Recent political commitments to apologise to Dalit and marginalised communities for historical discrimination have reopened an important national conversation in Nepal. Recognition matters. A public apology matters. But an apology alone is not enough. Real change begins only when acknowledgement leads to action.
For many years, Dalit and marginalised women have lived under three forms of exclusion at once: caste-based discrimination, gender inequality, and economic and social disadvantage. These are not abstract problems. They shape everyday life and deeply affect health. Many women still face barriers to maternal and reproductive health care, poor treatment in health facilities, weak outreach services in their settlements, and a lack of dignity within public systems. If this national conversation is to mean anything, it must move beyond symbolic acknowledgement and lead to concrete reforms.
Barriers from the Start
Dalit communities in Nepal have long faced exclusion from public spaces, shared resources like water sources, and social institutions. Although the law has changed, the legacy of caste discrimination remains strong in many places. Many Dalit families still live at the edge of villages, in remote settlements. For women, especially during pregnancy, reaching a health facility can mean walking for hours. In emergencies, delayed transport or the absence of ambulance services can become critical challenges.
Even when women manage to reach care, the financial burden remains heavy. Services may be officially free, but families still have to pay for transport, medicines, diagnostic tests, food, and accommodation for accompanying relatives. Missing a day’s wage can also be a serious loss for households already struggling to survive. For poor families, the cost of seeking care is often much higher than it appears on paper.
Discrimination Within the Health System
Discrimination inside health institutions also remains a serious concern. Some women experience neglect, shorter consultations, or a sense that their pain and symptoms are not taken seriously. These experiences weaken trust in the health system. When people expect disrespect, they delay care, avoid follow-up visits, or turn to traditional healing options until the condition becomes severe.
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Dalit women are often less likely to receive timely antenatal care. Distance, poverty, lack of support, and fear of mistreatment all contribute to this. As a result, some women continue to give birth at home without skilled support, increasing the risk of complications for both mother and newborn. Postpartum care is also often missed, and access to safe abortion and reproductive health services can remain limited.
WASH and Social Exclusion
In some communities, caste-based untouchability still affects access to shared water sources. This forces them to depend on distant or unsafe alternatives. Poor water, sanitation, and hygiene increase the risk of infection and add another layer of hardship for pregnant women, mothers, and children.
Social exclusion also cuts women off from community support. Mothers’ groups (Aama samuha) are important spaces for sharing health information on pregnancy, nutrition, sanitation, child care, and family planning. But stigma and discrimination can limit Dalit women’s participation in these groups. When women are excluded from such spaces, they are excluded not only socially, but also from knowledge that can protect health.
Household Decision-making
In many homes, a woman may know she needs care but may still not be able to seek it immediately. She may need money, transport, or permission from her husband or in-laws before going to a health facility. As a result, decisions about antenatal check-ups, institutional delivery, family planning, abortion care, or postnatal follow-up are often shaped by others rather than by women themselves.
When women do not have the right to speak or are too afraid to raise their voices, check-ups are missed, treatment is delayed, and home deliveries continue despite known risks.
This lack of autonomy is directly associated with social and financial dependence. In poor households, a woman’s health is often given less priority when the family is struggling to meet daily needs. When caste, gender, and poverty come together, women face barriers not only outside the home, but within it as well.
What Needs to be Done
Nepal does not need to start from scratch, but it does need to move beyond broad commitments and toward more targeted action. If health equity is to be taken seriously, the system must become more proactive in reaching women who are most likely to be left behind. Female Community Health Volunteers and local health workers can play a stronger role by identifying pregnancies early, keeping ward-level records of women in excluded settlements, making regular home visits, and following up when antenatal or postnatal care is missed.
At the same time, the financial burden associated with maternal healthcare remains insufficiently addressed. While maternity services may be officially free, women and their families often continue to bear substantial indirect costs, including transport, medicines, diagnostic tests, food, and lost wages. These out-of-pocket expenses can be considerable enough to delay or even prevent timely care-seeking. Therefore, stronger transport support and assistance in reaching higher-level health facilities should be provided, especially for women facing the greatest barriers.
Discrimination inside health institutions needs to be treated as a health system issue rather than a private social problem. Greater representation of health workers from marginalised communities can help build trust, but trust also depends on accountability. Simple complaint systems and regular monitoring can help make health facilities safer and more responsive for women who have long faced exclusion.
There is also a need to recognise that many barriers to care are shaped long before a woman reaches a health facility. Improving health outcomes requires working not only with women, but also with husbands, in-laws, community leaders, and local groups who influence decisions about care. Dalit women also need to be included in mothers’ groups, ward health committees, and local planning so that health interventions respond to their real needs and experiences.
Apology is Not Enough
If the current political moment is serious about justice, then an apology must be followed by reparative policy. That means directing more resources, more accountability, and more attention towards the women and communities who have carried the heaviest burden of exclusion for generations.
Nepal has made undeniable progress in health over the years. But progress that does not reach Dalit women equally cannot be called inclusive progress. And a public health system that still allows caste, poverty, and gender to determine who receives timely and respectful care is not yet delivering justice.
Dalit women do not need sympathy. They need a health system that sees them, reaches them, and treats them with dignity.
