KATHMANDU, Oct 8: For many women, pregnancy begins with hope: preparing for childbirth, welcoming a new baby and expecting care from family and health workers.
But for some women in Nepal, pregnancy also brings fear.
It can mean returning home to a husband who drinks and beats her, being pressured to terminate a pregnancy because the fetus is a girl, or being forced to have sex despite pain. Even at health facilities, women may face humiliation, inadequate information, examinations without proper consent or neglect when they need care.
For Mina, a 21-year-old woman from Mugu, pregnancy became a source of fear at home.
Five months pregnant, she told researchers that her husband, a daily wage laborer, spent much of his earnings on alcohol. When he returned home, she said, he beat her, accused her of carrying another man's child, and pressured her to terminate the pregnancy and leave the house.
Another 21-year-old woman from Mugu, referred to here as Saraswati, said her husband forced her to have sex even when she was pregnant and in pain. Repeated beatings, she told researchers, left her physically weak and feeling unable to endure the situation.
Their experiences are part of a 2026 fact-finding study by the Forum for Women, Law and Development (FWLD), which examined violence and violations of women's rights during pregnancy, childbirth and the postpartum period.
The study covered all seven provinces, 14 districts and 28 local units. Researchers surveyed 1,680 women—560 each during pregnancy, childbirth and the postpartum period—and interviewed health officials and providers. They also conducted focus group discussions, in-depth interviews and observations at 43 health facilities.
The findings are stark: 38.4% of pregnant women, 37.9% of women during childbirth and 35.9% of postpartum women reported experiencing some form of violence during the respective periods.
Violence begins at home
A woman does not have to leave her home to encounter violence. Sometimes, the person closest to her is the one causing it.
Kamala, 41, from Dang, told researchers that her husband forced her to have sex during pregnancy. When she refused, she said, he accused her of having an affair.
In Kapilvastu, Anita, 22, said she was expected to continue household chores during pregnancy and was humiliated or beaten over minor mistakes. She said her husband hit her, including around her abdomen and lower back.
In Sankhuwasabha, Rupa, 29, described being humiliated after giving birth to another daughter. She said her mother-in-law complained about the birth, while her husband, who she said drank daily, accused her of having an affair and threatened to marry another woman.
Among women who reported violence, family members and relatives were identified as perpetrators by 60% of pregnant women, 64.4% of women during childbirth and 71.1% of postpartum women. Husbands were identified by 52.1%, 44.9% and 47.8%, respectively. The categories overlap, meaning women could identify more than one perpetrator.
Emotional violence was the most widely reported form, affecting 30.7% of pregnant women, 32.7% of women during childbirth and 30% of postpartum women. Physical violence was reported by 4.5%, 3.2% and 4.5%, respectively, while sexual violence was reported by 16.1%, 9.5% and 16.4%.
FWLD Executive Director and lead researcher Sabin Shrestha said violence during pregnancy and childbirth occurs within families, communities and health facilities.
“Superstitions, traditional beliefs and gender bias, including preferences based on whether a woman gives birth to a son or daughter, also contribute to such violence,” he said.
He said reporting remains low because women often depend on family members for care and support.
According to Nepal Police, 14 complaints involving pregnant women who were beaten and subsequently suffered miscarriages were registered in fiscal year 2024/25. Shrestha said some cases are treated as family disputes and settled through reconciliation, while difficulties in establishing a direct link between assault and miscarriage can also discourage reporting.
When the baby is a girl
For some women, violence begins with the question of whether the baby will be a boy or a girl.
A woman from Siraha who already had two daughters told researchers that her mother-in-law took her for a fetal sex determination test. When the result showed a girl, she said her husband pressured her to terminate the pregnancy, while her mother-in-law scolded her and her husband beat her.
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In Surkhet, Laxmi, 23, said she underwent three abortions after fetal sex identification following pressure from her in-laws to have a son. She estimated that the procedures cost her family more than Rs 100,000.
The pressure can continue after childbirth. A 19-year-old woman from Mugu said she was not taken home after giving birth to a daughter but was kept at a neighbor's house. Another 19-year-old woman from Mugu, six days after childbirth, said she was staying outside her family home because of a tradition that considered postpartum women impure or untouchable.
Krishna Kumari Paudel Khatiwada, spokesperson and member of the National Women Commission, said son preference and traditional beliefs continue to reinforce gender inequality.
“Even educated families continue to discriminate against women because of son preference,” she said, stressing the need to take awareness and education campaigns to villages and schools.
Vulnerable even at health facilities
For a woman in labor, reaching a health facility should mean reaching safety. But the FWLD study found that some women encountered another form of vulnerability there.
A 27-year-old postpartum woman from Kaski, referred to as Laxmi, told researchers that she cried and asked a doctor to stop during an internal examination because she did not understand what was happening. She said the doctor scolded her instead of reassuring her.
Puja, 24, from Kathmandu, said a health worker behaved rudely while she was in severe labor pain and told her that the pain was normal and had to be endured.
The findings show that inadequate communication was widespread. Some 14.6% of pregnant women, 14.3% of women during childbirth and 13.9% of postpartum women said health providers did not provide information about the services they received.
The study also found that 15.2% of pregnant women and 13.8% of postpartum women underwent physical examinations without informed consent.
Among women during childbirth, 41.1% said they were not given a choice or alternative regarding the method of delivery, including vaginal delivery or cesarean section. Nearly one in five—19.5%—said providers did not create an environment where they could ask questions and receive proper answers.
Information and consent are not simply matters of courtesy. Without them, women cannot meaningfully participate in decisions about their own care.
Privacy is part of care
Pregnancy and childbirth involve some of the most intimate aspects of a woman's life. Yet 21.1% of pregnant women, 25.2% of women during childbirth and 27% of postpartum women said their privacy was not maintained during service delivery.
In Gandaki, the figure was even higher: 52.5% among women during childbirth and 56.3% among postpartum women.
The study also found that 14.1% of pregnant women, 15.4% of women during childbirth and 13.2% of postpartum women said providers failed to keep their personal information confidential.
Health workers cited staff shortages, heavy workloads and exhaustion as factors contributing to poor communication and irritability.
Dr. Gauri Pradhan, chief of the Family Welfare Division under the Ministry of Health and Food Safety, said health workers also face difficult working conditions.
“When we talk about standards and quality, we are still far from meeting WHO standards,” she said. Institutional deliveries have risen from around 10% when current staffing levels were established to about 80% today, while staffing has remained largely unchanged.
She said health workers also face unpredictable working hours, low salaries and pressure from patients and the public, but added that they continue to receive training in Respectful Maternity Care.
The pressures facing health workers, however, do not make mistreatment acceptable. They point instead to the need for adequate staffing, resources and training.
When neglect becomes harm
Violence does not always look like a slap or a shouted insult. Sometimes, it looks like a woman waiting while no one comes.
The study found that 18.4% of pregnant women said they were unable to obtain essential services they needed, while 17.1% said providers did not take their questions or concerns seriously.
Among women who gave birth at health facilities, 12.3% said they were left unattended when they needed essential assistance, while 7.9% said they received no assistance even after asking for it.
For postpartum women, 12.9% said their health and need for rest were neglected, 9.3% received no help with infant feeding, hygiene or pain management, and 19.1% received no emotional support or counseling.
The study also found that 24.3% of postpartum women were not allowed adequate rest and 9.1% did not receive adequate nutritious food.
For Maya, 20, from Lamjung, recovery after childbirth meant returning to household work. She told researchers that her mother-in-law expected her to wash dishes and clothes from morning to night despite her need for rest and adequate food.
In Kathmandu, Nirmala, 19, said her in-laws wanted her to return home only nine days after a cesarean section to help with the rice harvest. She said her husband warned that her stitches could tear, but his family dismissed the concern.
The postpartum period is often treated as the end of the medical story. For women, it is the beginning of another stage of recovery.
Poverty and distance
For women in rural and remote areas, access itself can become a barrier.
The study found that 5.5% of pregnant women surveyed said they experienced delayed care or were denied services because they could not pay pregnancy-related fees. In rural Madhesh, the reported figure was 22.5%.
Health workers also reported shortages of staff, beds, blood, ambulances, equipment and other infrastructure.
But access should not be measured only by whether a woman reaches a hospital. She may reach a facility without receiving the information she needs, receive treatment without being asked for consent, or give birth safely but leave humiliated or without emotional support.
Reaching a health facility is not the same as receiving respectful care.
What the police numbers reveal
According to Nepal Police data cited by FWLD, 14 cases involving forced miscarriage following physical assault against pregnant women were registered nationwide in fiscal year 2024/25. Twelve were registered in Madhesh and one each in Lumbini and Koshi.
These figures should be read carefully. Fourteen is the number of cases registered by police, not an estimate of the total number of such incidents in Nepal.
The small number may reflect underreporting, family pressure, lack of awareness and barriers to accessing justice.
DIG Abi Narayan Kafle, spokesperson for Nepal Police headquarters, said some incidents remain unreported because they are considered family matters or women do not wish to pursue legal action.
He said complaints can now be filed through social media, online platforms and the 100 hotline, and urged women facing violence or mistreatment during pregnancy or after childbirth to report it.
Rights on paper, gaps in practice
Nepal's laws provide significant protections for women.
The Constitution guarantees safe motherhood and reproductive health, protects privacy and prohibits physical, mental, sexual and other forms of violence against women. The Safe Motherhood and Reproductive Health Rights Act provides rights related to reproductive health services, information, counseling, confidentiality and maternal care. Other laws also protect informed consent, equal treatment and privacy.
Yet FWLD says gaps remain in implementation and accountability.
Binod Chandra Devkota, an advocate and information officer at FWLD, said obstetric violence has long been viewed as part of sexual and reproductive health rights but has received insufficient attention.
He said stronger legal recognition and accountability mechanisms are needed to ensure that women can seek remedies when their rights are violated.
Health Secretary Bikash Devkota, however, argues that Nepal's existing laws already provide a framework for protecting women.
“Rather than introducing a separate law on obstetric violence, I believe our existing laws, including the Safe Motherhood law, already cover the rights and care women should receive,” he said. “The main issue is ensuring these provisions are properly implemented.”
He called for stronger implementation of existing laws, guidelines and procedures and greater coordination among relevant agencies.
Changing the experience of motherhood
FWLD recommends defining respectful maternity care more clearly, strengthening mechanisms to address obstetric violence, ensuring skilled health workers, improving infrastructure, establishing grievance mechanisms and enforcing requirements related to information, consent and confidentiality.
It also recommends grievance units at health facilities and stronger monitoring by federal, provincial and local authorities.
Health workers should receive training on respectful maternity care and human rights, while communities need to understand that respectful treatment is not a favor. It is a right.
A woman should not have to know the law before she can expect dignity.
She should not have to challenge a doctor while in labor to receive an explanation.
She should not have to convince her husband that pregnancy does not give him control over her body.
And she should not have to accept isolation after childbirth simply because a practice has existed for generations.
The women interviewed for the FWLD study came from different provinces, communities and circumstances. Their experiences were different, too.
But they share a common thread: at a time when women should be surrounded by care, some are instead negotiating fear—at home, in their communities and sometimes in the very facilities where they seek help.
The study is exploratory and reflects experiences reported by participants during the periods examined. It is not a national lifetime-prevalence survey.
But its central question is difficult to ignore:
What does it really mean to care for a mother?
It means more than a hospital bed, a delivery kit or a safe birth.
It means listening to her, explaining what is happening, respecting her decisions, protecting her privacy and giving her time to recover.
Above all, it means ensuring that pregnancy, childbirth and motherhood never become periods in which a woman's dignity and safety are treated as secondary.
Editorial Note: Names of women who shared their experiences with researchers have been changed to protect their privacy.
