Nepal

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)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Nepal, you can purchase oral contraception (birth control pills) without a prescription. 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. 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. 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%).

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. 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. 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.

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 Dzire Dotted Condom and Dhaal Deluxe Condoms, which are produced by Nepal CRS Company. If you go to 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 Mero Shopping, which sells brands like Ocean Premium, Kohinoor Moods, or 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. You can also find 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 contraceptive implants, including brands like Norplant and Jadelle, at government hospitals and health care organizations. For Nepalese women, it's often totally free.. At private doctor's clinics, Jadelle typically retails for the price of Rs. 350, according to Nepal CRS Company.
• 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 here.

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 purchase Dhaal Deluxe Condoms for about Rs. 5, as of 2017. For a box of Dzire Dotted Condoms, you can expect to pay Rs. 35 at Nepalese stores, as of 2017. 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).
• 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)

One brand of the morning after pill in Nepal

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex to prevent pregnancy. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Nepal, you can purchase emergency contraception (the morning after pill) from pharmacists without a prescription. However, the overall knowledge of emergency contraception in the country remains relatively low. In 2011, it was found that 28.8% of women of reproductive age had knowledge of emergency contraception.

What to Get & Where to Get It

• You can find emergency contraception (the morning after pill) at pharmacies, IPPF-affiliated system and social marketing programs (eg PSI, DKT, MSI and PSIA). Some of the brands you can expect to see are Contragest, E-72, e-Con, Feminor, i-pill, Max-72, Pregnon and Unwanted 72.
• If you can't access dedicated emergency contraception in Nepal, you have other options. You can use regular birth control pills as replacement EC. To do this, you can take Duoloton L or Ovral. For these brands, you take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later. Alternatively, you can also take Lo-Femenal or Nordette. For these brands, you take take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later. Finally, you can also have an IUD inserted, which can help prevent pregnancy after unprotected sex.

Costs

In some Nepalese pharmacies, you can expect to pay around Rs. 80 for a single pack of i-pill or E-Con. Generally speaking, you can expect to pay between Rs. 70-160 for a single pack of emergency contraception.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

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. In Nepal, it is estimated that 0.2% of the population is infected with HIV, as of 2015. According to a 2015 UN Report, the majority of new HIV infections (85%) are sexually-transmitted. 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 here.

Testing Facilities

Nonprofit Options

• 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
• 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

For recommendations of specific clinics and hospitals, visit the city pages, like the Kathmandu page.

Support

• National Centre for AIDS and STD Control: Check out the website to learn about the ART sites and viral loading testing services in Nepal.
• UNAIDS Nepal: Contact person - Rubel del Prado, UNAIDS Country Director. Email: DELPRADOR@UNAIDS.ORG
• 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

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

What to Get & Where to Get It

• 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 CIWEC Clinic, along with other health care facilities.
• There is currently no Pre-exposure prophylaxis, or PrEP available in Nepal, as of September 2017.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

• You can find pads in numerous markets in Nepal. They are more commonly used than tampons, menstrual cups or other menstrual products.
• You can find tampons in certain stores, especially those that target foreigners, in larger Nepalese cities, like Kathmandu. However, they are less commonly used than pads, and the selection of available tampon brands available is rather limited.
• While menstrual cups are not commonly sold in Nepal, there are some interesting initiatives and organizations working on the issue, which we list below:
  • Putali Nepal: This organization is focused on starting a conversation about menstrual hygiene in Nepal as well as providing RubyCups to women in Nepal. Here's more information rom the organization (September 2017): "We sell and work with the brand Ruby Cup. You can purchase it in Kar.ma Coffee, a café in Jhamsikhel, Patan, which is involved in social projects working with local producers of coffee and supporting other projects like Dharti Mata, producer of reusable sanitary pads." "We sell the normal size, which is suitable for everyone. In case of a special request of e.g. young girls we have a few samples of the small size available. It comes in the colors pink and blue and costs Nrs. 2200." "Besides making Ruby Cup available for individuals our main focus lies on the education about menstrual hygiene management and Ruby Cup, since menstrual cups are a new method for periods in Nepal. We give trainings to staff members of organisations working in the field of reproductive health or women empowerment and groups of women of all ages. In our 2-3 hours sessions our Nepali trainers Saniya and Shristi teach them about the usage of Ruby Cup (insertion, removal, cleaning, storing) and create a platform for every single participant to speak about personal experiences. For many of them this moment is the first time they speak about the topic of menstruation. Besides we give a short review of what periods are and give tips for maintaining menstrual hygiene in the Nepali cultural context. Another tool to train younger girls and boys is the Menstupedia Comic book. We sell it to organisations which use it for their work in schools and communities in whole Nepal. We ourselves give trainings in schools in Kathmandu Valley with this resource. "
  • DivaCups for Nepal: This is a GoFundMe campaign from a female traveler who wanted to bring DivaCups to Nepal.

Gynecological Exams

What to Get & Where to Get It

Check out the city pages, like the Kathmandu page, for some local recommendations.

Pregnancy

Laws & Social Stigmas

In Nepal, women are given paid maternity leave. However, Nepalese maternity leave policy does not yet meet international standards, which calls for a minimum of at least 12 weeks off. The current policy allows government civil servants to receive 60 days of paid maternity leave and 15 days of paid paternity leave. For all other workers, Labour Rules 2050 allows for 52 days of paid maternity leave. This means that women are legally guaranteed 52-60 days of paid maternity leave, which is among the lowest in South Asia.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Since March 2002, abortion has been legal in Nepal under the 11th Amendment to the Civil Code. 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. However, it is illegal to request an abortion due to the sex of the child. 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.

What to Get & Where to Get It

• In Nepal, there are two main forms of abortion procedures: MVA-manual vacuum aspiration (also known as "surgical abortion") and MA, medical abortion (also known as "the abortion pill"). We'll discuss both options below:
  • Manual-Vacuum Aspiration (also known as "MVA" or "surgical abortion") - This is a procedure that's available in Nepal. For more information on how it works, click here.
  • Medical Abortion (also known as "MA" or "the abortion pill") - This is when you use a combination of pills to induce abortion. In Nepal, it is performed within the first 9 weeks of gestation. In Nepal, you can find this combination of pills (Misoprostol and Mifepristone), but they may be under different brand names. Typically, Misoprostol goes under the brand names Isovent, Misoprost, and Zitotec in Nepal.
• You can find abortion services in all 75 districts of Nepal, including in mountainous and remote areas (in addition to Kathmandu and urban centers). The government of Nepal certifies the health facilities that perform abortions, and they also certify the trained health care providers.

Useful Contacts/Resources:

• 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 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
• 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.
• 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.

Costs

The cost of an abortion in Nepal will vary, largely depending on whether you seek out public or private health care services. If you visit a public Nepali hospital, the fee should be around Rs. 1000 (as of 2015). However, we're not sure if this fee only applies to Nepali nationals, or if it apples to all people who seek out care in public facilities. We're still trying to gather information on average costs for an abortion at a private clinic or hospital in Nepal.

Advocacy & Counseling

What to Get & Where to Get It

• TUTH Suicide Hotline: 9840021600
• Transcultural Psychosocial Organization-Nepal Crisis Hotline: 1660 0102005
• Mental Health Helpline Nepal: 1660 0133666
• Women’s Helpline, Nepal: 977-1-4492904

List of Additional Resources

• Nepal Society Of Obstetricians and Gynaecologists (NESOG)
• Family Planning Association of Nepal (FPAN): "Key areas of emphasis include adolescents' sexual and reproductive health, HIV and AIDS prevention and treatment, safe abortion, advocacy for sexual and reproductive health and rights (SRHR), the prevention of gender-based violence (GBV) and support for its victims, and the promotion of access to sexual and reproductive health (SRH) information and services to marginalized and under-served groups."
• Marie Stopes Nepal: They provide contraception, sexual health services, abortion services to women, men, and youth. Phone: +977 01660 011 9756 (free on NTC network) / 0980 111 9756 (free on Ncell network)
• Click here to learn about LGBTQ rights in Nepal.
• Women's Skills Development Association: "We are a Fair Trade Organization which has been working since 1975 as a non-profit and income-generating program for economically disadvantaged, disabled, abused, single and outcast women from rural Nepal, supporting them to be self-supportive and independent." Address: Women's Skills Development Organization: Chautara Marg, Simalchour 8, Pokhara, Nepal. Phone: +977 61 534 025 or 980 282 1686
• WomenLEAD Nepal: "Our Mission: To provide young women in Nepal with the skills, support and opportunities to become leaders and change-makers in their schools, communities, nation and world." Address: GPO 8975, EPC 2234, Kathmandu, Nepal. Email: info@women-lead.org. Call us: (+977) 01.6923979 / 9818.553.355.
• Feminist Dalit Organization (FEDO) Nepal: "FEDO is a national level Non-Governmental Organization (NGO) founded in 1994 to establish the rights of Dalit women by organizing and empowering them for their mainstreaming into national development." Address: Feminist Dalit Organization (FEDO), Kupondol, Lalitpur, Nepal., G.P.O. Box No.: 4366, Ktm. Tel: +977-01-5520982,5543986. Fax: +977-01-5520982. Email: dms@fedo.wlink.com.np
• The Women's Foundation Nepal: "The mission of The Women’s Foundation Nepal (WFN) is to work towards a violence-free society by helping women and children in Nepal who are victims of violence, abuse and poverty." Address: The Women’s Foundation Nepal, Boudha, Kathmandu. Phone: +977 1 5155160 or +977 1 5155080. E-Mail: womens_foundation@hotmail.com, office@womenepal.org
• WomanKind Nepal: "Womankind Worldwide is a global women’s rights organisation working in solidarity and equal partnership with women’s rights organisations and movements to transform the lives of women."
• Ruwon Nepal: "Feminist social organization working for the rights & social justice of rural women, youth & children in Nepal." Address: G. P. O. Box: 20706, Kapan, Kathmandu, Nepal. Phone: +977 1 4810098. Email: info@ruwonnepal.org.np
• Tewa: "Tewa’s philosophy is to develop modern philanthropy, both in terms of minimizing social costs incurred in rapid transition, for self-reliant development that is not donor dependent, and for the empowerment of emerging groups of rural women in Nepal. With this philosophy in mind Tewa does local fund-raising, gives grants to women’s groups from all over Nepal, and strengthens the human resources of Nepal through various programmes." Location: Dhapakhel, Lalitpur. Telephone: +977 1 5229054 / 5229045. Fax: +977 1 5229059. Email: info@tewa.org.np. Mailing Address: P.O. Box: 11, Lalitpur