In Nepal, women always get the short end of the stick. They are made second class citizens in their own country because of unequal citizenship rights. And, in underdeveloped parts of the country—especially in the west, but also elsewhere wherever regressive attitudes lie—a woman’s menstruation cycle, too, is vilified; the most visible and degrading form of this being Chhaupadi. However, the level at which infertility and miscarriages have been stigmatised in Nepali society takes this to a whole new level.

Women do not feel comfortable openly speaking about the topic for fear of being marked, even if it is a widespread issue that affects many. But fertility is a multidimensional health issue, beyond genetic or biological problems, and around 8 to 10 percent of people around the world face it. Yet, because of the effects being most visible in women, they usually have to shoulder the burden of it alone. This is entirely unfair. Never mind that men also have fertility problems, and that this can easily be the cause for early-stage pregnancy losses. In fact, male infertility accounts for 40 to 50 percent of the problem couples go through when trying to conceive. And 2 percent of all men have suboptimal sperm, to begin with.

Chemical pregnancies—an early-stage pregnancy loss that accounts for 50 to 75 percent of all miscarriages—are very common and can be caused by a range of factors, including sperm quality. Yet, because such losses occur in the female body, women are blamed for them. Moreover, such miscarriages—even at the earliest stages—more often occur after the administration of a pregnancy test, thereby attaching more emotion to an event that occurs commonly. Yet, again, it is the women’s role that people view negatively and refuse to engage in discussions about.

Miscarriages and other fertility issues have a range of other causes that the woman alone cannot control. Shockingly, government intervention to solve one problem may induce unintended consequences. For instance, the introduction of iodised salt to prevent hypothyroidism has, due to the programme not being updated to match lifestyle trends, begun to cause thyroid problems which, in turn, causes an increase in infertility.

Environmental issues, such as smog, can also be a major factor. So can stress. Ironically, in Nepal, cases of in-laws and family members treating women who have had miscarriages as social pariahs are aplenty; this is bound to increase stress and further deteriorate the woman’s health and ability to carry a pregnancy to term. But the psychological consequences of social stigma can go much deeper than stress. It has been found that post-miscarriage, 30 to 50 percent of women experience symptoms of anxiety and 10 to 15 percent experience depressive symptoms.

The psychological damage from going through something so emotional, and yet having to shoulder it alone, can be tremendous. Nepali society must find a way to be more open about the subject of infertility and pregnancy loss. There also has to be a larger discourse on how men have a major role in pregnancy loss—that is is not the woman’s health or condition alone that causes such incidents to happen. Moreover, the government must actively participate in mitigating social stigma, by mass education. It should also play a major role in fighting infertility issues; institutionalised and cultural aspects, such as food habits, nutrition and the environment are, after all, major causes.