Monday morning, 7th September 2009
Fainting dead away on the floor of a Marie Stopes International (MSI) clinic wasn’t how I imagined I’d begin my experience as an intrepid aspiring journalist. In doing so, however, I was able to experience first hand the care and expertise of the medical professionals that work there…
MSI are a leading reproductive health provider in Nepal and, through their local Partner Sunaulo Parivar Nepal (SPN), operate 61 clinics in 45 of Nepal’s 75 districts. MSI is sponsoring the 2009 Guardian International Journalism Competition and were responsible for setting assignments for two of the finalists. At the briefing day at The Guardian offices in London earlier this year I was randomly allocated, as a finalist in the amateur category, an assignment to explore the issues around the impressive drop in Nepal’s maternal mortality ratio (MMR) since the beginning of this century.
Having spent an intensive week prior to the trip researching this issue (as a research assistant for the Teacher Education in Sub-Saharan Africa (TESSA) consortium it was both a subject and geographical area about which I knew very little) I started this trip overwhelmed. Not only are there many factors that contribute to a country’s maternal mortality ratio but there appear to be so many issues impacting on these factors, and of course the usual interplay of rural/urban, male/female, educated/non-educated, ethnicity, prestige… as well as the differing opinions and allocations of responsibility by different stakeholders.
Most perplexing for me is the fact that my brief instructs that I explore this issue in the context of the Millennium Development Goals (MDGs) (of which number 5 states an ambition to halve maternal deaths by 2015 and provide universal access to reproductive healthcare services). The MDG framework uses official UN statistics which, while they do still report a drop in maternal deaths in Nepal, are considerably less impressive than the ones issued by the Nepalese Government Health Survey, and therefore the ones used by organisations such as SPN. This difference of up to 500 women per 100,000 cases of maternal death is something I am particularly interested in exploring while I am here in Nepal.
But, back to this morning, more specifically to the beginning of the day and a point at which I was still conscious…
Tony Kerridge (Senior Communications Manager from MSI London), Matthew Race (Business Development Manager for The Guardian) and I visited the SPN headquarters in Kathmandu. Kamala Thapa, the SPN Director, gave an overview of the issues and emphasised that SPN’s mission was to enable women to “have children by choice, not by chance”. MSI in the UK are perhaps best known for their abortion provision. They also provide 70% of registered abortions in Nepal but there are also key providers of sterilisations (providing over 45,000 in 2008) and non- and semi-permanent contraception. Between in 1994 and 2008, SPN has served over 1 million (male and female) clients in Nepal.
After the presentation I was given the opportunity to interview Kamala on a one-to-one basis. Kamala is so knowledgeable and passionate about her work. She introduced me to so many more complexities in reducing MMR that when the allocated hour was up I had more questions than when we began. I suspect this may be a recurrent theme this week.
After the interview we were taken by Pushpa, SPN’s Assistant Director to a clinic. Actually, in writing this I have just realised that both the Director and Assistant Director of SPN are female. I wonder if this is unusual for a Nepalese NGO? Something else to add to the list headed “To find out……”.
At the clinic, I managed to bring the tour to an abrupt end when I ended up coming-to in the recovery room feeling awful (physically awful, as well as awfully embarrassed). Not all was lost however, and arguably some things were gained as I ended up lying next to some SPN clients who agreed that I could interview them. I don’t want to write too much about this because this could be important case study information for my article, but I was struck both by how openly they discussed their family planning (and one of them had just had a medical abortion) and by the range of options available to them. Each had chosen a different method of controlling their fertility (and of exercising their right to have children by choice, not chance, in SPN speak). After a morning of speaking to the people at the organisational level, it was really interesting to speak to those who access these services.
After fully recovering, helped by a delicious lunch of Nepalese curries back at the SPN Headquarters, we drove out to the SPN training clinic: Satdobato. More of this later….