It has been over a year since the 7.8 and 7.4 Richter scale-magnitude earthquakes struck the small Himalayan nation of Nepal. The earthquakes, as well as multiple aftershocks, resulted in the deaths of more than 9,000 people and injured more than 22,000 men, women and children.

The disaster exacerbated vulnerabilities in a country that already suffers from poor infrastructure and health service delivery. According to the United Nations Population Fund (UNFPA), the 2015 earthquakes negatively impacted 1.4 million women and girls of reproductive age, and an estimated 93,000 who were pregnant at the time of the first quake.

Since then, about 10,000 pregnant women each month have delivered babies that required emergency obstetric care, and 1,000 to 1,500 women were at risk of pregnancy-related complications and needed Caesarean sections, according to UNFPA.

Many health facilities in the hardest hit areas of Sindhupalchok and Gorkha districts are still operating in tents and damaged buildings. This is a significant barrier for women, especially pregnant women, from accessing safe and reliable health services.

In April 2016, the International Federation of Red Cross and Red Crescent Societies (IFRC) reported that “an estimated four million (Nepali) people were still living in sub-standard temporary shelters in conditions that pose a threat to their health and wellbeing.” The country’s National Reconstruction Authority, the agency tasked with rebuilding homes, only began its work in January 2016, after months of political negotiation. So far, it has only committed $1 billion of the $4.1 billion pool of international donor pledges.

Institutional incapacity, political instability, civil conflict and the four-and-a-half-month blockade at the India-Nepal border have impeded the country’s ability to rebuild following the devastation caused by the earthquakes. This has severely restricted the ability of women and girls to access reproductive health services, education and family planning, resulting in an even greater impact.

Many hoped the approval of Nepal’s constitution in September 2015 would finally return focus to rebuilding efforts and speed up the distribution of funds to those most in need. However, politically motivated, volatile clashes at the India-Nepal border in response to the new constitution triggered a blockade, restricting the import of essential humanitarian goods as well as daily living supplies such as fuel, cooking gas, food and medicines from India.

Within hard-hit areas in Nepal, fuel shortages caused by the unofficial blockade dramatically cut the availability of contraception and maternal health medications. NGOs working on family planning had to look into other funding and procurement methods.

The price of fuel, which became exorbitant due to the shortage, doubled and tripled the cost of providing sexual and reproductive health camps in earthquake-affected hilly and remote regions. In Nepal, the winter months of November to February are the peak time for the government and NGOs to run these health camps in Nepal. However, the blockade led to the cancellation of many of these camps, greatly disrupting many NGO projects and activities. This includes piloting new contraceptive methods and training government health workers in sexual and reproductive health needs. Throughout Nepal, essential reproductive health supplies, medicine and equipment were cut, with clinics and hospitals reporting an inability to provide adequate services.

Even in areas unaffected by the earthquake, such as the flat Terai region, fuel shortages limited transportation. This made it very difficult for healthcare providers to commute to towns and villages where women and girls depend on their services.

When access to contraceptive supplies is restricted, women and adolescent girls lose their ability to make choices about getting pregnant. The lack of availability and access to sanitary items also impacts women’s personal dignity and health, further affecting their sexual and reproductive health rights.

The Nepal National Human Rights Commission’s 2015 report, Key Concerns and Urgent Appeal Regarding Humanitarian Crisis and Its Impact on Human Rights in Nepal, highlighted the impact of border tensions on the people of Nepal, emphasizing the harmful impact on women’s rights and reproductive health. Even though the blockade ended in February 2016, the political instability that ignited the conflict at the border has yet to be resolved.

While Nepal is desperate to rebuild, the continued conflict at the India-Nepal border has intensified a growing health emergency in the disaster-weary country. The complexities of the current situation in Nepal are multifaceted, leading to decreased access to sexual and reproductive health services and family planning services. This impact on the human rights of adolescent girls and women in Nepal cannot be underestimated and needs to be addressed.

The views expressed in this article belong to the authors and may not reflect those of Women & Girls Hub.