A qualitative study on gender inequality and gender-based violence in Nepal.

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.

Does Forum Theater Help Reduce Gender Inequalities and Violence? Findings From Nepal.

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.

Awareness on Social Health Insurance Scheme among Locals in Bhaktapur Municipality.

BACKGROUND: Illnesses impose a huge economic burden on individuals and families. Costly health care also discourages people from using health services thereby generating prolonged or worsened health problems. The recently endorsed National Health Insurance Policy forecasts the integration of all social health protection schemes thereby ultimately achieving universal coverage. The aim of this study was to find out the awareness of health insurance and evaluate source of information about health insurance. METHODS: A cross sectional study was conducted on 385 participants from 5 randomly selected wards of Bhaktapur Municipality on July 2019. Households with health insurance were selected. The interview was taken either from the head of the family or the family member who takes financial decisions in the house. Face to face interview was taken in local language (Newari). Good and poor categories on awareness were developed. Descriptive statistics was applied. RESULTS: Good awareness of social health Insurance scheme was found among 335(87.2%) participants. 99% of the participants showed the importance of social health insurance. The main source of information was insurance agents (47.3%) and female community health volunteers (28.6%). Regarding benefits of opting health insurance, 66.5 % of the participants stated that it would reduce out-of-pocket expenditure. 65.5% opined that it would help in case of emergency medical situations. About 91.9% of respondents wanted to renew their health insurance in future also. CONCLUSIONS: Awareness regarding health insurance was found good, which shows the positive acceptance of social health Insurance scheme by community. Insurance agent and hemale community health volunteers (FCHV) seemed to have played an important role in dissemination of information.

Health Co-morbidities and Early Marriage in Women of a Rural Area of Nepal: A Descriptive Cross-Sectional Study.

INTRODUCTION: Early marriage is defined as the marriage of a young person less than 18 years. Early marriage is more prevalent in South Asia as more than half of all child marriage occurs here. Thirtyseven percent of girls in Nepal marry before age 18 years. This study was done to find out the health consequences of early marriage in women of a rural area of Nepal. METHODS: A descriptive cross-sectional study was conducted from 10th to 15th Feb 2020 February in 358 women from Panauti, Kavrepalchowk. The convenient sampling method was used. Ethical approval was taken from the Institutional Review Committee. Economic status was assessed by using Kuppuswamy’s socioeconomic scale. The collected data were analyzed using the Statistical Package for Social Science version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of early marriage was 187 (52.2%) (47.03 to 57.37 at 95% confidence interval). One hundred sixteen (62%) early marriage women had gynecological problems followed by depression problem 85 (45.5%) and miscarriage 32 (17.1%). The mean age of marriage was 17.2 years. The majority, i.e. 167 (89.3%) of respondents who married earlier were Hindu by religion. Early marriage was observed in 104 (55.6 %) of illiterate women. CONCLUSIONS: The prevalence of early marriage was high. Early married women had a lower level of socio-economic status, lower level of education, which harmed the participants' health status.

Agenda setting and framing of gender-based violence in Nepal: how it became a health issue.

Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Women's groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the country's new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.