lead them to commit rape landing them in prison.
Addition: There are different kinds of contents in porn. Like the soft core porn or hard core porn. So it is better to understand what you are watching. Most of the porn videos are made for the hype of the content which cannot be enacted in real life. Some cinematic clips such as wax or candle melting would only be arousing visually but too painful to enact in real life. Some BDSM stuff might be too painful for some people.
Teenagers watch porn mostly due to their curiosities. If these curiosities are properly addressed by sexual and reproductive health education, maybe the urge to watch porn would decrease in teenagers.
Also, masturbation is considered a taboo in the society. The number of teenagers watching porn would drastically decrease if masturbation is normalized. It removes the sexual urge. This would dampen the curiosity which might decrease the amount of sexual violence happening in the society.
How to change and improve?
》Family planning and child health programs should be conducted everywhere.
》Promotion of awareness through prints, publications, audio visual programs and movies.
》Dispelling myths and misconceptions regarding the reproductive and sex related issues must be prioritized and encouraged.
》Education on reproductive organs, adolescence related changes, health and hygiene of reproductive organs, safe sexual practices and different STDs should be given at an early age.
》Widespread awareness and education in different methods of birth control, maternal and infant care, post natal care etc. should be done.
》 Spreading awareness regarding sexual abuse and sex related crimes etc.
》Similarly awareness regarding the laws enforced to ensure women safety and security should be given.
》Ban on sex determination during pregnancy and its awareness to decrease foeticide of female girl child.
Some laws:
Some Questions
Question: What can parents and children do to foster sharing sexual and reproductive health issues between them?
Dr Basaula: Parents don’t receive same type of sexual and reproductive health education as us. This might be the reasons for awkwardness. They don’t receive the education from their own parents so they don’t feel obliged to do so for their children. They don't understand that sexual and reproductive health education should first come from home before the school. Girls should be provided enough education on menstrual health so they can take care of themselves. Boys should be made aware about ejaculation during puberty. Changes cannot be brought about suddenly, it is a gradual process. First step should be the mothers educating their girl child and the fathers educating their boy child about the changes that occurs during puberty in the body.
Question: In a time where there was no sexual health education, how did our parents and grandparents know that something like sex existed?
Dr Basaula: If you guys know, there is a ritual near the end of marriage ceremony, where she is taken inside a room by married women before bidding her farewell. They are educated about sex and sexual relations during the ritual. Similarly, males learn about sex from fathers or peers.
Question: At what age should we educate out younger siblings or children about sexual health education?
Dr Basaula: WHO has specified the age of adolescence around 12 or 13 years of age. This education should be given when the child enters into adolescence phase or start puberty. They should be educated about good touch and bad touch before that age, as early as the age of four to five, to make them aware of any sexual abuse they might face.
Question: How does sexual relations with multiple partners affect the health of a person?
Dr Basaula: It is their own choice if people wish to satisfy their sexual desire with multiple partners with consent but the sex should be safe sex to minimize the chances of STDs.
Addition: Extramarital affairs in marriage can be a ground for divorce. There is no other legal actions or punishments for multiple partners or extramarital affairs.
Question: How are test-tube babies made?
Dr.Basaula: The ova from female is extracted and fertilized with sperm in an external environment similar to the uterus. Then, the fertilized egg is replanted in the uterus in its 16 to 32-celled stage.
Question: What are the effects of incest marriages and incest sexual relationships in the child that is born as its result?
Dr Basaula: Incest marriage is deterred or prohibited for up to ten generations of same lineage. This is because the child from such relations are born with chromosomal mutations and other abnormalities. Some cultures allow marriages between the children of the siblings. In such cases, doctors have to ask the marriage histories to predict if the child would be born with any abnormalities or disease.
At last
People's perspectives are heavily influenced by their environment. Our participants had a lot of take-aways from this session. We hope, now, they contribute to bring a positive change in society's outlook towards reproductive and sexual health. Perhaps, the society will gradually stop limiting their knowledge to textbooks and exams and practically apply them too.
Cheers to the better days ahead!
😄
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