Women in Nepal Face Abuse, but the Real Problem Is Nobody Wants to Talk About It

The country's health care workers are rarely trained to identify victims of abuse and provide support—and that needs to change now, one physician argues.

A Nepalese woman takes part in a protest demanding stronger laws that protect women against physical and sexual abuse. (Photo: Navesh Chitrakar/Reuters)

Jul 23, 2015· 3 MIN READ
Kusum Thapa is an obstetrician and gynecologist with over 25 years of experience working in both Nepal and the United Kingdom. She is also a New Voices Fellow at the Aspen Institute.

It is a chilly night in a rural hospital in Nepal. I have been asked to attend to Sita Devi, who is lying in a pool of blood as nurses rush around her. A mother of three young daughters, she is four months pregnant. And badly beaten.

A local fortune-teller has told her husband that the baby is female. After resisting his demands to terminate the pregnancy, Sita has paid a heavy price. I’m an obstetrician, but there is little I can do.

A Nepalese government survey in 2011 showed that 22 percent of women ages 15 to 49 had experienced physical violence, and 12 percent had experienced sexual violence at least once. Among married women, one-third had experienced emotional, physical, or sexual violence from their spouse in their marital relationship, according to Nepal’s ministry of health and population.

Deeply rooted traditional practices are prevalent in Nepal, where women generally have low social status. In some communities, young girls are offered to temples for ceremonial purposes, where many also encounter sexual exploitation. Nepal’s disastrous earthquake in April only increased the risks that women face. Data from a tertiary hospital three months prior to the earthquake revealed that there were 45 cases of gender-based violence. The following month, after the earthquake, there were 32 reported cases as survivors crowded into makeshift tents.

Women are often silenced in their attempts to report such violence or are afraid to speak up if there is an opportunity. Gender-based violence survivors often come to health facilities to seek medical care after abuse, but only one out of 10 women reports the violence to the staff, according to a 2011 survey.

Sita had visited the health facility twice before. The first time she was beaten, she told the provider that she had hit herself while collecting water and gotten a black eye. The second time, she had bruises all over her back and arms and said that she had fallen down the stairs. If the provider had spent more time with her to understand the situation, she might not have been a victim of a repeat incident. The role of medical staff in identifying violence and providing treatment is key, but all too often this is done poorly, if at all.

The Nepalese government has taken important steps to combat gender-based violence. Nepal now has a Domestic Violence Act, government funding for programs on gender violence, and a hotline for survivors to register complaints. The government has also established guidelines for Hospital Based One-stop Crisis Management Centers in several districts, which would allow women to report violence and seek treatment at the same facility. Still, women like Sita continue to suffer.

So, Why Should You Care? In Nepal, as in many countries around the world, we need to ensure that frontline health workers are equipped with the knowledge and skills to handle women who suffer from gender-based violence. Nepal still has no unified training for health care workers to identify survivors, provide medical and emotional support, or carry out the necessary documentation and referrals. Intimate partner violence results not only in physical but also psychological trauma and stress—42 percent of women who have experienced physical or sexual violence at the hands of a partner have experienced injuries as a result, according to the World Health Organization. Women who experience violence in their own homes are twice as likely to experience depression, twice as likely to use alcohol in a harmful manner, and 4.5 times more likely to attempt suicide. Globally, more than one-third of all female murder victims are women killed at the hands of their intimate partner, against just 6 percent of all male murders.

Nepal and its development partners must do more to train providers to identify survivors of gender-based violence and be able to counsel and manage such cases appropriately. Equally important is to ensure the safety of survivors so that they do not go back to the same environment to suffer again. If Sita had been placed in a shelter, she would not have had to suffer her last beating. Providers should be nonjudgmental and supportive, and they should provide practical care that responds to the immediate situation. It is important to ask about history of violence, listen carefully, and avoid pressuring survivors, which can only increase the trauma. It is also important that the provider helps survivors access information, legal support, and other services. In many cases, medical evidence is not properly recorded and documented, leading to low prosecution and conviction rates for rape cases.

Fortunately, Sita survived. But despite all our efforts, we could not save her unborn child. Gender-based violence is a grave social and human rights concern affecting virtually all societies. In developing countries, the poorest citizens suffer the most. It is important for Nepal to ensure that post-earthquake funding also addresses this important issue. Effective plans to strengthen health facilities and equip health workers to deal with gender-based violence are of utmost importance and could save lives.

When the next Sita Devi first reports that she has been abused, a health care worker should be listening—and should amplify her voice so that other women realize there is an alternative to suffering in silence.