Nepal has one of the highest maternal mortality rates in the world, with an estimated 4,500 women dying yearly of pregnancy-related causes. Health care delivery has become even more challenging for NGOs and UN agencies like UNFPA during the current conflict, says Sultan Aziz, director of the Asia-Pacific Division of UNFPA, who was in Kathmandu recently.
Nepali Times: Where are we failing in reproductive health?
Sultan Aziz: It's not a question of failure but priorities. Dealing with women's reproductive health is an ongoing challenge even in some middle-income countries. There is no argument that the status of women in Nepal is not where it should be. Clearly, issues relating to governance of the health system are important.
Is it governance or programs?
It is not the lack of programs as many of them have been around for a long time. It is absolutely crucial that the government puts more resources and attention into this. You will find there is a really serious commitment to health services from us but recent events have made it difficult to go to these places where indicators are not improving.
Is it true that the conflict is affecting health care less than other sectors?
No, I completely disagree with that. I think there's a perception that somebody in a dire health situation will get help. But the argument should be that the very structure that supports the health system is suffering. If a particular road is blocked and a woman cannot reach the hospital to deliver, she dies or faces some complication. If health is to become completely neutral, then both sides have to be very clear that they are committed to saving lives, not destroying them.
How about women and children?
The people who usually suffer the most in a conflict situation are women and children. Men have a variety of opportunities to leave the conflict area. But women and children cannot travel like men can. And when they do travel, they end up in a camp. They are always in vulnerable situations and become easy prey for rape and many other types of exploitation.
Has conflict affected UNFPA's work in Nepal?
I think it's a fact that the conflict has affected all. The professionals whom we have invested in for years in Nepal cannot access certain areas to provide services. We have to train our co-workers to understand what the realities are in a crisis, so they are able to respond. We should no longer pretend that we can continue to do development in a crisis and in the absence of security.
How are demographic pressures changing?
In a sense, I'm not so scared about population growth. There are varieties of indicators that you can look at: quality of life indicators, quality of education and reduction of poverty. If you look at them you can say that we can afford to have certain growth in population. In the absence of all those indicators, a 4.5 Total Fertility Rate (TFR) is cause for concern because it squeezes your doubling period and yet you are faced with the challenges of a slow-growth economy and deteriorating infrastructure.
What can we learn from other countries like Bangladesh and Indonesia?
Certain types of integrated services such as quality care, family planning and providing services to youth are needed. Girls get married early in Nepal and so delaying the age of marriage is important. These can all come about through behavioural change using communication strategies. There's nothing magical about it. These are things that only the government can make happen simply because it is in a position to make it happen.