The Effort Behind the Victory: Q&A with Dr. Arzu Rana Debua about Nepal’s Safe Motherhood and Reproductive Health Rights Act, 2018
By Dorothy Monza, White Ribbon Alliance
In October, the Nepal House of Representatives passed the Safe Motherhood and Reproductive Health Rights Act, 2018. This legislation defines health as a fundamental human right, including the right to receive proper counseling and choice regarding healthcare services, the right to safe abortion, the right to confidentiality and privacy, family planning and the right to paid maternity leave. It also includes the importance of adolescent and disability rights around reproductive health and protects against discrimination related to and regarding religion, caste, sex, occupation, sexual orientation, marital status, pregnancy and other factors.
Dr. Arzu Rana Debua founded the Safe Motherhood Network Federation Nepal (SMNF), a national affiliate of WRA Nepal, and has been a leader in reproductive, maternal and newborn health and rights for decades. She spoke about the new Safe Motherhood Act and SMNF/WRA Nepal’s role in passing the legislation at the Global Respectful Maternity Care Council’s quarterly meeting in December. The Council is a group of more than 175 organizations, representing over 350 members from 45 countries and includes researchers, clinicians, advocates, attorneys, professional associations, United Nations agencies and donors. Below is a transcript of the question and answer session after her presentation, lightly edited for clarity.
Q: This is such a comprehensive bill. What was your biggest battle? Was there any issue that you were trying to address that had more resistance than others?
Dr. Arzu Rana Debua: One battle was maternity leave. We wanted more [than 98 days paid leave] and the government was not very keen, so that was one point we had a lot of contention about.
The bill would also keep getting lost. That’s why it took so long, it should have come at least a year ago. It would reach the secretary’s table, then suddenly it would vanish. The most recent Secretary of Health, Dr. Pushpa Chaudhary, played a very big role [in stopping] this. One of the things we lobbied for [was] a woman to be the health secretary. We realized that if a woman is not health secretary, then the bill does not get as much priority. She was very good about pulling it out of the drawer.
Q: Do you have allies in the health profession? How important, or not, is that?
Dr. Arzu Rana Debua: That’s very important. From the beginning, we started working with the professional associations, with obstetricians and gynecologists. There were many issues with practices only [they] were allowed to do. But there are very few obstetricians and gynecologists in Nepal, so if you do not train the senior nurses and midwives to do that, then women would not have access to services. So [doctors] themselves are very enlightened to begin with, and we created platforms where the midwives and the senior obstetricians and gynecologists could come together and talk to each other. Professionals are the practitioners within the larger area of reproductive health and are key to providing services. It’s very important to get them on our side and make them see why these things are important.
Q: This is a great accomplishment. What is your thinking regarding uptake and implementation?
Dr. Arzu Rana Debua: This is going to remain a big challenge for us. Abortion has been decriminalized for a long time in Nepal, but even today women die from unsafe abortion. Even though its legal, there are issues related to taboo, embarrassment, shame and many other issues that take even longer to contend with. Attitudes need to change, so this will pose a big challenge.
We also need to work out some of the things that are currently in the bill. That is going to require additional training, resources, guidelines. Nepal has just gone from a unitarian state to a federal state. We now have seven provinces, not all have the same level of human resources or health institutions. My biggest fear now even though the tertiary centers are controlled by the government, everything has been given to the federal government. What is the level of awareness among parliamentarians at the federal level? What is the budget they have in hand for delivering services? These are some big key questions that we need to look into. The act has been made, but the rules and regulations [have not].
Q: What motivated you and keeps you motivated? You have been essential in these efforts for a number of years, and the work is ever easy. What keeps you going?
Dr. Arzu Rana Debua: My own personal experience of near-death during childbirth was a great push for me to become involved in this sector. I’m not from the health field, my background is something entirely different. What really motivates me is finding like-minded people, whether at the national level or international level.
[I am motivated by] the members of the Safe Motherhood Network, who have been primarily volunteers. One of my colleagues, a young businessman named Sunil works more for the network than his own business sometimes. And even in the most remote and rural areas of Nepal, we’ve been able to reach out to organize women because it strikes a chord in their lives. Everyone has known or seen somebody who had died in childbirth. When we started, everybody knew someone who had. I think that kept all of us going.
The stories we’ve heard from women from all over the world, and leaders like Sarah Brown, who is a great leader who helped get this issue on the map. Meeting all these wonderful people who spoke up on the issue has kept all of us in Nepal very motivated and been an inspiration.