title: Barriers to sexual and reproductive health care among widows in Nepal.
abstract: OBJECTIVE
  To investigate how the social status of high-caste Nepali widows of reproductive age impacts their sexual and reproductive health care.
  
  
  METHODS
  Twenty-one in-depth interviews and 1 focus group (n=6) were conducted between September and November 2012 in the Kathmandu, Kavre, and Chitwan districts of Nepal. Participants were members of Women for Human Rights, Single Women Group. Interviews and the focus group with widows followed a semi-structured interview guide designed to elicit information on sexual and reproductive health problems, knowledge about them, and barriers to care. Two researchers used inductive and deductive coding to analyze transcripts for themes using ATLAS.ti.
  
  
  RESULTS
  Widows reported facing substantial obstacles to accessing sexual and reproductive health care. Widows suspected of having sexual and reproductive health problems, or who discussed or tried to access these services, could be ostracized by their families and experience severe economic and psychological consequences. Additionally, widows feared discrimination, lack of confidentiality, and sexual harassment by male providers if their status was known. These barriers appeared to stem from the perception that sexual relationships are necessary for widows to require care for gynecologic problems.
  
  
  CONCLUSIONS
  Widows expressed a need for sexual and reproductive health care and described cultural and systematic barriers to accessing this care; these barriers need to be addressed.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Haviland
authors.affiliation: Women for Human Rights, Single Women Group, Baluwatar, Nepal.
authors.forename: Abina
authors.initials: A
authors.lastname: Shrestha
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Duke Global Health Institute Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Kohrt
authors.affiliation: Women for Human Rights, Single Women Group, Baluwatar, Nepal.
authors.forename: Hari Maya
authors.initials: HM
authors.lastname: Kafle
authors.affiliation: Women for Human Rights, Single Women Group, Baluwatar, Nepal.
authors.forename: Srijana
authors.initials: S
authors.lastname: Lohani
authors.affiliation: Women for Human Rights, Single Women Group, Baluwatar, Nepal.
authors.forename: Lily
authors.initials: L
authors.lastname: Thapa
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Electronic address: psurkan@jhsph.edu.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
mesh_terms: D000328:Adult; D000368:Aged; D003219:Confidentiality; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D034121:Reproductive Health Services; D012923:Social Class; D057545:Social Stigma; D035862:Vulnerable Populations / Q000523:psychology; D017805:Widowhood; D016387:Women's Health; D055815:Young Adult
keywords: Health services accessibility; Healthcare disparities; Nepal; Reproductive health; Social stigma; Widowhood; Women’s health