Nepal’s Telephone Counselors Offer Life-Saving Sexual Health Advice

2016-10-10

As counselors for the Meri Saathi helpline, midwife Hima Mishra and her team field hundreds of calls a day from people with questions about sex, pregnancy and abortion, helping to shed light on reproductive health rights in Nepal.

Hima Mishra’s office in Kathmandu is a tiny room staffed with seven smiling women wearing headphones. It may look like a small operation, but the women receive up to 150 calls a day from men and women across Nepal.

“Morning to night, our voices are the same. We are always happy,” says Mishra, who runs the team. “You would think that we are very stressed and tired, but we’re not.”

In 2011, Marie Stopes International (MSI) launched a free helpline number called Meri Saathi, which translates to “My Friend,” to provide counseling on a range of issues from safe abortion, contraception, masturbation, penis size, menstruation and safe sex.

In mountainous Nepal, where it can take a woman days to get to the nearest primary healthcare center and where premarital sex is taboo, the call center is a lifeline for thousands of Nepalis who have little or no access to accurate information.

Although abortion is legal in Nepal during the first 12 weeks of pregnancy or up until 18 weeks in cases such as rape and incest, deaths from unsafe abortion still account for more than 5 percent of recorded maternal deaths.

Since abortion was legalized in 2002, more than 800,000 womenhave received safe abortion services from over 500 certified clinics, but challenges remain, including a lack of skills among health workers and overcrowding at referral hospitals, according to the latest Department of Health Services annual report.

Another major barrier to women seeking safe abortion services is that many don’t know it’s legal. Only 38 percent of women in Nepal are aware of the law on abortion, according to the 2011 Nepal Demographic and Health Survey, and only one in two know where to access services.

While the government last year pledged to make abortion services free across the country, it hasn’t happened yet. Women who don’t go through organizations like MSI have to pay the equivalent of $10, making safe abortion unaffordable for those living in rural areas.

Mishra has been working at the Meri Saathi call center since it launched, and has watched its popularity grow from 150 calls a month to 150 a day. The team is planning to move to a bigger work space, add more staff members and extend the hours the hotline is open to keep up with the number of requests.

“We’re overloaded with calls,” she says. “We don’t want to miss people.”

The main purpose of the hotline is to educate people about their sexual health and reproductive rights. The center also offers counseling via live chat on its website and through Facebook and Twitter, and the Meri Saathi workers follow up on existing clients whenever they can.

At the moment, the team gets more calls from adolescent boys than women or girls, asking questions about safe-sex practices, how to manage their sexual desires and the bodily changes they are experiencing.

“I tell them that masturbation doesn’t harm their body and they should keep busy, study, do sports and be creative. I give them tips for what is best for their future,” Mishra says.

For young women who call, the primary concerns are sexual propositions outside of marriage, contraception, menstruation pain and access to safe abortions. Stories of women inserting iron bars or using other potentially fatal methods to try to give themselves an abortion are all too common.

Determined to stop that happening, the Meri Saathi team callers to an MSI clinic or, if they live too far away from one, to a listed organization, healthcare center or government hospital that provides safe abortions

But women are often either too scared to tell their husbands, or their husbands insist on keeping the baby, particularly if they are hoping for a boy. “Often women don’t want another baby and they beg me not to listen to their husband and ask if they can get an abortion alone,” Mishra says. “Husbands call the center and ask about their wife’s abortion. I tell them [family planning] is also a father’s responsibility.”
Some of the calls haunt the counselors long after they hang up the phone – like the time a 22-year-old man asked for Mishra’s advice because he was having a sexual relationship with his mother. But then there are the times when the counselors see how one phone call can change a life for the better. One of Mishra’s happiest memories is when she was able to prevent a 14-year-old girl from western Nepal from getting married after speaking with her mother.

For Mishra, the biggest reward comes from guiding young women safely through some of the most difficult times in their lives. “I feel so proud that I have saved so many youths from unsafe sex and so many women from unsafe abortions,” she says.