Posted by Astha Ramaiya
One of the most entrenched forms of gender inequality in Achham is that of illiteracy. The literacy rate amongst young girls aged six to fifteen is only 16% compared to 54% among boys of the same age group. Adult literacy among women in Achham is an appalling 7% compared to 48% among men. A wealth of epidemiological data throughout the world shows that literacy rates among women correspond to key indicators such as fertility rate, maternal mortality, and infant and child mortality. As healthcare providers and advocates in Achham, we are confronted by this reality on a daily basis.
According to the Nepal Demographic Health Survey (NDHS, 2006), in addition to increased fertility rate and infant and child mortality, use of contraceptives is positively correlated with education (NDHS, 2006). The far western hill where Achham is located, reports 69% non-usage of current contraceptives (NDHS, 2006). Achham has seen many cases where lack of education has led to an overuse of Comprehensive Abortion Care (CAC) as a form of contraception. A mean number of 3 CACS are performed per day at Bayalpata Hospital for free by a trained doctor.
Once such instance was a 26 year old female who came to the doctor through the out-patient department complaining that she hadn’t had her menstrual cycle in 2 months. She was married and already had 2 children. She had passed her 7th grade and her husband was a migrant worker. The woman had come for the 2nd time in a period of only 2 months. The doctor requested a Urinary Pregnancy Test which came back positive. Although she had been provided with family planning advice during her first CAC, it was evident that she viewed abortion as a method of contraception and had been depending upon it for her current pregnancy. Nyaya staff members provide health education to all patients who undergo CAC. Although most of the time knowledge is acquired through formal education at school, health education can also be disseminated at health promoting hospitals. This form of health promotion, if coupled with an effective family planning program and a Community Health Worker (CHW) program, can lead to increased health literacy and as a result, contraceptive use.
Universally, education is considered a basic right. However, in a patriarchal society such as Nepal, men are given preference when it comes to education. Although the gap between the genders in terms of education has decreased, there is still a great disparity, especially in the rural areas. Nyaya sees, in many instances, the correlation between illiteracy and health decisions and access. Women, being the caretakers of households, also help in determining the health of the family. It is therefore critical to curb illiteracy amongst this group, in addition to other social factors contributing towards ill-health. A health-promoting hospital with access to family planning services and a CHW program could increase health literacy amongst women.