SRHR services in Kathmandu

Sexual health is “a personal sense of wellbeing, including the absence of disease, infections, or illness associated with sexual behavior”. Reproductive health refers to “a state of complete physical, mental, intellectual and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes”. SRHR stands for Sexual and Reproductive Health Rights, which has become a buzzword in the advocacy community with the introduction of the second wave of feminism.

In developing countries like ours, sexual and reproductive health problems pose as a major obstacle on the road to living a healthy life especially for girls and women of reproductive age, LGBTQIA+ community, people living with disabilities and other marginalized groups which include many castes and religions. These groups are vulnerable to an onslaught of problems such as STIs, HIV/AIDS, unwanted pregnancies, complications of unsafe abortion, gender-based violence, and problems related to pregnancy and childbirth. For adolescents and school going children the burden with living and dealing with these issues makes them unable to attend school regularly and receive formal education.

All of these concerns do not just vanish after the reproductive years, rather they are a lifetime concern for all individuals. This warrants for a life cycle approach to tackling the pertaining challenges starting from the most basic of services such as transport, to education and health care.

The services included under Sexual and Reproductive Health (SRH) can be visualized under four pillars:

1. Pre-conception

2. Antenatal care

3. Delivery

4. Post-partum

Pre-conceptional care doesn’t revolve around the notion of betting pregnant. It includes the prevention of unintended pregnancies, STIs and HIV, and promoting condom use. There is also a special focus on preventing prostate, breast and cervical cancer through screening. Post-abortion care and counselling about HIV/STI testing, care and communication about SRH. Antenatal care means the care that is provided to an individual after they have decided to continue their pregnancy. It includes promotion of medical male circumcision, treatment of STIs, antenatal nutrition, supplementation, vaccination, and regular check-ups. Delivery care includes safe delivery supervised by trained medical personnel, and modified delivery procedures. Post-partum care after the delivery includes post-natal care, routine STI/HIV testing, promotion of contraceptive use, and screening services for medical services.

Now the question is: Where are what are the services available in Kathmandu? If you are living in Kathmandu, you are somewhat blessed to be amongst the best health care institutions in the country. However, you might not be able to afford it. Along with highlighting the importance of SRH, it is important to point the service seekers towards affordable and friendly service centers. The right to health and reproductive freedom is a fundamental right and you need to know where you can go to exercise these rights.

There are government and semi-government hospitals like The Maternity Hospital in Thapathali, Tribhuwan University Teaching Hospital in Maharajgunj, and Patan Academy of Health Sciences in Lagankhel, where all of the aforementioned services are available either for free or at relatively low costs. The problem with these centers is that they are very busy and service delivery might not be able to keep up with the demands. MSI Nepal also has centers inside the valley at locations like: Satdobato, Baluwatar, Boudhha, Gongabu and Putalisadak. The services provided by Marie Stopes Nepal has been included in another article, and they are not free of cost. The service delivery is quick and includes user friendly counselling regarding pre and post care. Family Planning Association of Nepal (FPAN) also provides contraceptive services for free of cost.

An area of service provision that often gets under looked in Kathmandu because of the abundance of private health care centers, is the primary health care centers and health posts which are present in every municipality of the district. These centers are equipped with trained health care workers capable of providing a majority of the health care services and that too either free of cost or covered by the National Health Insurance scheme. FPAN has also been key in rolling LGBTQIA+ friendly clinics, being piloted in their Bhaktapur location.