Pranab Dahal

Background: Ensuring respectful maternity care is crucial to promote positive childbirth experiences among women. Globally, 22–100% women report experiencing at least one form of disrespect and abuse during facility-based birth, with a study in Nepal reporting 100% prevalence. Thus, interventions like Forum Play are needed to promote respectful maternity care but remain scarce. Forum Play is a participatory theatre technique which encourages the participants to create scenes based on their own experiences illustrating a situation of oppression. This study aimed to assess the effectiveness of a pilot Forum Play intervention in promoting respectful maternity care by investigating self-reported perception and behaviour among care providers. Methods: A quasi-experimental pre–post study with a control group was conducted among doctors and nurses in two tertiary hospitals in Nepal. Participants involved in providing care or interacting with women during labour and delivery were purposively selected for the intervention and control groups. The intervention group comprised 25 care providers (14 nurses and 11 doctors), while the control group included 75 care providers (42 nurses and 33 doctors). Two half-day Forum Play workshops were conducted separately for nurses and doctors in the intervention hospital. Data were collected using a self-administered structured questionnaire at baseline and two months post-intervention in both groups; however, the design was not strictly parallel. In the control hospital, data were collected later at the same intervals to provide contextual comparison. Data were analysed using IBM statistical package for social sciences version 20. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to measure the self-reported perception and behaviour on disrespect and abuse and perceptions of respectful maternity care. Mann Whitney U test was used to compare groups and Wilcoxon Signed Rank test was used to assess within-group changes before and after the intervention. Results: There were no differences in background characteristics between intervention and control groups (p=>0.05), nor in the overall disrespect and abuse of women at baseline (p = 0.09 to 0.35) whereas significant differences were observed at follow-up (p=<0.001 to 0.004, r = 0.33 to 0.61). There were no significant differences in perception scores towards respectful maternity care between the groups at baseline while significant differences were found at follow-up (z = −3.25, p = 0.001 and r = 0.32). The perception score was significantly higher in the intervention group after the intervention (z = −3.073, p = 0.002 and r = 0.61) while no significant difference was observed in the control group (z = −0.120, p = 0.90 and r = 0.05). Conclusion: Forum Play as a method of participatory intervention has the potential to enhance positive perception and behavioral change among care providers towards respectful maternity care. Scaling up the Forum Play intervention and systematically exploring women’s experiences are essential to determine its actual effectiveness.

Aims/objectives: The International Committee of the Red Cross (ICRC) initiated a program in Nepal in 2010 to assist Families of Missing Persons (FoMPs). The program, which aimed to provide emotional and psychological support, recruited many FoMPs themselves as “accompaniers” (psychosocial service providers) to function as agents of change. This study digs into retrospective data of accompaniers’ psychological status to see if accompaniers from the FoMPs experienced elevated stress compared to their peers who were non-relatives of the Missing. The study also compared their personal growth, meaningfulness of work, and work satisfaction as lay counselors. Methods: The purpose of the study was to evaluate and compare the level of stress of the two groups of accompaniers: those who were not related to the missing persons (n=39) and those who were (n=26). The study retrospectively compared the data of two groups using mixed methods, applying quantitative and qualitative methods. A locally developed 13-question self-administered perceived-impact scale covering five domains – negative effects of work, meaningfulness of their work, personal growth, level of supervision, and overall satisfaction with work - was used to gather the quantitative data. Individual interviews (five), and focused group discussions (FGDs, seven) were also employed to gather qualitative data from the respondents. The ethical clearance and data analysis procedures adhered to scientific protocols. Results: The study found that two-thirds of respondents (n= 65) from both FoMPs accompaniers and non-FoMPs accompaniers disagreed that their work was very stressful. One-third of both groups expressed that their stress was initially increased due to the narratives of personal loss, uncertain life circumstances of FoMPs, and economic hardships. Non-FoMPs accompaniers experienced stress due to their lack of exposure to families affected by the conflict, while for the FoMPs, it was similar stories that triggered their loss. Recruitment of FoMPs accompaniers helped build rapport with target communities. The acceptance and the welcome by the families helped accompaniers in their work, more so for FoMPs accompaniers. Both groups of individuals developed a repertoire that included problem-focused coping strategies and emotion-focused coping techniques to ease negative emotions. The methods employed by both groups were sharing feelings, spending time with friends and family, reading, and distraction. Over 90% of accompaniers in both cohorts expressed personal growth (96% FoMPs and 95% non-FoMPs) and their work as meaningful (91% FoMPs and 94% Non-FoMPs). 87% of accompaniers from FoMPs and 95% of accompaniers from non-FoMPs cohorts shared overall satisfaction working as an accompanier. Conclusion: The study findings showed that over two-thirds of individuals who served as accompaniers from FoMPs or Non-FoMPs did not suffer from severe stress or re-traumatization. Accompaniers, involved in this study, found hope, dignity, identity, opportunities, and pride due to their service. This study found that victims can be trained and supervised to function as agents of change for service recipients and themselves.

Background: Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence. Method: The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis. Results: The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality. Conclusion: The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.

Worldwide, a large number of women experience disrespectful and abusive behavior from care providers during childbirth. This violates the rights of women to attain respectful care. This study aimed to find out the women’s experience of disrespect and abuse during institutional delivery. A cross-sectional study was conducted in two hospitals of Morang district situated in eastern Nepal. Two hundred eighteen women from a public hospital and 109 women from a private hospital (N = 327) with normal vaginal delivery were selected purposively for this study. Data were collected through face-to-face interviews using a structured questionnaire based on the Disrespectful and Abusive Scale by Bowser and Hill. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%), respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively. Ethnicity, religion, place of delivery, and numbers of living children were the main predictors of reporting disrespect and abuse. Overall, the occurrence of disrespect and abuse during institutional delivery was found to be very high.

Gender inequality and violence against women are present in every society and culture around the world. The intensities vary, however, based on the local guiding norms and established belief systems. The society of Nepal is centered on traditional belief systems of gender roles and responsibilities, providing greater male supremacy and subordination for the females. This has led to the development and extensive practices of social gender hierarchal systems, producing several inequalities and violence toward women. This study has utilized Forum Theater interventions as a method of raising awareness in 10 villages in eastern Nepal. The study aimed to understand the perception and changes in the community and individuals from the interactive Forum Theater performances on pertinent local gender issues. We conducted 6 focus group discussions and 30 individual interviews with male and female participants exposed to the interventions. The data analysis utilized the constructivist grounded theory methodology. The study finds that exposure and interactive participation in the Forum Theater provide the audience with knowledge, develop empathy toward the victim, and motivate them to change the situation of inequality, abuse, and violence using dialogues and negotiations. The study describes how participation in Forum Theater has increased individual’s ability for negotiating changes. The engagement by the audience in community discussions and replication of efforts in one of the intervention sites show the level of preparedness and ownership among the targeted communities. The study shows the methodological aspects of the planning and performance of the Forum Theater and recommends further exploration of the use of Forum Theater in raising awareness.

‘We are looked down upon and rejected socially’: a qualitative study on the experiences of trafficking survivors in Nepal

Making working conditions safe and healthy is the interest of workers, employers and the Government.Although it seems simple and obvious, this idea has not yet gained meaningful recognition in Nepal. The study was conducted in ten small scale industries of Kathmandu valley. Altogether 545 questionnaires on socioeconomic and occupational history were filled up. Similarly, Workplace Occupational Health Assessment was done in all ten industries. A thorough medical examination of 135 child workers was done using a structured questionnaire to find out the health effects due to occupational hazards. Out of the total 545 workers present in the industries under study, 135 (24.8%) were child workers. Higher proportion of child workers (97%) was illiterate compared to 3% of children with primary level education. Among the child workers, 23 (17%) were girls. The majority of the child labourers were suffering from conditions like otitis externa, otitis media, scabies, anaemia, upper respiratory diseases, nasal problems, abdominal pain etc. The occupational health and safety practices in small scale industries in Kathmandu have been found to be unsatisfactory. Child labour is a serious problem. Out of ten industries, six have employed child workers and the working conditions range from bad to terrible. Health and welfare of the child workers was also not satisfactory.