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Earthquakes lead to boom in Nepal’s unregulated surrogacy industry

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3302 (Published 17 June 2015) Cite this as: BMJ 2015;350:h3302

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Vulnerability of adolescent sexual and reproductive health in post-quake Nepal

Author Sally Howard has highlighted human trafficking and child marriages in post-quake Nepal. Our concern is the vulnerability of adolescent sexual and reproductive health.

After a devastating 7.8 Richter scale earthquake on 25 April 2015, an estimated eight million people were affected, claiming over 8,000 lives and 23,000 injuries.(1) One third (24.1%) of Nepal’s population is adolescent.(2) A total of 1.2 million adolescents are in the most affected districts by this disaster.(1) The government earthquake assessment reports that a total of 446 public health facilities and 16 private health facilities are entirely damaged, and 765 facilities (701 public and 64 private) are partially damaged.(1). Adolescent health services receive little attention in Nepal, with 90% destruction of public health facilities in most affected districts, the delivery of adolescent friendly health service is severely disrupted.

Nepal Health Sector Programme II aims to improve health services for adolescents by upgrading 13 public health service centers per district to offer an adolescent friendly health service. However, an accessible adolescent friendly sexual and reproductive health service is a far cry from the resource-constrained health service in Nepal, which is further exacerbated by this disaster.

Following the mega earthquake, it is presumed that marginalized groups of the population, pregnant women and adolescents face severe psychological and reproductive health problems(3). The destruction of livelihoods, loss of protection and security provided by the community and family place adolescents at the risk of sexual violence, abuse, prostitution and trafficking (4). Evidence from the 2010 Haiti earthquake showed that teenage pregnancy, HIV and other sexually transmitted infections, early marriage, miscarriage, unsafe abortion are the major consequences of post disaster situation.(5) High chances of premature delivery due to stress and obstructed labour in teenage pregnancy are also likely(6, 7). UNOCHA focuses on the vulnerability of girls and early adolescent to the risks concerning their development, protection and participation and further predicting the risk of increase in child marriage post disaster.(8) These issues flare up due to the unavailability of adolescent friendly health services, destruction of service site and diversion of the government’s attention.

Nepal government has underscored national priority in reconstruction and rebuilding that further increases fear that key health issues of adolescents may receive little attention. We argue for a greater attention to provide services that safeguard their sexual reproductive health right including access to counseling, dignity kits, menstrual hygiene and sanitation facilities while living in temporary shelter at most. Further focus has to be given to establish adolescent friendly corners, and to train health workers on sexual reproductive health needs following the disaster.

We declare no competing interests.

References
1. Government of Nepal NPC. Nepal Earthquake 2015, Post Disaster Needs Assessment. Nepal: 2015 June 2015. Report No.
2. CBS N. National Population and Housing Census 2011. National Report. 2012.
3. Yule W, Bolton D, Udwin O, Boyle S, O'Ryan D, Nurrish J. The long-term psychological effects of a disaster experienced in adolescence: I: The incidence and course of PTSD. Journal of Child Psychology and Psychiatry. 2000;41(04):503-11.
4. Kolbe AR, Hutson RA, Shannon H, Trzcinski E, Miles B, Levitz N, et al. Mortality, crime and access to basic needs before and after the Haiti earthquake: a random survey of Port-au-Prince households. Medicine, conflict and survival. 2010;26(4):281-97.
5. Krause S, Heller L, Tanabe M. Priority Reproductive Health Activities in Haiti. Priority Reproductive Health Activities in Haiti: WomenÆs Refugee Commission; Save the Children; CARE; International Planned Parenthood Federation (IPPF); 2011.
6. Glynn LM, Wadhwa PD, Dunkel-Schetter C, Chicz-DeMet A, Sandman CA. When stress happens matters: effects of earthquake timing on stress responsivity in pregnancy. American journal of obstetrics and gynecology. 2001;184(4):637-42.
7. Baltag V. Adolescent pregnancy: a culturally complex issue. Bull World Health Organ. 2009;87:410-1.
8. UNOCHA. Nepal Flash Appeal Revision, Nepal Earthquake. Nepal: 2015.

Competing interests: No competing interests

05 August 2015
Samaj Adhikari
Medical Doctor
Tara Ballav Adhikari, Vishnu Khanal
Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
Maharajgunj, Kathmandu, Nepal