Women sitting in a circle and talking.

Group dialogues in Nepal gave women a chance to have frank conversations about sexual health issues previously veiled by privacy and fear. Photo: NAMUNA.

In Nepal, better communication unlocked women's access to new choices

For many years, women in Nepal were subject to some of the strictest abortion laws in the world. To end unwanted pregnancies, women endured illegal and unsafe abortions and served lengthy prison sentences for abortion-related “crimes.” The toll on public health was great: Nepal had one of the highest maternal mortality rates in Asia, and more than half of gynecological and obstetric hospital visits were due to abortion-related complications.

In 2002, Nepal legalized abortion and began offering abortion services in public hospitals. With a stroke of a pen, abortion became a legal and safe choice for women seeking to end unintended pregnancies. But for many women, ingrained fears and shame about abortion remained. As in other Asian countries where abortion was legalized after years of silence and stigma, women in Nepal continued to seek clandestine, unsafe abortions.

PATH recognized that for the new laws to improve health, it would be necessary to address long-held beliefs standing between women and safe abortion.

Walking in her shoes

Believing that critical reflection could produce new and healthier behavior, the government of Nepal invited PATH to apply its expertise in using dialogue to inspire social change. We established “dialogue groups”—opportunities for people to gather and share real-life dilemmas and concerns related to sexual health and access to safe abortion. In this supportive group environment, hundreds of participants—most of them women—delved into health issues affecting them, their families, and their communities.

This approach, relatively new in Nepal, gave women a chance to have frank conversations about issues normally veiled by privacy and fear. To reach the greatest number of women possible, PATH trained community members to serve as facilitators who engaged others by sharing anecdotes and asking for insights from the group. For example, the story of a young woman who became pregnant after being pressured into sex became the basis for role-playing, discussion, and brainstorming about possible resolutions. By walking in the shoes of the young woman, dialogue group participants began to understand how social pressures can affect decisions about health. As a result, social norms began to shift.

Transformation and trust

Through these shared personal experiences, participants had a chance to think deeply—and differently—about the choices they were making every day. As participants grew more comfortable, their discussions began to work their way into community-wide conversations. Participants became resources for their communities, providing advice to women considering abortion, assistance in negotiations between women and their partners, and referrals to safe abortion services.

The balance of trust also began to shift—toward husbands and partners, who have great influence on women’s decisions about contraception and abortion. One woman’s husband noted, gratefully, “We used to have rare conversations regarding any household matter; but now she does not hesitate to discuss contraceptive use and sensitive reproductive health issues with our son and me.”

As a result of this trust, the number of women using contraception had increased by 23 percent by the end of the project. Among married women of reproductive age, 65 percent of project participants reported using a modern method of contraception—a much greater proportion than the national rate of 35 percent.

New tools in Nepal

Dialogue groups are just one of many tools PATH projects have used to help change behavior and influence social norms in Nepal. PATH has also collaborated with local and national nonprofits working in reproductive health to offer training and hands-on assistance to local staff. In addition, our Nepalese partners developed brochures, posters, and radio programming to spread information about clinic referrals and access to safe and legal abortions—and to share the stories of people who were making safer choices about their reproductive health.

After PATH’s project in Nepal ended, many of our partners continued the group dialogue process, reaching more women and addressing additional topics, such as HIV prevention and gender equity. Together, these efforts improved the health and lives of women in Nepal, and set the stage for lasting change for years to come.