“When I was about to give birth, we called for an ambulance or a vehicle to help but even after five hours of calling, no vehicle arrived,” recalls 32-year-old Mona Shrestha. “The birth was difficult. For five hours I had to suffer from delivery complications.” Mona’s story is a familiar one for women in rural Nepal. Like thousands of women across the country, she lives in a small, remote village, at the end of a winding, potholed road. There are no permanent medical facilities or staff based in the village of Bakultar: medical camps occasionally arrive to dispense services, but they are few and far between. Life here is tough. The main livelihood is farming: both men and women toil in the fields during the day, and in the mornings and evenings, women take care of their children and carry out household chores. The nearest birthing centre is an hour’s drive away. Few families can afford to rent a seat in a car, and so are forced to do the journey on foot. For pregnant women walking in the searing heat, this journey can be arduous, even life-threatening. “Fifteen years ago, there was a woman who helped women give birth here, but she’s no longer here,” Mona says. “It’s difficult for women.” Giving birth without medical help can cause severe problems for women and babies, and even death. Infant mortality remains a major problem in Nepal, and maternal mortality is one of the leading causes of death among women. Only 36% of births are attended by a doctor, nurse or midwife.  A traumatic birth can cause long-term physical, psychological, social and economic problems from which women might never recover. Access to contraception and other family planning services, too, involves walking miles to the nearest health clinic. Mona says she used to use the contraceptive injection, but now uses an intrauterine device. Like many villages in Nepal, Bakultar is awash with myths and gossip about the side-effects of contraception. “There are so many side effects to these devices – I’ve heard the coil can cause cancer,” Mona says. “This is why we want to have permanent family planning like sterilisation, for both men and women.” These complaints heard frequently in villages like Bakultar. As well as access to facilities and contraception, people here desperately need access to education on contraception and sexual health and reproductive rights. Misinformation as well as a lack of information are both major problems. “It would be really helpful to have family planning services nearby,” says Mona.

 “People used to shout at me when I was distributing condoms. ‘You’re not a good girl,  you’re not of good character’ they’d say. They called me many bad things.”  “But later on, after getting married, whenever I visited those families they came and said:  ‘you did a really good job. We realise that now and feel sorry for what we said before.”  Rita Chawal is recalling her time as a volunteer for the Family Planning Association of  Nepal (FPAN), Nepal’s largest family planning organisation. Her experiences point to the crucial importance of family planning education and support in Nepal, a country still affected by severe maternal and infant mortality rates and poor access to contraception.  Poor government services, remote communities, a failing transport network and strict patriarchal structures can make access to family planning and health services a  challenge for many people across the country. Services like FPAN’s are vital to reach as many people as possible. Rita is now 32 years old and herself a client of FPAN. She lives with her husband and six-year-old son in Bhaktapur, an ancient temple city, 15 kilometres from the centre of Kathmandu. Before getting married, she spent 10 years working as a family planning youth volunteer for FPAN, running classes on sexual health, safe abortion and contraception. Her time at the organisation set her in good stead for married life: after marrying she approached FPAN right away to get family planning support, antenatal classes, and, later on, contraception. “I had all this knowledge, so I decided to come and take the services,” she says. “I found that the services here were very good.” But Rita is far from the norm. She shudders when she recalls the abuse she received from neighbours and her community when she worked distributing contraception. Stigma still surrounds contraception in many places: for an unmarried young woman like Rita to be distributing condoms was seen as immoral by many, particularly older, people, even in an urban setting like Bhaktapur. Stigma can be even more extreme in rural areas. Across Nepal, rumours about the side effects of different contraceptive devices are also a problem. Attitudes are slowly changing. Rita says people now come to her whenever they have a family planning problem. “I have become a role model for the community,” she says. She herself is now using the contraceptive implant, a decision she arrived at after discussing different options with FPAN volunteers. She has tried different methods. After her son’s birth, she began using the contraceptive injection. “After the injection, I shifted to oral pills for six months, but that didn’t suit me,” she says. “It gave me a headache and made me feel dizzy. So I had a consultation with FPAN and they advised me to use the implant. I use it now and feel really good and safe. It’s been five years now.” This kind of advice and support can transform the lives of entire families in Nepal. Reductions in maternal and infant mortality, sexual health, female empowerment and dignity, and access to safe abortion are just a few of the life-changing benefits that organisations like FPAN can bring.