Background: Gender inequality and violence are not mutually exclusive phenomena but complex loops affecting each other. Women in Nepal face several inequalities and violence. The causes are diverse, but most of these results are due to socially assigned lower positioning of women. The hierarchies based on power make women face subordination and violence in Nepal. The study aims to explore participants' understanding and experience to identify the status of inequality for women and how violence emerges as one of its consequences. Furthermore, it explores the causes of sex trafficking as an example of an outcome of inequality and violence. Method: The study formulated separate male and female groups using a purposive sampling method. The study used a multistage focus group discussion, where the same groups met at different intervals. Six focus group discussions, three times each with male and female groups, were conducted in a year. Thirty-six individuals, including sixteen males and twenty females, were involved in the discussions. The study used constructivist grounded theory for the data analysis. Results: The study participants identify that a power play between men and women reinforce inequality and increases the likelihood of violence for women. The findings suggest that the subjugation of women occurs due to practices based on gender differences, constricted life opportunities, and internalization of constructed differences among women. The study identifies that interpersonal and socio-cultural violence can result due to established differences between men and women. Sex trafficking, as an example of the outcome of inequality and violence, occurs due to the disadvantageous position of women compounded by poverty and illiteracy. The study has developed a concept of power-play which is identified as a cause and consequence of women's subordination and violence. This power play is found operative at various levels with social approval for men to use violence and maintain/produce inequality. Conclusion: The theoretical concept of power play shows that there are inequitable power relations between men and women. The male-centric socio-cultural norms and practices have endowed men with privilege, power, and an opportunity to exploit women. This lowers the status of women and the power-play help to produce and sustain inequality. The power-play exposes women to violence and manifests itself as one of the worst expressions used by men.

Worldwide, a large number of women experience disrespectful and abusive behavior from care providers during childbirth. This violates the rights of women to attain respectful care. This study aimed to find out the women’s experience of disrespect and abuse during institutional delivery. A cross-sectional study was conducted in two hospitals of Morang district situated in eastern Nepal. Two hundred eighteen women from a public hospital and 109 women from a private hospital (N = 327) with normal vaginal delivery were selected purposively for this study. Data were collected through face-to-face interviews using a structured questionnaire based on the Disrespectful and Abusive Scale by Bowser and Hill. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%), respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively. Ethnicity, religion, place of delivery, and numbers of living children were the main predictors of reporting disrespect and abuse. Overall, the occurrence of disrespect and abuse during institutional delivery was found to be very high.

‘We are looked down upon and rejected socially’: a qualitative study on the experiences of trafficking survivors in Nepal

Gender inequality and violence against women are present in every society and culture around the world. The intensities vary, however, based on the local guiding norms and established belief systems. The society of Nepal is centered on traditional belief systems of gender roles and responsibilities, providing greater male supremacy and subordination for the females. This has led to the development and extensive practices of social gender hierarchal systems, producing several inequalities and violence toward women. This study has utilized Forum Theater interventions as a method of raising awareness in 10 villages in eastern Nepal. The study aimed to understand the perception and changes in the community and individuals from the interactive Forum Theater performances on pertinent local gender issues. We conducted 6 focus group discussions and 30 individual interviews with male and female participants exposed to the interventions. The data analysis utilized the constructivist grounded theory methodology. The study finds that exposure and interactive participation in the Forum Theater provide the audience with knowledge, develop empathy toward the victim, and motivate them to change the situation of inequality, abuse, and violence using dialogues and negotiations. The study describes how participation in Forum Theater has increased individual’s ability for negotiating changes. The engagement by the audience in community discussions and replication of efforts in one of the intervention sites show the level of preparedness and ownership among the targeted communities. The study shows the methodological aspects of the planning and performance of the Forum Theater and recommends further exploration of the use of Forum Theater in raising awareness.

Background: Ensuring respectful maternity care is crucial to promote positive childbirth experiences among women. Globally, 22–100% women report experiencing at least one form of disrespect and abuse during facility-based birth, with a study in Nepal reporting 100% prevalence. Thus, interventions like Forum Play are needed to promote respectful maternity care but remain scarce. Forum Play is a participatory theatre technique which encourages the participants to create scenes based on their own experiences illustrating a situation of oppression. This study aimed to assess the effectiveness of a pilot Forum Play intervention in promoting respectful maternity care by investigating self-reported perception and behaviour among care providers. Methods: A quasi-experimental pre–post study with a control group was conducted among doctors and nurses in two tertiary hospitals in Nepal. Participants involved in providing care or interacting with women during labour and delivery were purposively selected for the intervention and control groups. The intervention group comprised 25 care providers (14 nurses and 11 doctors), while the control group included 75 care providers (42 nurses and 33 doctors). Two half-day Forum Play workshops were conducted separately for nurses and doctors in the intervention hospital. Data were collected using a self-administered structured questionnaire at baseline and two months post-intervention in both groups; however, the design was not strictly parallel. In the control hospital, data were collected later at the same intervals to provide contextual comparison. Data were analysed using IBM statistical package for social sciences version 20. Descriptive statistics (frequency, percentage, mean and standard deviation) were used to measure the self-reported perception and behaviour on disrespect and abuse and perceptions of respectful maternity care. Mann Whitney U test was used to compare groups and Wilcoxon Signed Rank test was used to assess within-group changes before and after the intervention. Results: There were no differences in background characteristics between intervention and control groups (p=>0.05), nor in the overall disrespect and abuse of women at baseline (p = 0.09 to 0.35) whereas significant differences were observed at follow-up (p=<0.001 to 0.004, r = 0.33 to 0.61). There were no significant differences in perception scores towards respectful maternity care between the groups at baseline while significant differences were found at follow-up (z = −3.25, p = 0.001 and r = 0.32). The perception score was significantly higher in the intervention group after the intervention (z = −3.073, p = 0.002 and r = 0.61) while no significant difference was observed in the control group (z = −0.120, p = 0.90 and r = 0.05). Conclusion: Forum Play as a method of participatory intervention has the potential to enhance positive perception and behavioral change among care providers towards respectful maternity care. Scaling up the Forum Play intervention and systematically exploring women’s experiences are essential to determine its actual effectiveness.