Feature Stories

Sister Kumari Pawa of Rautahat

Rautahat, June 2009
By Sarita Subba, Anna Adhikari and Keshab Bhurtel

She may be shy and unassuming, but Kumari Pawa is well known to the women of Rautahat district. She is an Auxiliary Nurse Midwife (ANM) at Sampur Health Post. Thirty-five year old Jarina,ⁱ from Akolowa village, is one of many women who smile when they hear her name spoken. As the district purveyor of Copper-T, a long-acting contraceptive device, Kumari Pawa is a name that district women now associate with increased choice.

"I have four sons and two daughters who I love dearly, but having a big family is a challenge. I didn't know about contraceptives until I joined a mothers' group. That was thanks to sister Taranum, a Female Social Facilitator,ⁱⁱ and sister Sakina, a Female Community Health Volunteer (FCHV).ⁱⁱⁱ I am grateful that they share with us the skills and knowledge they acquired from the UNFPA. Knowing family planning methods was one thing - I could get pills and injections. Yet as a working mother and wife this wasn't very practical; I can't simply go to the health post any time the need arises. Kumari Pawa's work changed things for me.

My husband is a religious person in our community. He is a Mullah, and it was challenging enough to start talking about my deteriorating health, and supporting future children if we expand our family. The idea of my regularly visiting the health post for contraceptives was unacceptable. Luckily, around the same time that my health began to deteriorate, I learnt about the work of Kumari Pawa. She came to the nearby health center in Rajpur to inform us of a contraceptive method that would last for 12 years [Copper-T]. You wouldn't believe it, but it was my husband who brought the news home and himself took me to the health post! It was a great relief to reach this level of understanding with him. I've been encouraging other women in my village to use Copper-T."

Kumari Pawa has been at the fore in raising awareness in the district about women's reproductive health issues. Her recently acquired Copper-T related skills and knowledge, however, have expanded her ability to help other women in ways she couldn't before.

"I've been working as an ANM (Auxiliary Nurse Midwife) for 25 years, with responsibility for conducting ante-natal and post-natal check-ups. I've been informing patients about reproductive health and safe deliveries, and providing them with some contraceptives, immunizations, and counseling. Yet only recently did I qualify to insert Copper-T."

Her chance for skills upgrading came last year, when the UNFPA offered Copper-T training. "Sarita, a Public Health Nurse working with the UNFPA, convinced me to take part in it. You may wonder why providing Copper-T is such an important skill? You see, pills are not a sure method for women who work from dawn to night. Depo injections [a temporary contraceptive] merely last for three months. Only Norplant and coil are alternatives to tubectomy (sterilization). My colleague in charge of the health post has the qualifications to insert Norplant, but he is a man. In our corner of the world, it is a problem to reveal even a naked arm to a man.

I went to Kathmandu in August of last year. Without access to even basic equipment, I couldn't use my skills when I returned. I asked the District Health Officer (DHO) to provide Copper-T insertion kits for our health post. At the beginning of this year, they finally arrived. We started to inform women about the availability of the new services. We spread the word via Female Community Health Volunteers, mothers' groups, and other groups in our district supported by UNFPA implementing partners. The results were quick and demonstrative. The people from neighboring communities learned about Copper-T services provided in Sampur. Women in other villages started talking with the staff at their village health posts. Eventually, village-wide requests for Copper-T filtered up to our District Health Officer. While he couldn't send more ANMs for trainings, the DHO devised an alternate solution of organizing satellite health camps. I now visit other health facilities five times a month in order to support their staff.

As recently as two days ago I worked in Rajpur's primary health care center inserting seven coils. Today I'm in Ganga Pipra, yet unfortunately the Female Community Health Volunteers did not inform the area residents of our visit, and people are yet to arrive. That happens. Since I started the new services in the district in March of this year, I've inserted 54 coils. Before that, according to the District Health Office record, there was not a single recipient of Copper-T in the past year.

Copper-T is a long lasting solution but I expect to have a growing number of clients for some time yet. The service was not available at all until now. There are more than five hundred thousand people in the district [on average about 20 per cent of the population are married women]. In Rautahat alone, women in their thirties have five, six, or more children. They need these contraceptive services badly. While it is true that our communities are a bit conservative, women everywhere are pragmatic and they know how to convince their husbands of the value of contraceptives. The information is spreading very quickly because women talk to each other.

My own life has changed after the training. At the beginning, I was scared to perform the procedure on my own in the field. At present, I feel more confident and also more responsible. I want to move beyond my health post to the villages, in order to serve women having few choices on issues of their reproductive health. I have found that women are glad to have a long-term contraceptive option available in their villages. Women come to me for counseling and information and I tell them about various possibilities and help them decide. I respect their views and maintain their privacy."

Sarita Subba is Public Health Nurse at UNFPA, District Programme Support Unit, Rautahat

Keshab Bhurtel is Development Coordinator at UNFPA, District Programme Support Unit, Rautahat

Anna Adhikari is Communications Officer at UNFPA, Nepal

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i. The name has been changed for reasons of privacy and confidentiality.
ii. Female Social Facilitators are part of a Community Based Program implemented by the District Development Committee with the
    support of UNFPA
iii. FCHV - Female Community Health Volunteer; The Government of Nepal initiated the Female Community Health Volunteer
    (FCHV) program in 1988. FCHVs are local women voluntarily serving the community by providing community-based health
    education and primary healthcare services.

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