Young women work to prepare their family fields for planting wheat as a young male relative watches near Bayalpata, Achham in the Far West Region. Image by Allison Shelley. Nepal, 2012.

Dr. Arzu Rana Deuba’s laughter sprinkled our sun-soaked conversation. We sipped black coffee in the back garden of her expansive, well-manicured brick home. Both of us sported oversize sunglasses to keep from squinting against the bright Kathmandu morning sun.

Jasmine-scented lotion in her Western-style bathroom, as well as the myriad household help scrubbing the SUV out front and bustling to serve our coffees, left no question of this women’s rights activist and successful Nepali politician’s social standing.

Arzu’s home seemed a world away from the story I came to Nepal to report on—chaupadi, the practice of isolating women while they are menstruating. But beneath her good nature, Arzu was a survivor of the same discrimination against women that underlies the chaupadi practice and so many other realities in Nepali women’s lives.

Days later I would embark on a bumpy one-hour flight and a ten-hour jeep ride to reach Achham, the Far Western district where we are covering the clash between culture and reproductive rights. In Achham, red brick was replaced with mud brick, and mansions shrank to cow sheds where women often shiver through their menstrual periods, separated from their families, barred from entering their homes and treated as untouchable.

Yet, even in this supposed bastion of tranquility in the suburbs of the capital, the steep mountains blocking Nepali women’s experience of equality and empowerment were all around. Nepal ranks 113th out of 187 countries on the UNDP Gender Inequality Index. The women fighting for gender equity in the capital—educated, eloquent and safe as they are—fuel their fight with their own experiences of this inequality.

When Arzu was pregnant with her son she traveled to the Far West Region with her husband, three-time Nepali Prime Minister Sher Bahadur Deuba. Deuba was born in Dadeldhura and was the first prime minister from the Far West. His region has long been considered the country’s most remote and underdeveloped. The construction of roads under Deuba’s tenure has drastically increased connectivity with the rest of the country, but conditions remain stark.

On her first visit to the Far West, Arzu met women who told her that childbirth was their biggest fear. “I thought these women from the village don’t know how to express themselves,” she said. At the time Arzu considered childbirth simple, something she would do just like every woman does.

But five months later her own delivery dragged on for hours and was riddled with complications. She remembered lying on the bed, imagining her own death and the death of her child—“It was the most desperate feeling.”

“But I knew I had a chance of survival because I was in a hospital, my mother was there, and my father, my husband, the whole family were there to support me.” She finally survived after an emergency cesarean surgery.

Arzu’s own near-death experience led to conversations with her gynecologist, which exposed her to the high rates of women dying in pregnancy in Nepal. The estimated rate of maternal death in 1990 was 850 women per 100,000 live births.

Arzu started the Safe Motherhood Network Federation in the 1990s. The organization is widely lauded for pushing improvements in Nepal’s maternal care, and Nepal has been recognized for making significant progress toward the fifth Millennium Development Goal of reducing maternal mortality by two-thirds by 2015. The current rate of 229 deaths per 100,000 live births is a vast improvement, but women still lag behind in almost every metric. Less than half of Nepali women and less than a third of women in the Far Western region participate in decisions concerning their own healthcare.

Samjhana Phuyal, a pink-scooter riding, fashionable young program officer for the Rural Women’s Development and Unity Center, is fiery in her critique of gender disparity in Nepali society. Halfway through our interview she interrupted her litany of facts, figures and programs to ask, “Is it okay if I talk about me?”

She gave birth to her daughter in a public hospital in Kathmandu, fearing the private hospitals and their reputation for unnecessary surgeries. The public hospital was “very crowded, like a New York subway.” She labored mostly standing, with no chairs available to sit. When she requested a bed in her last hour of labor the nurses berated her. “The nurse said, 'Are you the princess in the palace?'” Phuyal remembered. “When I gave birth they said, ‘Why are you shouting? Be quiet!’”

A modern Kathmandu woman, Phuyal drives herself to her full-time job and plans to continue her studies through a doctorate. Her husband is “of this generation” and she holds him to his one-time promise that she can study and work as much as she wants. She counts herself among the lucky few Nepali women with access and options, but her birth experience leaves a bitter taste that fuels her work for rural women. “If I am an educated woman, I know things and my experience is this, what can it be for the women in the Far West?”

Across town, Pushpa Bhatt is a global doctor with roots in India and ties to the U.S. She worked as a physician for eight years in the Far West and brims with stories of her medical practice clashing with local cultural practices—so many she wrote a forthcoming book about it. When she assisted with deliveries she was temporarily treated as untouchable along with the new mother, so strong was local aversion to menstrual blood.

Bhatt holds a masters degree in public health from Columbia University and now works as a technical adviser to the Safe Motherhood Network Federation. But her transition from government doctor to NGO technocrat was anything but smooth.

Her voice dropped as she recounted traveling with a male colleague to Pokhara, Nepal’s second largest city, for a workshop. “He came to my room at 12 o’clock midnight and he said, 'Pushpa would you like to sleep with me with condom or without condom?'”

Shocked, scared, embarrassed and shaken, she reported the incident to a superior in the ministry of health: “She said, 'Look if you talk to other people they will say she is a loose character woman, so don’t talk to anyone.'” Bhatt would have nothing of it and quit her job. But that degradation lingers with her.

“I, a married woman, qualified, educated, with much more education than that man, if he is thinking of me in that way, what about the other people who are not qualified, who have no voice?”

Bhatt describes Nepali women as third-class citizens, ranked behind men and milk-producing cows. “Women are becoming stronger,” she said, “but certainly still it will take a long [time]. It is a long, long, long, long way. It is not a short solution.”

“If I do not have support, if I do not have backing, I cannot raise my voice, so in the village, poor women, how can they raise their voice? They will be expelled out. Who will talk for them? Who will support? Tell me! This is the story.”

And this is the story we are here to report. These fierce, educated women have gender-based scars, deep-rooted experiences of Nepal’s gender disparity. The women they work for in the Far West suffer parallel trials with fewer tools to address them.

Follow this project on twitter @AllynGaestel, on this page, and on Tumblr as we document Nepali women’s struggles to assert themselves amidst deeply entrenched social, cultural and religious practices.

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In rural western Nepal, many women are sent to live in animal sheds while they are menstruating. This ingrained cultural practice, called chaupadi, can wreak unintended havoc on their health.

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