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'''OVERVIEW''' | '''OVERVIEW''' | ||
Over the past few decades, Nepal has seen major developments surrounding sexual health and family planning. However, there are still major inroads to make so that health care continues to become more accessible, inviting and personalized for women in Nepal. Currently, you can purchase birth control pills without a prescription at Nepalese pharmacies, and NGOs throughout the country work to ensure that women in remote areas can also access contraceptives. You can also find IUDs, contraceptive shots and contraceptive implants in Nepal. Female sterilization and injectables are especially popular contraceptive methods for married Nepalese women. You can also purchase emergency contraception (the morning after pill) without a prescription at pharmacies, however many Nepalese women do not yet hold substantial knowledge of EC. There are no travel restrictions related to HIV status, and Nepal provides ARV sites for PLIV throughout the country. Furthermore, you can receive STI tests at local NGO sites, public hospitals or private hospitals. There is currently no PrEP in Nepal, as of September 2017. There is an HPV vaccination program in the country. Regarding menstrual products, you'll mostly find pads and tampons in Nepalese stores, and you may not find any menstrual cups at all. However, there are some interesting initiatives related to menstrual cups in Nepal, and you can certainly purchase them online and have them delivered to your Nepalese address. Regarding gynecologists, we have a list of recommended providers (check out the "Gynecological Exams" section). Nepal offers maternity leave, although the maternity leave policy does not satisfy international standards. Finally, abortion is legal during the first 12 weeks of gestation. | |||
==Contraception (Birth Control)== | ==Contraception (Birth Control)== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Nepal, you can purchase oral contraception (birth control pills) without a prescription.<ref>[http://ocsotc.org/wp-content/uploads/worldmap/worldmap.html Global Oral Contraception Availability]</ref> <ref>[http://freethepill.org/where-on-earth/ Free the Pill: Where on Earth?]</ref> According to a 2015 report, it's estimated that 52.4% of | In Nepal, you can purchase oral contraception (birth control pills) without a prescription.<ref>[http://ocsotc.org/wp-content/uploads/worldmap/worldmap.html Global Oral Contraception Availability]</ref> <ref>[http://freethepill.org/where-on-earth/ Free the Pill: Where on Earth?]</ref> According to a 2015 report, it's estimated that 52.4% of Nepalese women (who are of reproductive age and married or in unions) use some form of contraception, including traditional methods, and 23.9% have unmet family planning needs.<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]</ref> This shows a slight change over 2011 data, collected by Nepal Population and Housing census, which found that 49.7% of women took any form of contraception and that 27% had unmet family planning needs.<ref>[http://www.searo.who.int/entity/maternal_reproductive_health/documents/nep-mmr.pdf?ua=1 Nepal and Family Planning: An overview]</ref> In 2015, the most common forms of contraception were female sterilization (18.3%), injectables (13.2%), birth control pills (4.8%), male sterilization (4.8%) and withdrawal, also known as the "pull-out method" (3.9%). It was found that only 3.8% of Nepali women used condoms as their primary form of contraception. Meanwhile, there was very low usage of IUDs (1.7%) and contraceptive implants (1.3%).<ref>[http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf Trends in Contraceptive Use Worldwide 2015]</ref> | ||
For Nepalese women, it's common to get married at a young age, sometimes in the teen or adolescent years. For the majority of the population, which is Hindu, the marriage is typically arranged. However, "love marriages" are becoming increasingly popular in Nepal. Regardless of whether a marriage is arranged or a "love marriage," many women have their first child at a young age. According to studies, over half of married women in Nepal do not want any more children. Over the past few decades, contraceptives have become more prevalent in Nepalese society. In fact, NGOs and local organizations distribute contraceptives to women in Nepal.<ref>[https://www.theguardian.com/global-development/2012/jul/07/zoe-williams-nepal-contraception-pregnancy Zoe Williams: how contraception is rocking Nepalese society]</ref> Over the past few decades, Nepal has seen a drop in its fertility rates, going from 5.1 births per woman in 1985 to 2.6 births per woman in 2011.<ref>[http://www.searo.who.int/entity/maternal_reproductive_health/documents/nep-mmr.pdf?ua=1 Nepal and Family Planning: An overview]</ref> According to some sources, Nepalese society does not carry an overwhelmingly negative stigma toward contraception. Yet it should also be noted that Nepal is still very much a patriarchal society, where married women usually live in the house of their husband and follow the rules dictated by their mother-in-law, husband and other men in their lives. For this reason, not all women have the agency or autonomy to make such choices on their own.<ref>[https://www.theguardian.com/global-development/2012/jul/07/zoe-williams-nepal-contraception-pregnancy Zoe Williams: how contraception is rocking Nepalese society]</ref> | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* You can purchase '''condoms''' in Nepal at pharmacies, general stores, certain department stores and non-governmental organizations, like Marie Stopes International. There are also locally-produced condom brands, such as [http://crs.org.np/page.php?title=dzire-dotted-condom Dzire Dotted Condom] and [http://crs.org.np/page.php?title=dhaal-deluxe-condoms Dhaal Deluxe Condoms], which are produced by Nepal CRS Company. If you go to [http://www.mariestopes.org.np/en/faq/men/contraception/male-condoms?section=men Marie Stopes Nepal], you'll probably get Jodi Condoms, which is the condom brand that MSI International endorses. Finally, if you prefer to purchase condoms online, there are certain online retailers that sell condoms to the Nepalese market and can deliver condoms to your Nepalese address. Some of these online companies are [https://www.meroshopping.com/condom Mero Shopping], which sells brands like Ocean Premium, Kohinoor Moods, or [https://www.caretobeauty.com/np/condoms/?limit=all Care to Beauty], which sells Durex condoms. However, if you purchase online, the price for a box of condoms will typically be much higher than if you purchase them in person in a Nepalese pharmacy or store. | * You can purchase '''condoms''' in Nepal at pharmacies, general stores, certain department stores and non-governmental organizations, like Marie Stopes International. There are also locally-produced condom brands, such as [http://crs.org.np/page.php?title=dzire-dotted-condom Dzire Dotted Condom] and [http://crs.org.np/page.php?title=dhaal-deluxe-condoms Dhaal Deluxe Condoms], which are produced by Nepal CRS Company. If you go to [http://www.mariestopes.org.np/en/faq/men/contraception/male-condoms?section=men Marie Stopes Nepal], you'll probably get Jodi Condoms, which is the condom brand that MSI International endorses. Finally, if you prefer to purchase condoms online, there are certain online retailers that sell condoms to the Nepalese market and can deliver condoms to your Nepalese address. Some of these online companies are [https://www.meroshopping.com/condom Mero Shopping], which sells brands like Ocean Premium, Kohinoor Moods, or [https://www.caretobeauty.com/np/condoms/?limit=all Care to Beauty], which sells Durex condoms. However, if you purchase online, the price for a box of condoms will typically be much higher than if you purchase them in person in a Nepalese pharmacy or store. | ||
* You can purchase '''oral contraceptives (birth control pills)''' without a prescription at pharmacies. Some of the international brands you can expect to see are Duoluton L, Ovral, Lo-Femenal and Nordette.<ref>[http://ec.princeton.edu/ Princeton EC Website]</ref> You can also find [http://crs.org.np/page.php?title=nilocon-white Nilocon White], which is a low-dose oral contraceptive that was launched by Nepal CRS Company in the 1980s, and it may only be available in Nepal. | * You can purchase '''oral contraceptives (birth control pills)''' without a prescription at pharmacies. Some of the international brands you can expect to see are Duoluton L, Ovral, Lo-Femenal and Nordette.<ref>[http://ec.princeton.edu/ Princeton EC Website]</ref> You can also find [http://crs.org.np/page.php?title=nilocon-white Nilocon White], which is a low-dose oral contraceptive that was launched by Nepal CRS Company in the 1980s, and it may only be available in Nepal. | ||
* You can get an '''IUD''' in Nepal. If you have issues with your IUD (such as cramping, pain, etc), you can call Meri Saathi Free Helpline on 16600119756 (ntc) or 9801119756. | * You can get an '''IUD''' in Nepal. If you have issues with your IUD (such as cramping, pain, etc), you can call Meri Saathi Free Helpline on 16600119756 (ntc) or 9801119756. | ||
* You can get '''contraceptive implants''', including brands like Norplant and Jadelle, at government hospitals and health care organizations. For | * You can get '''contraceptive implants''', including brands like Norplant and Jadelle, at government hospitals and health care organizations. For Nepalese women, it's often totally free.<ref>[Conversation with Kathmandu gynecologist, 2017]</ref>. At private doctor's clinics, Cadelle typically retails for the price of Rs. 350, according to Nepal CRS Company.<ref>[http://crs.org.np/page.php?title=jadelle Jadelle]</ref> | ||
* You can get the '''contraceptive shot/injectable''' in Nepal, which usually goes under the name Sangini. It typically retails for around Rs.50 per vial. To learn more about Sangini in Nepal, click [http://www.crs.org.np/page.php?title=sangini-depoprovera here]. | |||
===Costs=== | ===Costs=== | ||
* '''Condoms''' - If you go to Marie Stopes Nepal, you can probably get a box of condoms for a reduced price or free. If you go to a Nepalese store, you can | * '''Condoms''' - If you go to Marie Stopes Nepal, you can probably get a box of condoms for a reduced price or free. If you go to a Nepalese store, you can purchase Dhaal Deluxe Condoms for about Rs. 5, as of 2017.<ref>[http://crs.org.np/page.php?title=dhaal-deluxe-condoms Dhaal Deluxe Condoms]</ref> For a box of Dzire Dotted Condoms, you can expect to pay Rs. 35 at Nepalese stores, as of 2017.<ref>[http://crs.org.np/page.php?title=dzire-dotted-condom Dzire Dotted Condoms].</ref> However, if you would like to buy condoms online, you can expect to pay anywhere between Rs.50-Rs.2300 for a box of condoms. | ||
* '''Birth Control Pills''' - For Nicolon White, you can expect to pay around Rs. 50 for a one-month supply (as of 2017). For Duoluton L, you can expect to pay Rs. 223.2 for a one-month supply (as of 2017). | * '''Birth Control Pills''' - For Nicolon White, you can expect to pay around Rs. 50 for a one-month supply (as of 2017). For Duoluton L, you can expect to pay Rs. 223.2 for a one-month supply (as of 2017). | ||
* '''Contraceptive Implants''' - Depending on where you go, you can expect to pay no money (free) to around Rs. 350. Note that prices may be different for non-Nepalese citizens. | |||
* '''Contraceptive Shots''' - Depending on where you go, you can expect to pay no money (free) to around Rs.50 per vial. Note that prices may be different for non-Nepalese citizens. | |||
==Emergency Contraception (Morning After Pill)== | ==Emergency Contraception (Morning After Pill)== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Nepal, it is estimated that 0.2% of the population is infected with HIV, as of 2015.<ref>[http://www.unaids.org/en/regionscountries/countries/nepal UNAIDS - Nepal, HIV & AIDS Estimates]</ref> According to a 2015 UN Report, the majority of new HIV infections (85%) are sexually-transmitted.<ref>[http://www.unaids.org/sites/default/files/country/documents/NPL_narrative_report_2015.pdf Country Progress Report - NEPAL]</ref> The key affected populations include injection drug users, sex workers, transgender people and migrant laborers. However, it is important to remember that HIV impacts all people | There are currently no travel restrictions for people with HIV in Nepal. This means that you can travel to Nepal, regardless of your HIV status, and you won't be asked for medical documents to confirm your HIV status.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=131 NEPAL - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> In Nepal, it is estimated that 0.2% of the population is infected with HIV, as of 2015.<ref>[http://www.unaids.org/en/regionscountries/countries/nepal UNAIDS - Nepal, HIV & AIDS Estimates]</ref> According to a 2015 UN Report, the majority of new HIV infections (85%) are sexually-transmitted.<ref>[http://www.unaids.org/sites/default/files/country/documents/NPL_narrative_report_2015.pdf Country Progress Report - NEPAL]</ref> The key affected populations include injection drug users, sex workers, transgender people and migrant laborers. However, it is important to remember that HIV impacts all people, and one should always use protection. For a detailed report on HIV in Nepal, click [http://www.unaids.org/sites/default/files/country/documents/NPL_narrative_report_2015.pdf here]. | ||
===Testing Facilities=== | ===Testing Facilities=== | ||
'''Nonprofit Options''' | |||
* [https://mariestopes.org/where-we-work/nepal/ Marie Stopes Nepal]: This NGO focuses on sexual and reproductive health care for women around the globe. They often provide free or low-cost STI tests, and they have over 30 centers in Nepal. You should contact them to find the center that's closest to you. Address: Marie Stopes Nepal, Baluwatar, GPO Box 11254, Kathmandu, Nepal. Phone: (+977) 01 4419 371 / 01 4439 681. Email: msi@msinepal.org.np | |||
* [http://rakshanepal.org/ Raksha Nepal]: This is a nonprofit that provides HIV/AIDS testing and prevention services. The organization focuses on ending the sexual exploitation on women and girls. Address: Kathmandu Metropolitan 29, Lainchaur Bagmati Nepal. Phone: +977-1-4437552. Email: info@rakshanepal.org | |||
'''Government (Public) Hospitals''' | |||
* Bir ART Clinic: This clinic is included in the AIDS Healthcare Foundation Global Directory, so they should either provide HIV tests or be able to direct you to a clinic that does. Furthermore, Bir Hospital is the oldest hospital in Nepal. Address: Bir Hospital, Mahaboudha, Kathmandu, Nepal | |||
'''Private Hospitals''' | |||
* [http://www.grandehospital.com/department/infectious-diseases Grande International Hospital]: This private hospital will most likely be more expensive than public hospitals, or perhaps even some other private ones. However, if you do want a hospital/clinic that specializes in helping foreigners, this is an option. For an appointment, call +977 15159266, 015159267ENGLISHENG . | |||
* [http://ciwec-clinic.com/service-location/kathmandu/ CIWEC Clinic]: This is another private clinic, established in 1982, that provides specialty services for foreigners. They do HIV tests and other laboratory tests. Open 24 hours. They are known to be higher quality but also more expensive. | |||
===Support=== | ===Support=== | ||
* [https://www.ncasc.gov.np/ National Centre for AIDS and STD Control] | * [https://www.ncasc.gov.np/ National Centre for AIDS and STD Control]: Check out the website to learn about the ART sites and viral loading testing services in Nepal. | ||
* [http://www.unaids.org/en/regionscountries/countries/nepal UNAIDS Nepal]: Contact person - Rubel del Prado, UNAIDS Country Director. Email: DELPRADOR@UNAIDS.ORG | * [http://www.unaids.org/en/regionscountries/countries/nepal UNAIDS Nepal]: Contact person - Rubel del Prado, UNAIDS Country Director. Email: DELPRADOR@UNAIDS.ORG | ||
* [https://www.aidshealth.org/#/archives/countries/np AIDS Healthcare Foundation Nepal]: Contact person - Deepak Dhungel, Country Program Manager. Address: Pulchowk (behind Nidan Hospital), Lalitpur, GPO Box: 10377, Kathmandu. Tel: +977-1-5532173. Email: Deepak.Dhungel@aidshealth.org | * [https://www.aidshealth.org/#/archives/countries/np AIDS Healthcare Foundation Nepal]: Contact person - Deepak Dhungel, Country Program Manager. Address: Pulchowk (behind Nidan Hospital), Lalitpur, GPO Box: 10377, Kathmandu. Tel: +977-1-5532173. Email: Deepak.Dhungel@aidshealth.org | ||
===Costs=== | ===Costs=== | ||
The Nepalese government provides free HIV treatment at 61 ART centers across the country. These free services may only be for people with Nepalese citizenship (we need confirmation on this). | |||
==Medications & Vaccines== | ==Medications & Vaccines== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* There is currently no PrEP available in Nepal, as of September 2017.<ref>[http://www.prepwatch.org/ PrEPWatch World Map]</ref> | * If you have a '''yeast infection''', you can ask the pharmacist for Fluconazole, which is an antifungal medication often used to treat yeast infections. While the pharmacist may not specifically have Fluconazole, the pharmacist can give you similar medication with the same (or similar) active ingredients. You can also try to ask the pharmacist for Canesten, which is a yeast infection medication that is common in certain Asian countries. | ||
* The '''HPV vaccine''' is available in Nepal, and it's recommended for girls ages 11-12 and up. It can be found at [http://ciwec-clinic.com/health-articles/immunization-for-children/ CIWEC Clinic], along with other health care facilities. | |||
* There is currently no '''Pre-exposure prophylaxis, or PrEP''' available in Nepal, as of September 2017.<ref>[http://www.prepwatch.org/ PrEPWatch World Map]</ref> | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* [https://mariestopes.org/where-we-work/nepal/ Marie Stopes Nepal]: They provide gynecological examinations with pap smear tests for Rs.400 rupees (price as of September 2017). They keep costs down because Marie Stopes is an international NGO that provides low-cost family planning services around the world. They have many clinics in Nepal, so you should contact them to find the one closest to you. If you message them on the [https://m.facebook.com/profile.php?id=1508015916178155 MS Nepal Facebook page], they usually get back to you that day. | |||
* Suphatra Koirala at [http://ciwec-clinic.com/ CIWEC Clinic]: This doctor and clinic was recommended by a Kathmandu local. She says, "I've been very impressed by my obgyn at CIWEC. Suphatra Koirala is the Dr. It's pretty pricey there, around US$30 for a quick visit, $60 for a longer consultation." | * Suphatra Koirala at [http://ciwec-clinic.com/ CIWEC Clinic]: This doctor and clinic was recommended by a Kathmandu local. She says, "I've been very impressed by my obgyn at CIWEC. Suphatra Koirala is the Dr. It's pretty pricey there, around US$30 for a quick visit, $60 for a longer consultation." | ||
* Dr. Gerda Pohl at at [http://ciwec-clinic.com/ CIWEC Clinic]: This doctor and clinic was recommended by a Kathmandu local. | * Dr. Gerda Pohl at at [http://ciwec-clinic.com/ CIWEC Clinic]: This doctor and clinic was recommended by a Kathmandu local. | ||
* Dr. Abha Shaky Shrestha at [http://www.grandehospital.com/ Grande International Hospital]: This doctor and clinic was recommended by a Kathmandu local. She says, "My ob/gyn at Grande Hospital is impressive as well, Dr. Abha Shaky Shrestha. My husband is Nepali so I get the Nepali price, it's under $4.50 for a visit, $10 for an ultrasound. Grande International Hospital is #1 in Nepal and I'm an American confident delivering there." Address: Tokha Rd, Kathmandu 44600, Nepal. Hours: Open 24 hours. Phone: +977 1-5159266. | * Dr. Abha Shaky Shrestha at [http://www.grandehospital.com/ Grande International Hospital]: This doctor and clinic was recommended by a Kathmandu local. She says, "My ob/gyn at Grande Hospital is impressive as well, Dr. Abha Shaky Shrestha. My husband is Nepali so I get the Nepali price, it's under $4.50 for a visit, $10 for an ultrasound. Grande International Hospital is #1 in Nepal and I'm an American confident delivering there." Address: Tokha Rd, Kathmandu 44600, Nepal. Hours: Open 24 hours. Phone: +977 1-5159266. | ||
* Furthermore, gynecologists are available in nearly all hospitals | * [http://www.vayodhahospitals.com/ Dr. Meera Hada at Vayodhaya Hospital]: She is a Sr. Obstetrician & Gynecologist and has been recommended by a Kathmandu local, who calls her "excellent." Hospital Address: Kirtipur 44600, Nepal. Hours: Open 24 hours. Phone: +977 1-4286427 ext. 4286428 | ||
* Furthermore, gynecologists are available in nearly all hospitals. The hospitals which are near to Tribhuwan International Airport are: 1) Om Hospital and Research centre pvt. ltd. chahabil,kathmandu, 2) Kathmandu medical College Teaching Hospital, Sinamangal,kathmandu 3) Medicare Hospital,chahabil | |||
===Costs=== | ===Costs=== | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
Check out the "Gynecological Exams" (previous section) for ob/gyn recommendations in Kathmandu. | |||
===Costs=== | ===Costs=== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
Since March 2002, abortion has been legal in Nepal under the 11th Amendment to the Civil Code.<ref>[https://www.womenonwaves.org/en/page/4886/nepal--abortion-law Nepal: Abortion law]</ref> According to the law, abortion is legally available upon request during the | Since March 2002, abortion has been legal in Nepal under the 11th Amendment to the Civil Code.<ref>[https://www.womenonwaves.org/en/page/4886/nepal--abortion-law Nepal: Abortion law]</ref> According to the law, abortion is legally available upon request during the first 12 weeks of gestation. This means that, for all women, they can obtain an abortion for nearly all reasons during this period. Furthermore, younger women should not be turned away or discriminated against because of their age.<ref>[http://asap-asia.org/blog/10-things-you-should-know-about-abortion-service-in-nepal/#sthash.N4ez5hnq.dpbs 10 Things To Know about Abortion Services in Nepal]</ref> However, it is illegal to request an abortion due to the sex of the child.<ref>[https://www.womenonwaves.org/en/page/4887/nepal--organizations-and-clinincs Women on Waves - Nepal: Organizations and clinics]</ref> After 18 weeks of gestation, abortion is only legal if the pregnancy was caused by rape or incest. It should be noted that, if any time in the pregnancy, a physician believes that an abortion is advisable, or if the pregnant woman's physical or mental health is at stake, or if there is serious risk of fetal malformation, an abortion can also be legally permitted.<ref>[http://asap-asia.org/blog/10-things-you-should-know-about-abortion-service-in-nepal/#sthash.N4ez5hnq.dpbs 10 Things To Know about Abortion Services in Nepal]</ref> | ||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
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'''Useful Contacts/Resources:''' | '''Useful Contacts/Resources:''' | ||
* [http://www.mariestopes.org.np/en/what-we-do/safe-abortion Marie Stopes Nepal]: This is an international health organization with clinics around the globe, specializing in sexual and reproductive health care. They | * [http://www.mariestopes.org.np/en/what-we-do/safe-abortion Marie Stopes Nepal]: This is an international health organization with clinics around the globe, specializing in sexual and reproductive health care. They provide abortion services in Nepal. Click [http://www.mariestopes.org.np/en/faq/women/safe-abortion/abortion-fees here] to learn more about their packages and fees. For more information, you can call them on their Meri Saathi Free Helpline:16600119756 OR 9801119756(NCELL). Address: GPO Box No. 11254, Char Khal Adda, Dillibazar, Kathmandu | ||
* [http://asap-asia.org/ Asia Safe Abortion Partnership]: This is an organization that focuses on safe abortion access for women in Asia. They do work across the continent, including in Nepal, and they also have a fact sheet on their website about Nepalese abortion policy and history. You can potentially also contact them to get referrals of local health care providers. | * [http://asap-asia.org/ Asia Safe Abortion Partnership]: This is an organization that focuses on safe abortion access for women in Asia. They do work across the continent, including in Nepal, and they also have a fact sheet on their website about Nepalese abortion policy and history. You can potentially also contact them to get referrals of local health care providers. | ||
* [http://www.fpan.org/ Family Planning Association of Nepal]: This is the official family planning organization in Nepal, which is associated with the government. They may be a good resource to learn about abortion policy, what's available, your rights, etc. | * [http://www.fpan.org/ Family Planning Association of Nepal]: This is the official family planning organization in Nepal, which is associated with the government. They may be a good resource to learn about abortion policy, what's available, your rights, etc. | ||