Group dialogues in Nepal give women a chance to have frank conversations about sexual health issues normally veiled by privacy and fear.
Communication influences informed choice for Nepali women
Less than a decade ago, women in Nepal were subject to some of the strictest abortion laws in the world. To end unwanted pregnancies, women endured illegal and unsafe abortions and served lengthy prison sentences for abortion-related “crimes.” The toll on public health was great: Nepal had one of the highest maternal mortality rates in Asia, and more than half of gynecological and obstetric hospital visits were due to abortion-related complications.
In 2002, Nepal legalized abortion and began offering abortion services in public hospitals. With a stroke of a pen, abortion became a legal and safe choice for women seeking to end unintended pregnancies. But for many women, ingrained fears and shame about abortion remain—and as in other Asian countries where abortion has become legal, women in Nepal continue to seek clandestine, unsafe abortions.
This is where PATH comes in: helping address the long-held beliefs that still stand between women and safe abortion.
Walking in her shoes
Believing that critical reflection can produce new and healthier behaviors, the government of Nepal invited PATH to apply our expertise in using dialogue to inspire social change. Our focus in Nepal was on establishing “dialogue groups”—opportunities for people to gather and share real-life dilemmas and concerns related to sexual health and access to safe abortion. In the context of this supportive group environment, hundreds of participants—most of them women—delved into the health issues affecting them and their communities and families.
This approach, relatively new in Nepal, gave women a chance to have frank conversations about issues normally veiled by privacy and fear. PATH trained community members as facilitators, who engaged others by sharing anecdotes and asking for insights from the group. For example, the story of a young woman who became pregnant after being pressured into sex was the basis for role-playing, discussion, and brainstorming about possible resolutions. By walking in the shoes of this young woman, dialogue group participants began to understand how social pressures can affect decisions about health. As a result, social norms began to shift.
Transformation and trust
Through these shared personal experiences, people who participated had a chance to think deeply—and differently—about the choices they were making every day. As participants grew more comfortable, their discussions began to work their way into community-wide conversations about women’s right to choose. Participants became resources for their communities, providing advice to women considering abortion, assistance in negotiations between women and their partners, and referrals to safe abortion services.
The balance of trust also began to shift—toward husbands and partners, who have great influence on women’s decisions about contraception and abortion. One woman’s husband noted, gratefully: “We used to have rare conversations regarding any household matter; but now she does not hesitate to discuss contraceptive use and sensitive reproductive health issues with our son and me.”
As a concrete result of this trust, the number of women using contraception had increased by 23 percent by the end of the project. Among married women of reproductive age, 65 percent of project participants reported using a modern method of contraception—a much greater proportion than the national rate of 35 percent.
New tools in Nepal
Dialogue groups are just one of many tools helping change behavior and influence social norms in Nepal. PATH’s role also included networking with local and national nonprofits working in reproductive health to train and offer hands-on assistance to local staff. Our Nepalese partners developed brochures, posters, and radio programming to spread information about clinic referrals and where to access safe and legal abortions—and to share the stories of people who were making safer choices about their reproductive health.
These partners now carry on the group dialogue process, reaching more women and addressing additional topics, such as AIDS prevention and gender equity. Together, these efforts will improve the health and lives of women in Nepal.