Kathmandu Be it the pregnancy related complications or issues of early marriage, women need to maintain their reproductive health to stay fit. “Reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so,” according to World Health Organization (WHO). In case of women, “pregnancy, childbirth, safe motherhood, family planning, use of contraceptives, safe abortion, sexually transmitted infections, uterine prolapse, cervical carcinoma et cetera come under reproductive health,” according to Dr Jagadeesh Chandra Bist, Assistant Professor at Department of Obstetrics and Gynaecology, Chitwan Medical College, Bharatpur, Chitwan. The sexual and reproductive rights related to men and women are also included in it. Major concerns A woman with unhealthy reproductive system may suffer from various pregnancy related complications — post-partum haemorrhage, hypertension and infections. “These are some of the major causes of mortality in women,” informed Dr Bist. Early marriage, a common problem in Nepal, also contributes in the deterioration of women’s reproductive health. Women in Nepal get married at a fairly young age. Because of early marriage, they get pregnant earlier and are likely to bear more children. “It increases the risk of women suffering from anaemia, frequent release of urine among others,” informed the doctor. Uterine prolapse is another problem related to reproductive health, common in women above 49 years old. “It usually happens when a woman gives birth to many children, when her childbirth is unattended and if she resumes her work immediately after delivery,” the doctor further stated. Genital tract infections like gonorrhoea and syphilis; malignancies of uterus and ovary; and cervical cancer are other problems a woman may suffer in her lifetime. To keep the reproductive health problems at bay, Dr Bist suggested, “Get timely treatment of menstrual pain, irregular menstruation, and other problems to get rid of reproductive health problems as they are also some of the causes for deteriorating health in women.” Unsafe abortion can also lead to reproductive health problems. It may make a woman infertile later in her life. “So, safe abortion should be practised to prevent future infertility,” the doctor added. Condition in Nepal Antenatal care is one of the important things every women should get to reduce the risks associated with reproductive health. “Almost 60 per cent of Nepali women receive some antenatal care (ANC) from skilled providers such as doctor, nurse, or midwife. This marks continued improvement since 2006 when only 44 per cent of women had any ANC from a skilled provider,” as per Nepal Demographic Health Survey (NDHS) 2011. Probably the rise of awareness in women about the significance of reproductive health could be one of the reasons behind this. “Female community health volunteers are here to aware, inform and educate people about reproductive health,” expressed Dr Bist. To encourage women to visit hospitals for delivery, “the government also provides incentives and free services for women post delivery” as per the doctor. Family planning services too are free in the country. It is a positive sign that women are being aware of the issues of reproductive health and getting some facilities too. “Yet lack of education, and different cultural factors have been hindrances in the use of contraceptives, birth spacing and limiting the number of children,” Dr Bist expressed his concern. Vaccines can also help women prevent the risk of getting cervical carcinoma. And it is currently being practised at Chitwan Medical College as per the doctor. “Women till the age of 18 can take this vaccine to prevent cervical cancer — the appropriate age to take the vaccine is 11 and 12. And the vaccine has to be taken before a woman has her first sexual intercourse,” Dr Bist argued.