We’ve been fortunate to work with Lisa Shannon of Every Woman Treaty over the past few years, collecting stories from around the world about the impacts of Trump’s Global Gag Rule on real people with real health care needs. We know that without the stories, the data and statistics and foreign aid appropriations can seem cold, unfeeling, and hypothetical. But the outcomes of the Trump administration’s cruelty are anything but hypothetical.
One of the places Lisa visited, in the fall of 2018, was Nepal. Recently, there have been many news articles and agency reports about the reproductive health care situation in that mountainous country, so we decided that it would be interesting to dedicate an entire issue of our magazine to those stories.
Lisa’s article begins on page 12 and it’s a troubling read. She describes how Trump’s Global Gag Rule has brought an end to mobile outreach providers who venture, often on foot, to the most remote regions of the Himalayas. The article that follows Lisa’s is a reprint from Outside magazine (page 20), and it tracks two mobile outreach workers who hike through treacherous terrain to bring contraception and other health services to women living far from health posts. Without their brave dedication to ensuring access to reproductive health care for all—urban and rural, educated and illiterate, wealthy and poverty-stricken—thousands of women would go without.
Nearly half (44 percent) of women in Nepal have an unmet need for family planning. That is, they do not want to become pregnant in the next two years (20 percent of women with unmet need) or ever again (80 percent), but are not using modern contraception.
The government of Nepal has been increasing its family planning budget by 7 percent each year since 2015, in order to help raise the rate of contraceptive use. But Nepal is a poor country, with a per capita GDP of only $1,034. Donor assistance is critical to scaling up family planning initiatives and continuing to work toward improving reproductive health indicators.
Over the course of 20 years (1996–2016), Nepal’s fertility rate halved, from 4.6 births per woman to 2.3. Progress like that doesn’t happen on its own. It happens because of health care providers at hospitals, clinics, and mobile outreach events. It happens because of funding from Nepal’s government, from the United States, from the United Nations, and from other international donors such as the UK’s Department for International Development (DFID).
One of my biggest work-related pet peeves is when people say that fertility rates are coming down on their own. They’re not. They’re coming down because women who want to plan their pregnancies are able to do so thanks to modern contraception and the education to properly use it and manage side effects. And don’t be fooled into thinking that the momentum of past fertility decline is powerful enough to continue on its own after funding is cut. It’s not. Couples continue having sex regardless of what’s happening in Washington, DC, and regardless of whether they have birth control at their disposal.