– SHASTA Kansakar

Almost half of Nepali women of reproductive age use contraceptive measures. Condoms, morning-after pills, and intrauterine devices (IUD) are a commonality for contemporary Nepalis. Having these choices and access to contraceptives is crucial for reproductive healthcare and empowerment. This allows for ease of family planning as well as sexual liberation. It is great that Nepal has reached many milestones with regard to reproductive health, for example meeting MDGs and SDGs. However, it is to be noted that women bear the brunt of using contraceptives over men. 

In 2019, 47 percent of Nepali women aged 15 to 49 reportedly used permanent or temporary contraceptives. These contraceptive methods commonly included female sterilization, birth control pills, IUDs, injectables, implants, and female condoms for women while men used condoms or underwent sterilization. Most of these contraceptives – bar condoms – are either injected or ingested, making them invasive procedures. According to a 2016 study, 28 percent of Nepali women relied on sterilization, 17 percent on injectables, nine percent on birth control pills, six percent on implants, and three percent on IUDs. In contrast, only ten percent of men had undergone sterilization. As per this data, women largely endure invasive procedures over men. Such temporary contraceptives for women largely affect their quality of life due to the side effects. On the other hand, for men, there are no temporary birth control measures aside from condoms in the market. 

Women often report mood changes, weight gain, nausea, migraines, thinning hair, and irregular periods as a few of the side effects of contraceptives. Studies have also concluded that hormonal contraceptives could lead to severe conditions like depression, anxiety, and fatigue. Dr. Heera Tuladhar, head of gynecology and obstetrics at KIST Teaching Hospital, Kathmandu says that these side effects depend on the age and pre-existing conditions of the individuals. For instance, older women tend to experience more side effects. Similarly, while less than ten percent of women may be severely affected by hormonal contraceptives, progestin-only pills like Depo-Provera may lead to bleeding problems. Estrogen and progestin-based contraceptives like pills may lead to heart problems. As further mentioned by Dr. Tuladhar, only a small portion of women may experience severe reactions. Nonetheless, the minor side effects also impact the quality of life of many users and hence should not be ignored. Ironically, there have been many studies speculating whether the negative effects of women’s contraceptives are placebo or not. This is frustrating because not only do women overwhelmingly use contraceptives that intrude on their bodies, but their concerns are also brushed off and understudied by academics. Moreover, holistic research on the physical, mental, and sexual well-being of contraceptive users is acutely lacking. Sex is viewed as a purely biological process instead of a recreational one that intertwines with one’s social or familiar life. So, the sexual functioning or libido and the emotional state and burden of contraceptive-using women should be studied beyond medical side effects. 

The emotional aspect in particular is also gravely undermined. Despite the ubiquity of contraceptives, it is still taboo to speak about them openly. This puts a mental burden on women, especially unmarried ones. There are many instances of gynecologists slut-shaming unmarried women for their sexual choices. It can hence be difficult for women to speak about their experiences with their peers and even medical professionals, isolating them from the support they might need. 

Moving forward, Dr. Tuladhar hopes that newer contraceptives will have low doses and high efficacy. On the other hand, she says that healthcare providers should create a safe space for contraceptive users to express their discomfort. They should also not discriminate against unmarried women and prioritize the needs of the patients instead. In addendum, it is only proper to mention that contraceptives still have not saturated their reach in certain parts of Nepal. That being said, the ones who do have access to contraceptives should receive the care that they deserve. So perhaps it is high time we reflect on the physical and emotional impact it has on women, and the way forward in research and in society to enhance the experience of contraceptive users.

This blog is a part of NIPoRe’s blog series on Women’s History Month 2023

– SHASTA KANSAKAR

The opinion piece originally appeared in the March 2023 Issue of New Business Age Magazine. Please read the original article here.

On January 10, 2023, Kathmandu Metropolitan City (KMC) announced that it would be illegal to conduct informal businesses, such as hawking and vending, on the streets of Kathmandu. KMC will now be able to seize products from street vendors if caught. The decision came after years of conflict between KMC and street vendors, with the city attempting to remove street vendors while workers resisted. Under former KMC Mayor Bidya Sundar Shakya, street vending was restricted in inner city areas, including Indrawchowk, New Road, and Sundhara, and over 100 police officers were involved in detaining several vendors. Shakya’s successor, Balendra Shah, has continued these restrictions more strictly since his election in May 2022, with KMC aiming to clear city pavements and regularly dispatching metropolis police who seize or destroy goods and intimidate street workers. Their treatment of street vendors has ranged from hostility to brutality.

To provide further context, Balendra Shah has a civil engineering background and a capitalist vision for development, prioritising wider roads and bigger buildings. The ban on street vending aims to clear the pavements and widen the roads for pedestrians, citing sustainable urban management. However, this short-sighted approach, although the intention may be good, harms working-class individuals, especially women and those from low-income families. Over 20,000 street vendors now face loss of employment and increased risk of poverty. Even though street businesses contribute to the economy, providing affordable goods, and being integral to the urban landscape, they have been shunned for decades. In contrast, countries like Thailand and India have enacted laws to manage traffic and protect street vendors simultaneously. The KMC should follow suit by drawing on policies from these countries to balance the needs of street vendors and pedestrians.

The Lore of Street Vending
The vibrant city life of old Kathmandu, characterised by street vendors selling fruits and vegetables and farmers carrying their kharpans – a pair of baskets slung on a pole and carried across the shoulders; has been immortalised in Newa folklore, including the story of ‘Dhon Cholecha.’ Street vending is an age-old profession that has faced prejudice for generations. However, street vendors contribute to the economy of cities, provide essential goods to locals, and offer accessible trade opportunities for working-class individuals.

Historically, street vendors have faced negative perceptions and prejudices. For example, in 1933, the city council of Amsterdam restricted street vendors after years of disdain towards them. Street traders were viewed as unhygienic people who distorted the aesthetics of the city. They were accused of creating unfair competition for formal businesses. These vendors, often from poor and marginalised groups, however, added value to Amsterdam by providing affordable goods but were boycotted from joining guilds with other formal businesses. This stigma against street vendors was also prevalent in other parts of the world, as Edward Said, the author of Orientalism, famously critiqued Westerners who travelled to the Middle East in the 1800s and viewed vendors selling goods as barbaric and uncivilised.

Despite the prevalent contempt towards street vending globally, it is undeniably core to urban life. Vending provides jobs for working-class individuals, affordable goods to locals and economic benefits to the state. Firstly, the informal sector is characterised by the ease of entry into the trade and the small-scale nature of the business where skills from formal settings are not a requirement. Naturally, this becomes accessible for many, especially if one lacks formal education and does not have a lot of seed capital. As for the locals, they can receive affordable and fresh goods from street vendors. Such convenience is often viewed as a perk of city life. Furthermore, people engaging in the profession generate a sizable income as well. Bagmati Province alone makes an annual average profit per engaged person of Rs 103,305 from informal sectors. This profit recirculates in the economy when vendors buy supplies from the market. Hence, indefinitely banning street traders negatively affects several stakeholders.

The Implications
The ban primarily affects vendors who are often daily wage earners. The KMC has not proposed any alternative plans to provide employment for the workers following the ban. Over 20,000 individuals, especially women involved in the trade, have been impacted. Vendors either have to operate in fear or are rendered unemployed for the time being. Some of their testimonies are well-documented by major publications. Moreover, 90.5% of the female workforce in Nepal are engaged in informal sectors, compared to 81.1% of working men, so they are affected disproportionately.

When it comes to employability in the formal sector, it’s important to note that many people don’t engage in it due to the lack of opportunities available. In fact, 84.6% of Nepalis are employed informally across all sectors. Therefore, attempting to completely eradicate street vending, a system that many rely on, is futile. Street vending provides job opportunities and helps to alleviate poverty. While the ban may not entirely prevent people from working in this profession, it will likely lead to an increase in police brutality towards vendors and deprive people of their livelihoods. Article 6 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR), a UN treaty ratified by Nepal, outlines the government’s responsibility to create job opportunities through technical and vocational support. As such, the KMC’s decision to neither allow informal jobs nor provide job alternatives in the formal sector is a violation of the ICESCR treaty.

Way Forward
Given the importance of street vending for working-class individuals and its cultural significance in a metropolis like Kathmandu, it should not be completely eliminated. While ensuring pedestrian safety and comfort is important, the current law, if implemented, would lead to impoverishment for many working-class families. Instead, the focus should be on managing traffic between pedestrians and vendors. Countries like Thailand and India have laws that regulate and protect street vendors. Thailand’s Public Cleanliness and Orderliness Act B.E. 2535 (1992) allows for vendors in designated areas, while Bangkok has guidelines for street vending that prioritise hygiene and cleanliness. India’s Street Vendors Bill (2009) requires a town vending committee, which includes street vendors and women. This committee has a registration process and regulations on vending hours and locations. The execution and success of these laws are debatable, but the KMC should learn from these efforts to incorporate street vending in Kathmandu. Specific locations and hours can be designated for vendors, and hygiene regulations can be developed in collaboration with street vendors. The KMC should also listen to the concerns of street vendors and work towards a system that benefits both vendors and pedestrians. At the very least, the city should show empathy towards street workers.