Tagged / Nepal

Why suicide rates among pregnant women in Nepal are rising

File 20180308 30989 ov7dje.jpg?ixlib=rb 1.1

Shutterstock/By KristinaSophie

By Bibha Simkhada, Liverpool John Moores University and Edwin van Teijlingen, Bournemouth University

Huge numbers of pregnant women and new mothers are taking their own lives in Nepal as they deal with extreme poverty, natural disasters, domestic violence and oppression. Research shows suicide represents 16% of all deaths in women of reproductive age. The rate is higher than previously recorded and there has been a considerable increase over the past few years. But a new project which trained midwives about mental health issues might hold the key to turning this around.

Suicide is primarily associated with unwanted pregnancy or the feeling of being trapped in poverty or situations of sexual and physical abuse. A study of 202 pregnant women (carried out between September and December 2014) found that 91% of them experienced some kind of physical, emotional or sexual abuse – mostly at the hands of their husbands and/or mother-in-laws.

The sad fact is that almost 40% of suicides in the world occur in South-East Asia. And one in three pregnant woman and new mothers are taking their own lives in low-income countries. In Nepal, 21% of the suicides among women aged 15-49 were in girls under 18 due to violence and being powerless in their families and communities.

Pregnancy is a known trigger for mental health problems. But gender discrimination and domestic violence are making matters worse. In addition to these issues, natural disasters are also a huge contributing factor to the spiralling mental health problems of young mothers.

A woman on a collapsed building in Kathmandu after the earthquake in May, 2015. Shutterstock/Somjin Klong-ugkara

Lack of control

In Nepal, making decisions about seeking maternity care is not in the hands of the pregnant woman but usually lies with her mother-in-law or husband. When young women marry they move in with their husbands’ family and their lives are ruled by their in-laws. These women often have little say in seeking health care during pregnancy, childbirth and the postnatal period.

In many poor families, husbands migrate for work leaving their young wives with family. Nepal has a real migrant workers economy with close to 50% of Nepalis relying on financial help from relatives abroad. Mental health problems can worsen for women who have been taken away from their own families. In other cases, young women face domestic violence due to their husbands’ drinking leading to mental health issues and suicide.

There is also a lack of understanding of pregnancy and childbirth-related mental health issues and husbands and mothers-in-law often fail to support these vulnerable young women. They in turn are reluctant to seek help due to the stigma associated with mental illness.

Cultural and social norms

Cultural practices and social norms, like gender inequalities and early marriage, hinder women who have a lack of choice when it comes to their role as mothers. There is also a preference for sons rather than daughters, who are seen as an “economic burden” in many families. If a woman is expecting a daughter, especially for the second or third time, this can also trigger mental health issues.

Depression and anxiety are common and affect ten to 15 out of every 100 pregnant women in the country. Postnatal depression is often reported, but less attention is given to more common and less obvious mental health issues.

Natural disasters and midwives

Recurrent earthquakes and floods exacerbate issues of depression and helplessness as women are forced to live in temporary shelters and have the burden of increased poverty.

For many rural Nepali women, the most qualified birth attendant they can expect to look after them is the Nepali Auxiliary Nurse Midwives (ANMs). But a study found that they received little or no formal training on perinatal mental health issues. Although there have been gradual improvements in health care for women during pregnancy, mental health support is leaving many women feeling that suicide is their only option.

As part of a Tropical Health and Education Trust project, funded by DFID, around 80 ANMs were trained on perinatal mental health issues. The project used UK-based volunteers in Nepal over two years.

The training helped raise awareness of mental health well-being and improved access to mental health care for pregnant women and new mothers. This is a vital first step towards improving community-based services for pregnant women in rural Nepal. But to offer hope to more young women there needs to be a significant increase in this type of training and awareness raising.

Bibha Simkhada, Postdoctoral Researcher in School of Nursing and Allied Health, Liverpool John Moores University and Edwin van Teijlingen, Professor of Reproductive Health Research, Bournemouth University

This article was originally published on The Conversation. Read the original article.

Latest editorial on Nepal by Dr. Regmi in FHSS

Last week the Journal of Manmoham Memorial Institute of Health Sciences based in Nepal published as its editorial ‘What can we learn from the Nepal Health Facility Survey 2015. [1]  The Nepal Health Facility Survey 2015 is a first of its kind.  It is a much needed start to help analyse and improve the workings of the country’s health system.  This is very important and timely as one of the targets of the Sustainable Development Goals (SDG) is to reduce premature mortality by one-third from non-communicable diseases.  Success in this effort will depend on the concerted efforts on health facilities (for both health promotion, prevention and management) for an early and optimal care. The editorial also raises some of the ethical and methodological issues associated with the first ever Nepal Health Facility Survey 2015.  The lead author of the editorial is Dr. Pramod Regmi and our co-authors include Prof. Padam Simkhada (Visiting Faculty in the Faculty of Health & Social Sciences).  The Journal of Manmoham Memorial Institute of Health Sciences is an Open Access journal hence freely available to scholars and politicians and health managers across the globe, including those based in low-income countries such as Nepal.

 

Reference:

  1. Regmi, P., van Teijlingen, E., Simkhada, P, Kurmi, O, Pant, P. (2017) What can we learn from the Nepal Health Facility Survey 2015? Journal of Manmohan Memorial Institute of Health Sciences (JMMIHS) 3(1): 1-5

 

Systematic Review birthing centres by CMMPH PhD student Preeti Mahato

BU PhD student Mrs Preeti Mahato published her latest scientific paper ‘Determinants of quality of care and access to Basic Emergency Obstetric and Neonatal Care facilities and midwife-led facilities in low and middle-income countries: A Systematic Review’ in the Journal of Asian Midwives [1].  This paper is co-authored by Dr. Catherine Angell and Prof. Edwin van Teijlingen, who are both based in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) and Prof. Padam Simkhada, BU Visiting Professor and based at Liverpool John Moores University (LJMU).  Journal of Asian Midwives is a free Open Access journal, freely available for anybody across the globe to read online.

The authors highlight that maternal mortality is a major challenge to health systems in Low and Middle-Income Countries (LMICs) where almost 99% of maternal deaths occurred in 2015. Primary-care facilities providing Basic Emergency Obstetric and Neonatal Care (BEmONC) facilities, and facilities that are midwife-led are appropriate for normal birth in LMICs and have been proposed as the best approach to reduce maternal deaths. However, the poor quality of maternal services that leads to decreased utilisation of these facilities is among the major causes of maternal deaths worldwide. This systematic review studied factors affecting the quality of care in BEmONC and midwife-led facilities in LMICs.

Thematic analysis on included studies revealed various factors affecting quality of care including facility-level determinants and other determinants influencing access to care. Facility-level determinants included these barriers: lack of equipment and drugs at the facility, lack of trained staff, poor attitudes and behaviour of service providers, and poor communication with women. Facility-level positive determinants were: satisfaction with services, emotional support during delivery and trust in health providers. The access-to-care determinants were: socio-economic factors, physical access to the facility, maintaining privacy and confidentiality, and cultural values.  The authors include that improving quality of care of birthing facilities requires addressing both facility level and non-facility level determinants in order to increase utilization of the services available at the BEmONC and midwife-led facilities in LMICs.

This is the fifth paper co-authored by CMMPH’s current most published PhD student.  The evaluation of birth centres in rural Nepal by Preeti Mahato under joint supervision Dr. Angell and Prof. Simkhada (LJMU) and Prof. van Teijlingen.

References:

  1. Mahato, P., van Teijlingen, E., Simkhada, P., Angell, C. (2017) Determinants of quality of care & access to Basic Emergency Obstetric & Neonatal Care facilities & midwife-led facilities in low & middle-income countries: A Systematic Review, Journal of Asian Midwives 4(2):25-51.
  2. Mahato, P., van Teijlingen, E., Simkhada, P., Angell, C. (2016) Birthing centres in Nepal: Recent developments, obstacles and opportunities, Journal of Asian Midwives 3(1): 18-30. http://ecommons.aku.edu/cgi/viewcontent.cgi?article=1033&context=jam
  3. Mahato, P., van Teijlingen, E., Simkhada, P., Sheppard, Z., Silwal, R.C. (2017) Factors related to choice of place of birth in a district in Nepal. Sexual & Reproductive Healthcare 13: 91-96.
  4. Mahato, P.K., Regmi, P.R., van Teijlingen, E., Simkhada, P., Angell, C., Sathian, B. (2015) Birthing centre infrastructure in Nepal post 2015 earthquake. Nepal Journal of Epidemiology 5(4): 518-519. http://www.nepjol.info/index.php/NJE/article/view/14260/11579
  5. Regmi, P., van Teijlingen, E., Hundley, V., Simkhada, P., Sharma, S., Mahato, P. (2016) Sustainable Development Goals: relevance to maternal & child health in Nepal. Health Prospect 15(1):9-10. www.healthprospect.org/archives/15/1/3.pdf

Two papers on health & migration in Nepal

This last week two separate papers have been accepted on aspects of health and well-being among migrants workers from Nepal.  The first in the International Journal of Migration, Health and Social Care is based on a completed PhD project in the Faculty of Health & Social Sciences with Dr. Pratik Adhikary as first author [1].  This paper ‘Health and well-being of Nepalese migrant workers abroad’ is co-authored by two former FHSS staff Dr. Zoe Sheppard and Dr. Steve Keen, and Prof. Edwin van Teijlingen of the Centre for Midwifery, Maternal & Perinatal Health (CMMPH).

 

The second paper ‘A study of Health Problems of Nepalese Female Migrants Workers in the Middle-East and Malaysia’ was accepted by the Open Access journal BMC International Health & Human Rights [2].  The lead author of this paper is Bournemouth University (BU) Visiting Faculty Prof. Padam Simkhada (based at Liverpool John Moores University) and two of his co-authors are based in Nepal: Manju Gurung (chair of Pourakhi Nepal) and Dr. Sharada Prasad Wasti and one at BU: Prof. Edwin van Teijlingen .

There is  a growing momentum in migration research at BU with further academic papers being published related to studies on migrant workers from Nepal [4-8], relatives of migrant workers [9], migration into the UK [10-12], Eastern European migration issues [13-15], migration and tourism [16], migration and the media [17] as well as migration in the past [18].

 

References:

  1. Adhikary P, Sheppard, Z., Keen S., van Teijlingen E. (2018) Health and well-being of Nepalese migrant workers abroad, International Journal of Migration, Health and Social Care (accepted). https://doi.org/10.1108/IJMHSC-12-2015-0052
  2. Simkhada, P.P., van Teijlingen, E.R., Gurung, M., Wasti, S. (2018) A study of Health Problems of Nepalese Female Migrants Workers in the Middle-East and Malaysia, BMC International Health & Human Rights (accepted Jan.).
  3. Adhikary, P., Simkhada, P.P., van Teijlingen E., Raja, AE. (2008) Health & Lifestyle of Nepalese Migrants in the UK BMC International Health & Human Rights 8(6). Web address: www.biomedcentral.com/1472-698X/8/6.
  4. van Teijlingen E, Simkhada, P., Adhikary, P. (2009) Alcohol use among the Nepalese in the UK BMJ Rapid Response: www.bmj.com/cgi/eletters/339/oct20_1/b4028#223451
  5. Adhikary P., Keen S., van Teijlingen, E. (2011) Health Issues among Nepalese migrant workers in Middle East. Health Science Journal 5: 169-175. www.hsj.gr/volume5/issue3/532.pdf
  6. Adhikary, P., Sheppard, Z., Keen, S., van Teijlingen, E. (2017) Risky work: Accidents among Nepalese migrant workers in Malaysia, Qatar and Saudi, Health Prospect 16(2): 3-10.
  7. Aryal, N., Regmi, PR., van Teijlingen, E., Simkhada, P., Adhikary, P., Bhatta, YKD., Mann, S. (2016) Injury and Mortality in Young Nepalese Migrant Workers: A Call for Public Health Action. Asian-Pacific Journal of Public Health 28(8): 703-705.
  8. Simkhada, PP., Regmi, PR., van Teijlingen, E., Aryal, N. (2017) Identifying the gaps in Nepalese migrant workers’ health & well-being: A review of the literature, Journal of Travel Medicine 24 (4): 1-9.
  9. Aryal, N., Regmi, PR., van Teijlingen, E., Dhungel, D., Ghale, G., Bhatta, GK. (2016) Knowing is not enough: Migrant workers’ spouses vulnerability to HIV SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS 8(1):9-15.
  10. Scammell, J., 2016. Nurse migration and the EU: how are UK nurses prepared? British Journal of Nursing, 25 (13), p. 764.
  11. Holscher, J., 2017. The effects of Brexit on the EU, the UK and Dorset – a migrant’s account. BAFES Working Papers, 1-11.
  12. Sapkota, T., Simkhada, P., van Teijlingen, E. (2014) Nepalese health workers’ migration to United Kingdom: A qualitative study. Health Science Journal 8(1):57-74.
  13. Filimonau, V., Mika, M. (2017) Return labour migration: an exploratory study of Polish migrant workers from the UK hospitality industry. Current Issues in Tourism, 1-22.
  14. Janta, H., Ladkin, A., Brown, L., Lugosi, P., 2011. Employment experiences of Polish migrant workers in the UK hospitality sector. Tourism Management, 32 (5): 1006-1019.
  15. Mai, N., Schwandner-Sievers, S. (2003) Albanian migration and new transnationalisms, Journal of Ethnic & Migration Studies 29(6): 939-948.
  16. Dwyer, L., Seetaram, N., Forsyth, P., Brian, K. (2014) Is the Migration-Tourism Relationship only about VFR? Annals of Tourism Research, 46: 130-143.
  17. Marino, S., Dawes, S. (2016). Fortress Europe: Media, Migration and Borders. Networking Knowledge, 9 (4).
  18. Parker Pearson, M., Richards, C., Allen, M., Payne, A., Welham, K. (2004) The Stonehenge Riverside project Research design and initial results Journal of Nordic Archaeological Science 14: 45–60.

New paper by BU’s Lecturer in International Health

Congratulations to Dr. Pramod Regmi on the publication of his latest article ‘Local elections and community health care in Nepal’.[1]  Pramod is our newly appointed Lecturer in International Health, who started this post exactly a month ago.  The editorial, co-authored with BU Visiting Faculty Prof. Padam Simkhada (based at Liverpool John Moores University), Nirmal Aryal (based at the University of Otago, New Zealand) and CMMPH’s Prof. Edwin van Teijlingen, highlights the important link between local democracy and health in Nepal.

The paper argues that elected local governments are critical for public accountability on the operationalization of the SDGs (Sustainable Development Goals) at local level.  Furthermore, having elected leaders in communities after such a long gap will certainly give Nepalese people rights and hopefully improve provision and access to health care services they are entitled to. Thus the role of civil society, community-based non-governmental organisation, development partners and the mass-media is critical in both advocacy for, and the effective monitoring and implementation of, local activities.

The paper appeared today in Health Prospect an Open Access journal published in English in Nepal as part of the Nepal Journals Online (NepJOL) service .

 

Reference

  1. Regmi, P., van Teijlingen, E., Simkhada, P., Aryal, N. (2017) Local elections and community health care in Nepal, Health Prospect: Journal of Public Health, 16(2):1-2.