Violence Against Women in Three Districts of Nepal:
A Qualitative Assessment of Services and Needs
Presenter: Fabiola Milord, DDS, MPH
Authors: J. Cha, PhD, MPH, I. Garcia, MPH, MPS, ATR-BC, R. Johnson, PharmD, MPH, BCPS, F.Milord, DDS, MPH S. Smith, MSc, MPH, V. Tripathi, MPH,
N.VanDevanter, DrPH, RN.
INTRODUCTION /OBJECTIVES
RESULTS
In Nepal, violence against women (VAW) is widespread and has significant, negative impacts on
the health and well-being of women, girls, and children (Dhakal 2008, Asia Foundation 2010).
Research carried out in 2008 in the Surkhet and Dang districts of Nepal revealed that 81 percent
of women face domestic violence frequently. The Demographic Health Survey (DHS) of 2011
shows one in three or (34 percent) of women age 15-49 years have experienced physical
violence within the past 12 months. A November 2012 report from the Office of the Prime
Minister is stated as saying, “Despite the upsurge in efforts since 2009 by both governments and
civil society, GBV persists throughout Nepal.”
CONCLUSIONS/RECOMMENDATIONS
III. Types of Discrimination Identified
Key Observations and Emerging Themes
0
I. Perception of Violence
4
6
8
10
12
14
16
18
20
Life course
“Domestic violence is very common, and females accept [it as] a part of living.”
(Mental Health Provider, Kathmandu)
HealthRight International , whose mission is to build lasting access to health for excluded
populations , including women in developing countries, commissioned New York University’s
Capstone team to conduct a multi-level qualitative assessment to 1) identify existing services
and community needs to address VAW; 2) summarize current policies affecting VAW
programming and services; 3) identify existing services and remaining gaps and community
needs to address VAW in the three districts in Nepal: Arghakhanchi (ARG), Kapilvastu (KPV),
Kathmandu (KTM).
2
Types of VAW
trafficking,
violence related to
citizenship related
documents, child
marriage,
abandonment,
polygamy, sexselective abortion,
and accusation of
witchcraft, etc.
The Three Nepali Target Districts
Widow
Work at home
Property rights
# of times each code was applied
Chapaudi
Neglect
•Chapaudi: A social tradition in the western part of Nepal for Hindu women which prohibits a woman
from participating in normal family activities during menstruation because they are considered impure
Arghakhanchi
IV. Health Care Providers (HCPs)
Kapilvastu
Kathmandu
The team produced recommendations to assist the HealthRight Nepal office and its key partners
in developing a program strategy, identifying program priorities and possible interventions. The
recommendations matched the organization’s strengths with locally-identified needs, and
reflect global best practices.
METHODS
1. Systematic literature reviews were performed with a focus on healthcare and policy dimensions.
2.The project protocol and eight (8) assessment tools for key stakeholder groups were developed.
–
NOTE: All assessment tools were validated and HealthRight-tested in Nepal before use.
–
All stakeholders interviewed signed confidentiality forms.
3. Data Collection: Purposive Sampling
•
Seven (7) Focus Group Discussions
•
25 Key Informant Interviews
Table 1: List of Assessment Tools—Eight (8) Semi-structured
Questionnaires/ Number of Interviews per District
Stakeholder Group
Number of Interviews
District (s)
National Authorities
4
KTM
District Authorities
6
ARG, KPV, KTM
NGOs engaged with VAW
2
KTM
Health care Providers
7
ARG, KPV, KTM
Psychosocial Services
3
KTM
VAW Shelter (director or staff)
3
KPV, KTM
Community-based focus group
5
ARG, KPV
Shelter-based focus group
2
KPV, KTM
32
ARG, KPV, KTM
Total Number of Interviews
4. Interviews were recorded and notes were taken during interviews. Recorded interviews were retranslated for completeness. Team members revisited the recordings and enriched and expanded
upon their notes to ensure accuracy and capture any details or information that was missed or
incomplete.
5. Dedoose software was used for coding and analysis
•
•
Tests for inter-rater reliability measured the reliability of team members’code
application utilizing Cohen’s Kappa
Team scored an average of 0.86 using the Landis and Koch Benchmarks
6. A total of 1,706 excerpts were coded, analyzed and results triangulated with literature review to
corroborate findings.
Perpetrators are identified as mostly husbands and In-laws (husband’s family
and his siblings).
HCPs expressed the greatest need for VAW training. Training needs were the
highest for mid-wives.
--- “It mostly happens in the husband’s house. …When they go back to their
father’s house the violence happens there as well because they have left their
husbands.” (From a FGD, Kapilvastu)
All stakeholders felt VAW is a very common occurrence.
---“Women experience violence regularly but they don’t know that this is
violence.… Beatings are a day-today habit” (FGD, Kapilvastu)
---We are not well trained about how to pick up GBV. We don’t have a specific
room and we don’t have protocols. We are not adequately trained for a
psychological assessment either.” (Physical Health Care Provider, Kapilvastu)
Screening for VAW is not routinely performed by HCPs and providers are rarely
considered as access points in case reporting.
Mental health providers recommended a need for better health care
coordination and greater psychosocial services.
II. Causes and Risk factors
Greater confidentiality is needed when providing care.
Lack of education (denoted as level of schooling), drinking, poverty and sociocultural norms – particularly related to religion and Nepal as a “maledominated society” – were the most frequently cited risk factors and causes of
VAW. These findings are supported by the literature (Oshiro et al. 2011, UNFPA
2009).
--- “Lack of education and husbands’ behavior – drinking, drug use” (From a
FGD, Kathmandu).
---“Women are dependent on men and their families. In our culture, and our
society, that is the framework of our society and family.” (NGO, Kathmandu)
5
10
15
V. Policies
Common Themes
Quotes
GBV policies exist but community and HCPs may not b e
aware of them nor are they consistently enforced.
“In context to this district, we have to minimize child
marriage…The government should include child marriage in
the educational curriculum so that students are aware of
this and how to avoid child marriage” (Shelter Directors,
Kapilvastu)
Education of the human rights perspective and laws should
target women, men and children
Enforcement of existing policies and strengthening of the
criminal justice system is needed
Improved coordination of services between health
practitioners, NGOs and government authorities is needed
Perceived Risk Factors and Causes of VAW
0
Chart 1: Summary of Conclusions
Challenges described include a lack of resources, socio-cultural barriers, Difficulties in reporting cases and in the legal process,
politicization and lack of awareness of the issue.
20
25
Chart 2: Recommendations Summary
The study shows the need for a
comprehensive and holistic
approach to managing and
addressing VAW in the three
studied districts. Mainly, in
the following four areas of
intervention:
 Awareness raising of VAW
 Strengthening coordination and
partnership
 Improving and strengthening
advocacy channels
 And, strengthening services in
healthcare and protection.
REFERENCES
“We have so many problems implementing legislation; we
make fantastic legislation but we have problems with
implementation because of lack of resources and lack of
consultation with the proper stakeholders” (National
Authority)
VI. Identified Needs
Level of schooling
Socio-cultural norms
Drinking
Poverty
Identified Needs
Quotes
Need additional women’s shelters
“Is there protection for the woman? No. That is the
problem; they live in the same house. If she files
charges then she has to return home” (NGO,
Kathmandu)
Remote/Rural
Need to improve education and job support to
improve economic independence
Financial
Increase women representation in government
Civil conflict
Improve accountability
Dowry
Living in Terai regions
Increase funding
Migration
Political Stability
Workplace
# of times each code was applied
Husband's house
Public transportation
Need for training related to VAW, with the
exception of NGOs and shelter-based focus
groups.
We need shelter and money to change the mentality
of the community. Unless the constitution process is
complete, many issues remain unsettled. NGOs and
government should take the lead for the solution.
Government should also be responsible for
providing safe house. Within the government, there
should be a certain percentage of women involved
in decision making matters in a more meaningful
way” (FGD, Arghakhanchi)
Photo credit: F. Milord, DDS,MPH
For the complete list of our resources, please visit the New York University Institute
of Global Public Health website at:
http://giph.nyu.edu/mph/public-health-practice/capstone/past-capstones.html
Or
the HealthRight Interntational’s website at: www.HealthRight.org
ACKNOWLEDGEMENTS
We would like to thank the following people for all of their guidance, time and effort: The HealthRight International teams in New
York and Nepal, Dr. Nancy Van Devanter and the New York University Master of Public Health program, all participants, particularly
the survivors of violence against women; we appreciate everyone’s time and contributions but are not acknowledging anyone by
name, to maintain confidentiality. Finally the Catholic Charities Regina Maternity Services for donating non-incentive gifts for
participants.