Ensuring women’s health is challenging issue -Nepal Earthquake

The earthquake on 25^th April 2015 in Nepal has killed more than 8,800 people and injured more than 23,000. More than 4, 50,000 people were displaced & leaving many homeless with more than 5, 00,000 houses including entire villages flattened in many earthquake-affected areas in the country. The earthquake has triggered intense physical, economical, socio-cultural, impact on different sectors including the tourism sectors in more than twenty districts.

In Nepal existing patriarchal society is major risk factors for higher morbidity & mortality rate of women .In addition to above fact, the earthquake has triggered intense women’s & girls health damage which is further aggravated by poor women empowerment in terms of poor literacy rate, lack of accessibility & affordability to health services, gender based violence, restriction of social participation and lack of decision making role. The deleterious health effects on women are further described under specific areas below:

A.     Physical Health: The rate of functional impairment, injuries, permanent disability & deaths has increased. According to data published by Nepal Police, 55% of the causality were women & children.

B.     Mental & psychological Health:  The burden of psychological stress & trauma, loss of self esteem, anxiety and threat in people has tremendously increased. There may be increasing risk taking behavior including post traumatic stress disorder (PTSD).The situation is even more critical for girls and women. The possible reasons are loss of family members including husband &children and loss of physical properties due to poverty.

C.     Maternal Health: Maternal and child health issues including nutritional demand, antenatal care services, delivery care and postnatal care for women are emerging problems.  In Nepal 75% of population affected are either women or children, and similarly 25% of the population at risk are women of reproductive age, of them 20% likely to pregnant.  Decreased access to obstetric care increases risk of maternal & neonatal death. Others possible causes responsible for poor maternal health are poor communication & transportation, inadequate trained health-workers, health infrastructural damage and disintegrated community & family life.

D.     Reproductive & sexual health: The UNFPA estimated that approximately 50,000 pregnant women were affected from earthquake.  Lack of family planning devices at temporary shelters has triggered increasing risk of unwanted pregnancy & unsafe abortion. Other possible consequences are uterine prolapse, fistula, chronic infections, pregnancy complications, pelvic inflammatory diseases etc. Some newspapers have reported that there has increased using rate of emergency contraception in order to prevent from possibility of having abnormal birth outcome. There may be possibility of increasing sexual abuse on women & girls at temporary shelter due to mix population, loss of guardian & unsafe shelter etc. There may be also possibility of occurring sexual abuse, harassment, rape, unsafe sexual relations etc. and consequences may be transmission of HIV & sexual transmitted diseases (STI) at higher rate.

E.      Unhealthy behavior: This includes smoking, alcohol & drug use, sexual risk taking, physical inactivity, overeating etc.

F.      Social health:  This includes homeless, disintegrate from community etc.

G.     Others: There may be possibility of increasing rate of femicide, suicide, girl trafficking of girls & women, domestic violence etc.

What should we do to ensure women’s health?

- Preparedness for reproductive health in crisis in terms of technical support, advocacy, collaboration, coordination etc.

-Gather information (basic demographic info, RH, morbidity and mortality, available services, socio-cultural issues related to RH)

-Identify resource needs and order essential supplies (condoms, post-rape & obstetric emergencies, clean delivery kits)

-Recruit and train staff

-Plan for camp set-up (coordination among organizations, gender concerns site and layout concerns

Minimize risk of gender-based violence)

What tools we have?

•       Minimum Initial Service Package (MISP) (set of activities)

•       Inter-agency Field Manual

•       RH Kit for Emergency Situations (UNFPA)

What is beneficences of Minimum Initial Service Package (MISP) ?

•       Prevent and manage the consequences of sexual violence

•       Reduce HIV and STI transmission

•       Prevent neonatal and maternal morbidity and mortality

•       Plan for integrating comprehensive RH Services in Primary health care as soon as possible (Resume services)

Prevent and manage the consequences of sexual violence
-   Plan camp design, & food & other distributions
-   Medical response (trauma care, emergency
     contraception, pregnancy test, STI treatment, HIV)
 -  Awareness raising in the community
-  Referral to legal, social and other services
-  Ensure confidentiality

•       Reduce HIV transmission

-Universal precautions (safe handling of sharps,

Cleaning disinfecting and sterilization, gloves &

–      Protective clothing…)

–      Free condoms

–      Safe blood transfusions

•       Prevent neonatal and maternal morbidity and mortality

–      Clean home deliveries [ Shelter homes]

–      Clean and safe deliveries at health facility

–      Referral for obstetric emergencies

Plan for comprehensive RH services, integrated into PHC, as soon as possible

•       Assess needs and resources (staff, sites, equipment)

•       Design program & seek funds

•       Order supplies

•               Train staff

•       Block 1. Kits serving the needs of 10 000 people for 3 months  

•       Kit 0: Administration/training supplies

•       Kit 1: Condoms

•       Kit 2: Clean delivery, individual

•       Kit 3: Post rape treatment

•       Kit 4: Oral and injectable contraception

•       Kit 5: Treatment of sexually transmitted infections

•       Block 2. Kits serving the needs of 30 000 people for 3 months

•       Kit 6: Clinical delivery assistance

•       Kit 7: Intrauterine device

•       Kit 8: Management of miscarriage and complications of abortion

•       Kit 9: Suture of tears (cervical and vaginal) and vaginal examination

•       Kit 10: Vacuum extraction delivery

•       Block 3. Kits serving the needs of 150 000 people for 3 months

•       Kit 11: Referral level kit for reproductive health 32

•       Kit 12: Blood transfusion

http://www.ekantipur.com/2015/05/19/top-story/earthquake-55-pc-of-dead-are-women-children/405428.html

http://www.ekantipur.com/2015/04/29/national/around-50000-pregnant-women-affected-from-earthquake-unfpa/404628.html (accessed WRITE DATE)

http://www.ekantipur.com/the-kathmandu-post/2015/05/10/news/quake-hit-susceptible-to-diseases/276124.html

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960963-1/fulltext#.VYMM8jrywhU.facebook