The History
The Tharu people are indigenous to the Terai region that lines the southern border of Nepal, and have a long history of marginalization and bonded labour (1). Malaria was historically endemic in the Terai region, which led to the high prevalence of sickle cell disease among the Tharu people. However, this kept outsiders away and allowed the Tharu people to lead self-sufficient lives and cultivate the land. When malaria was eradicated in the 1950s, settlers colonized the region and as a result, the Tharu people lost their land and were forced into bonded labour (1). When slavery was abolished in Nepal, the Tharu people were freed but their land was not restored, leaving them in extreme poverty (1). This
eventually led to the Kamlari system, where ex-bonded labourers would trade their daughters to land owners in exchange for a piece of land (1,2). These practices have had long-standing impacts on women in these communities, and many families are unable to provide their children with sufficient education opportunities, thus perpetuating a cycle of poverty. CP Nepal has worked closely with the Tharu communities in Dang to provide educational opportunities to these marginalized youth and women through scholarship programs, building community centres and classrooms, providing bicycles, and delivering courses to youth and mothers’ groups. However, there is still much work to be done.
Current Conditions
In low resource countries like Nepal, adolescents are more vulnerable to gender inequality, child marriage, domestic violence, unwanted pregnancies and non-consensual sex (3). This is particularly common in rural communities where parents are often forced to choose child marriage for their daughters and prioritize education for their sons in order to financially support the family (4). Early childbearing has negative consequences on the health of the mother and baby, girls’ education and employment, and ultimately hinders the country’s economic development (3,5).
Although the Nepali government has made commitments to improve adolescent sexual and
reproductive health through the implementation of sexual education into the school curriculum, there remain huge barriers that prevent young girls and women from seeking the healthcare they need. The current sexual education curriculum uses a textbook and is mostly didactic, and adolescents report that they feel they still lack knowledge around physical changes during puberty and when and where to go to seek healthcare (6). In addition to the narrow scope of sexual and reproductive health education offered, these classes are available as an elective, and often not taken as a result. Opportunities to access this information elsewhere are extremely limited; persisting gender inequality and social stigma around speaking about women’s rights and sexuality makes it difficult for adolescent girls in Nepal to feel comfortable discussing these issues with friends and family, let alone in a school or medical setting (6). Our partners have expressed to us that the views surrounding sexual health and marriage are undergoing a social shift, and pre-marital relationships are becoming increasingly common in Nepal. While this is a positive social progression, it stresses the importance of increasing the sexual health literacy in both girls and boys, in order to minimize potential risks and promote healthy behaviours. The purpose of this project is to empower youth and improve the overall health of adolescents in rural Nepal by increasing awareness and knowledge around sexual and reproductive health. After the success of our initiatives on SCD, we plan to follow a similar structure, focusing on knowledge translation to relevant groups in the community. In doing so, we hope to educate adolescents on the choices they have and steps they can take to actively participate in their own health. Expanding the general knowledge in the domains of sexual and reproductive health is a step towards improving the health and wellbeing of women and their families, and attempts to achieve equitable healthcare on a global scale.
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