Effect of Conflict on Access
to SM Services
A study carried out by the Nepal Safer Motherhood Project
(NSMP) on the 'Effect
of Conflict on Community Access to Maternity Services' showed
that the conflict in the country represents an extra barrier
equivalent to about 10% on top of the usual burden. This
subjective assessment suggests this is mainly due to communities'
general difficulties of access being aggravated by the
This is not to under-state the significance and tragedy
of the Maoist-driven conflict in Nepal which has been ongoing
since 1996 when the Communist Party of Nepal declared a
'Protracted People's War' on the government. Since then,
large areas of the country have been embroiled in a progressively
worsening escalation of violence which, to date, has claimed
over 7,000 lives.
In 2002, a state of emergency was announced including
a ban on public gatherings and the introduction of nightly
curfews and some travel restrictions. These resulted in
the suspension of many safe motherhood activities at community
level, a reduction in the amount of public transport available,
especially at night, and significantly increased journey
times to health facilities.
Measuring the Impact of Insecurity
Monitoring Tool' to gauge the impact
of the conflict on access to essential obstetric care (EOC) services
and adjust the programme accordingly. This involves partner
organisations collecting key data on factors that are likely
to change as a result of conflict. Collected quarterly, the
information covers transport, travel restrictions, local economic
factors (such as access to loans), work patterns of local health
staff and other demographic indicators.
Such restrictions inevitably
have an effect on the ability of rural women to access EOC services.
For example, Maoist looting of community-based funds has reduced
the availability of loans for EOC, with many individual lenders also refusing loans to
the poorest families, being unsure when they might repay them.
Consequences of Conflict
As a result of the situation in Nepal,
there are aggravated barriers
to access of safe motherhood services. These include:
- Economic barriers:
- A significant reduction in employment opportunities
in conflict areas.
- An associated drop in income from produce
as local markets contract.
- Transport barriers:
- A ban on night travel has led to several,
well-publicised, obstetric deaths as women were unable
to reach district hospital services in time.
- Maoist attacks on ambulances
during Bandhs (transport strikes) have been reported.
- The shortage
of men in villages to carry 'khatiya'
(stretcher ambulances) leads to further restrictions
in rural access to maternity care.
- Personal support barriers:
- The migration of young men from the
worst affected areas in order to escape being forced into
the Maoist forces.
- Fear of being interrogated by security personnel.
- Wealthier families
leave to escape persecution and extortion by Maoist groups.
The project's response
to these challenges is to continue working in conflict-affected
areas to the maximum extent possible, without exposing staff,
partners or beneficiary groups to undue personal risk. In order
to do this, it has modified some of its working methods and introduced
This has resulted in new and innovative approaches to
communications , many of them developed by NSMP local partners. These include:
- Using mass media techniques
such as safe motherhood radio
- Adding safe motherhood messages to printed materials, including
exercise books and diaries.
- Working with local Department of Education
offices to add safe motherhood to His Majesty's Government
of Nepal's (HMGN) Non-Formal
Education (NFE) curriculum
- Taking the lead in negotiating directly with security
forces to ensure that:
- Ambulance services run at night.
- Community emergency
obstetric funds are protected.
- Local porters are available at short notice to carry women
to health facilities.