TALAMARANG, Nepal — After the 2015 earthquake in Nepal destroyed an estimated 800,000 homes and damaged another 300,000, families that were already experiencing poverty set about rebuilding their lives. The humanitarian response to the earthquake was hampered by the remote location of many victims, which also further complicated the country’s efforts at improving nutrition.
In Nepal, 36% of children under age 5 are stunted, nearly 22% of babies have a low birth weight, and over 35% of women ages 15 to 49 are anemic. But in the wake of the earthquake, providing safe shelter took priority over nutrition, said Usha Jha, a member of Nepal’s National Planning Commission.
“They were houseless. Their immediate goal was to get a space where they could sit and sleep with their children comfortably. The main goal was … to get food, and it was not the kitchen garden,” Jha said of the country’s population. “People were mentally damaged. It was really difficult to rebuild.”
“The sense of sisterhood is strong here and so these women’s groups, the female community health volunteers, can actually do a lot to contribute to nutrition, health, and other issues.”— Pooja Pandey Rana, deputy chief of party, HKI’s Suaahara program
The earthquake had a negative impact on national eating habits, Jha said. Due to agriculture and food supply disruption, many people started eating packaged food higher in sugar, salt, and fat that had not previously been a part of their diet.
“People started because they didn’t have much access to the rice or a proper balanced diet, and it was the junk food which was supplied very easily,” Jha said. “We are slowly trying to recover that now.”
The Nepalese diet, high in staple crop rice, lacks sufficient diversity, and mothers, infants, and young children do not typically follow best feeding practices. According to USAID, undernutrition heavily impacts women in Nepal due to gender discrimination that priortizes food distribution for men, as well as the prevalence of frequent, close-together births. But they are also key in addressing nutrition challenges, with female community health volunteers and mothers at the forefront of the country’s efforts to promote good nutrition in the first 1,000 days of each child’s life, from conception through their second birthday.
The Suaahara program, a partnership between the government and NGOs, is designed to address these challenges and capitalize on the role women can play in better nutrition by focusing on the first 1,000 days.
Female health volunteers
The first iteration of the USAID-funded program began in 2011, and the second phase, implemented by Helen Keller International, launched in 2016. Suaahara is a $63 million project in 40 of Nepal’s districts that targets the period of a child’s life in which good nutrition can maximize positive future growth and development.
“Suaahara was designed by USAID to operationalize the multisectoral nutrition plan,” said Pooja Pandey Rana, deputy chief of party for Suaahara with HKI. “If [Nepalese women] have access to information and resources, they can make good decisions about what to feed, what’s good for the family.”
Eleven of the Scaling Up Nutrition Movement countries are on track to meet World Health Assembly stunting-reduction targets by 2025. Yet across the 61 SUN countries, approximately 95 million children under age 5 are stunted and nearly 24 million suffered from wasting in 2018.
The integrated program aims to mount a comprehensive, multisectoral approach to improving nutrition in Nepal and to reducing stunting, underweight, and wasting among children under 5. It focuses on behavior change to encourage healthier diets, establishment of kitchen gardens, better management of infant and child illness, and WASH practice promotion, among others.
The program also works with the government’s female community health workers who help spread information about better nutrition to remote areas of mountainous Nepal. Jha said that the volunteers play a crucial role in teaching women best nutrition practices, but the program is not yet widespread in more geographically remote areas. The government is working to expand access to the entire country, she said.
Women in rural Talamarang — separated from Kathmandu by a drive of four-plus hours, depending on road conditions — meet once per month to discuss a variety of nutrition- and health-related issues. The group is led by a female community health worker who facilitates instructional discussions on topics such as growing vegetables, raising chickens for animal source-protein, and assessing whether their children are malnourished.
Many women in the group lost their homes during the earthquake. They decide each month what they’d like to talk about at the next meeting, and the community health worker tailors their conversations accordingly, incorporating visual materials that are easily understandable to women who are unable to read.
“Female volunteers are really the backbone,” Rana said. “The sense of sisterhood is strong here and so these women’s groups, the female community health volunteers, can actually do a lot to contribute to nutrition, health, and other issues.”
The women also have their own savings group, to which members each contribute 50 rupees every month. This gives them access to cash in the event of an emergency and a greater sense of independence in a culture where rural women do not often have financial resources at their disposal, several women in the group told Devex.
Rana said this is changing slowly as Nepal undergoes demographic shifts: Many women have become the head of household because so many men have migrated in search of work. A Suaahara survey showed that more than 50% of men had left for Kathmandu, India, or the Persian Gulf, leaving women further in control of nutritional decisions for their households.
“Because a lot of men are away, women are also empowered, but they also have a lot of responsibility on them,” Rana said.
Technology has also played a role in empowering women, as access to cellphones, TV, and Facebook and YouTube, along with the rest of the internet, spreads to rural areas. Suaahara has used mobile messaging campaigns to target women throughout the first 1,000 days and supports a national radio program called “Mothers Know Best,” a serial radio drama. After each episode, there is a live show where women can call in with questions for an expert on a different topic each week.
“It’s not just empowering me — I want to empower the other women in the community. I’ve also learned from them, and I’ve taught what I’ve learned to my peers.”— Sarita Dhungana, member of a women’s group in Talamarang
Sarita Dhungana is a member of the women’s group in Talamarang and has also received support from Suaahara to raise chickens. She received five chickens after participating in a two-day training and was then nominated to attend a more extensive training about raising the birds. Since then, Dhungana has started a formal commercial business raising and selling chickens. During a recent Nepalese holiday, she made $6,500 selling the animals.
This money has allowed Dhungana to send her 7-year-old daughter to boarding school. It also means her husband, who had traveled to Saudi Arabia to find work, is back at home helping grow the business. They are also still rebuilding their home, which they lost during the earthquake.
“I want to save money and use it for my children’s future,” Dhungana said through an interpreter.
Chickens have given Dhungana’s family consistent access to animal-source protein in eggs and chicken meat, which can be rare in rural areas of Nepal. Dhungana also grows orange-fleshed sweet potatoes, which she harvests each week and sells to an organic distributor.
“It’s not just empowering me — I want to empower the other women in the community. I’ve also learned from them, and I’ve taught what I’ve learned to my peers,” Dhungana said. “I want to change our male-dominated society.”
Editor’s note: SUN facilitated Devex’s travel to the SUN Global Gathering in Kathmandu, where this reporting took place. Devex retains full editorial control and responsibility for this content.
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