The beginnings: When experience taught me what education had not
When I began my career as a health professional, I knew very little about gender. Although I had worked on women's empowerment and women's health projects, I did not fully understand what gender meant, how it differed from sex, or how gendered power relations shaped women's lives. My understanding of gender did not emerge from a single lecture or textbook. It evolved gradually through my lived experiences, the stories women shared with me, and the questions that arose from my work.
In June 1996, I joined the Kathmandu-based Women's Rehabilitation Centre (WOREC) Nepal as a Rehabilitation In-charge. My responsibility was to support the rehabilitation of women and girls returning from brothels, particularly those who had experienced exploitation and trafficking. It was here that I first encountered, at close quarters, the devastating consequences of gender-based discrimination, social exclusion, and unequal power relations. I listened to women and girls recount how people from their own villages, and sometimes even members of their own families, had deceived or trafficked them into sexual exploitation in Indian brothels. Their stories revealed a world of vulnerability, betrayal, and suffering that I had never fully understood through my formal nursing education.
I heard the word gender occasionally, but its deeper meaning remained unclear to me. I cannot remember whether I learned about the distinction between sex and gender during my nursing studies, but I am certain that I did not then have a meaningful understanding of the concept. Even when I worked as a Social Mobilisation Officer for CARE Nepal's Polio Eradication Initiative Project, from February 2001 to January 2004, my understanding remained limited. I continued to encounter discrimination through conversations with colleagues and the experiences of women in the communities where we worked, yet I had not developed the conceptual tools to understand fully why these inequalities persisted.
Remarkably, even after completing my Master of Public Health in Australia in 2006, I had not yet developed a comprehensive understanding of gender. Looking back, I realise that my professional journey had already brought me face to face with gender inequality long before I acquired the language to explain it. My early learning came not from theory, but from listening, observing, and witnessing how social and economic disadvantage could shape women's choices, opportunities, dignity, and lives.
An awakening: Finding a purpose beyond professional practice
After completing my Master of Public Health, I returned to Nepal in April 2006 with a growing determination to make a meaningful difference in the lives of women and girls. While teaching Bachelor of Public Health and Bachelor of Nursing students at HOPE International College, affiliated with Purbanchal University, I came across Nepal's newly endorsed National Policy on Skilled Birth Attendants 2006, issued by the Ministry of Health and Population. That policy became a defining moment in my professional life.
It helped me recognise a practical opportunity to contribute to women's health while supporting the development of midwifery in Nepal. I began thinking more seriously about how I could help educate, empower, and energise women who had experienced discrimination, domination, and oppression throughout their lives—from the womb to the tomb.
Three interconnected ideas began to take shape in my mind.
First, I wanted to empower nurses to make a difference in other women's lives while gaining firsthand experience in social entrepreneurship. I believed that nurses could do more than work within existing health institutions; they could also establish and lead services that responded directly to women's needs.
Second, I wanted to create an alternative birthing environment for women who deserved respectful, affordable, and compassionate maternity care. I had previously worked as a Staff Nurse at Paropakar Maternity and Women's Hospital (PMWH), so I knew how crowded the hospital could be. For many socioeconomically disadvantaged women, it was one of the few accessible options for maternity services. I wondered whether we could establish another place where women could give birth safely, affordably, and with dignity.
Third, I wanted to create a practical learning environment for newly graduated nurses, where they could develop their skills while providing care to women who needed it most. Over time, I hoped that such a centre could also become a training site for skilled birth attendants, contributing to the broader development of Nepal's maternity care workforce.
These were not simply professional ambitions. They were rooted in a conviction that women should have access to respectful healthcare and that nurses themselves could become agents of social change.
Turning a vision into reality: Establishing Birthing Centre (APS Kendra)
With these ideas in mind, I began working towards establishing what I envisioned as Nepal's first and only women-nurse-led birthing centre. I gathered 14 female health professionals who were willing to join the initiative and sought advice from Dr. Laxmi Pathak, a former Director General of Health. He encouraged me to move forward and described the initiative as a valuable undertaking.
However, he also offered a humorous warning. Because I had brought together an all-women founding group, he cautioned me to ensure that everyone would still have hair on her head in the end. His remark alluded to the possibility that disagreements among the women might become so heated that they would end up pulling one another's hair!
I found his comment amusing, but it also made me think deeply. Establishing a new organisation with 14 founding members would require more than a shared vision. It would demand patience, mutual respect, conflict management, and a willingness to work through differences without allowing disagreements to destroy the initiative.
I took his warning seriously. I knew that if we were to turn our shared vision into a functioning service, I would need to remain calm, take responsibility, and find ways to keep the group focused on its purpose. Rather than allowing potential disagreements to undermine the initiative, I resolved to do my best to ensure that the birthing centre could become a reality.
On 22 April 2007, we registered the centre under the name Aadharbhut Prasuti Sewa (APS) Kendra, which translates into English as the Basic Maternity Service Centre. I was appointed Managing Director, responsible for its day-to-day operations and overall management. Having imagined the centre and helped bring its founding members together, I felt a strong personal responsibility to make it work.
Yet establishing the centre was only the beginning. The real challenges emerged as we began providing services and interacting with pregnant women and their families.
Seeing the invisible barriers: Who decides about women's health?
While managing APS Kendra, I encountered many pregnant women who needed permission from their husbands or other household members, even their mothers-in-law and fathers-in-law, before they could seek healthcare. These experiences troubled me. Why should a woman need someone else's approval to obtain care for her own health? Why did decisions about pregnancy, childbirth, and maternal healthcare so often rest with people other than the women directly affected?
These encounters prompted me to think more critically about the relationship between women's health and the power structures within their households. I began to recognise that access to healthcare was not determined by the availability or affordability of services alone. It was also shaped by women's decision-making power, their social position, and the authority exercised by husbands and senior family members.
Interestingly, my Master of Public Health research had already offered me an early insight into these issues. In 2005, I conducted a major research project entitled Knowledge, Attitudes and Practices in Relation to Maternal Health Care in Rural Nepal: A Study of Married Women of Reproductive Age and Their Household Heads. The study involved 336 married women of reproductive age and 335 household heads in Mahottari District, where I had previously worked through CARE International in Nepal.
The research helped me examine gaps in knowledge and understanding of antenatal, childbirth, and postnatal care among household members who often influenced maternal healthcare decisions, particularly husbands, mothers-in-law, and fathers-in-law. My subsequent experiences at APS Kendra brought those research findings to life. What I had examined through a research project, I was now witnessing in women's everyday experiences.
I began to understand that improving maternal health required more than providing clinical services. It also meant addressing the social relationships, expectations, and unequal power structures that could prevent women from making decisions about their own bodies and health.
The personal cost of commitment: Learning to value my own contribution
In the early days of APS Kendra, my commitment was all-consuming. I sometimes spent as long as 72 consecutive hours at the centre without returning home, accompanying the founding members who were also providing services to women. I was determined to keep the centre functioning, even when doing so demanded extraordinary personal sacrifices.
Although I was a trained nurse, my clinical experience did not equip me to provide the full range of services required by the centre. Apart from basic antenatal check-ups and counselling, I needed the support of colleagues with more extensive clinical expertise. I therefore requested each co-founding member with relevant skills to contribute time to the centre. Of the 14 founding members, six agreed to have their names included in the duty roster, which I personally managed.
For a year, I devoted myself to keeping the centre running. My commitment was driven by the belief that we were building something meaningful for women who had few alternatives. But dedication alone could not resolve the practical challenges of sustaining the service or supporting my own livelihood.
One day, our chairperson, Rashmi Rajopadhyaya, spoke to me about my future. She had played a key role in establishing the birthing centre at Patan Hospital in 1995, with the support of Dr. Geetha Rana, an obstetrician known for her supportive approach to women's care. Rashmi asked me why I was not looking for paid employment to support myself.
Her words hurt me at first. I felt that she had not fully recognised the value of the time and effort I was contributing. While the other founding members were working full-time and earning an income, I was volunteering extensively to keep the centre operational. I wondered whether my dedication had gone unnoticed.
With time, however, I understood that I had misinterpreted her intention. She was not dismissing my contribution; she was concerned about my livelihood and future. Her advice forced me to confront a difficult truth: even when our work is meaningful, we must find ways to sustain ourselves if we are to continue contributing over the long term.
I accepted her advice and applied for a position with the German Development Cooperation, GIZ. On April 2008, I joined the project Support of Measures to Strengthen the Peace Process (STPP), where I worked with the Maoist People's Liberation Army (PLA) in the cantonments, contributing to health-related activities. I was also assigned the responsibility of gender focal person for the project.
That appointment became a turning point in my intellectual and professional development.
Discovering gender as a framework for understanding power
Before joining GIZ, I had heard the word empowerment repeatedly, but I had not fully grasped the concept of gender or how it could help explain the inequalities I had witnessed throughout my career. Working as a gender focal person created an opportunity to explore these questions more systematically.
For the first time, I began to understand gender not merely as a term associated with women or women's programmes, but as a framework for examining how societies assign roles, distribute resources, exercise authority, and create unequal opportunities. I started to see connections between the individual experiences of women I had met and the wider structures that shaped their lives.
One resource that captured my attention was the Global Gender Gap Report, published by the World Economic Forum since 2006. It introduced me to a comparative framework for examining gender disparities across four dimensions: health and survival, educational attainment, economic participation and opportunity, and political empowerment. The framework helped me look beyond individual experiences and consider how gender gaps could be examined at institutional and societal levels.
I also began to appreciate the importance of distinguishing between equality and equity. Equality concerns equal rights, opportunities, or treatment, while equity recognises that different circumstances and structural disadvantages may require different forms of support to achieve fair outcomes. This distinction helped me think more carefully about what meaningful empowerment would require in practice.
My learning did not happen overnight. It developed through professional responsibilities, conversations, reflection, and the gradual process of connecting theory with lived experience. The women I had encountered at WOREC, the pregnant women I supported through APS Kendra, and the household power dynamics explored in my earlier research all took on a deeper meaning as I acquired a clearer understanding of gender.
I began to recognise that the challenges facing women were not isolated problems. They were often connected to wider patterns of unequal power, economic dependency, social expectations, and limited control over decisions affecting their bodies and lives.
From lived experience to doctoral research
My journey into gender studies was therefore neither accidental nor purely academic. It emerged from years of professional engagement with women whose lives had been shaped by exploitation, poverty, discrimination, and unequal decision-making power.
At WOREC, I had heard the painful accounts of women and girls who had experienced trafficking and sexual exploitation. Through CARE Nepal, I had worked with communities and witnessed how social circumstances influenced people's lives. At APS Kendra, I had seen pregnant women struggle to exercise autonomy over their own healthcare decisions. Through my MPH research, I had examined the influence of household heads on maternal healthcare. Finally, my role as a gender focal person at GIZ gave me a framework through which to connect these experiences and investigate the structures underlying them.
These experiences strengthened my conviction that improving sexual and reproductive health and rights required more than clinical knowledge or the provision of services. It required an understanding of gender-power relations: who holds decision-making authority, whose needs are prioritised, whose voices are heard, and who is left without meaningful choices.
Since beginning my development-sector career at WOREC in 1996, sexual and reproductive health and rights had remained at the heart of my professional commitment. Over time, I came to understand that gender and power were essential to examining the barriers women face in exercising those rights.
This realisation ultimately shaped the doctoral research project I conceived and pursued for my PhD in Sexual and Reproductive Health and Gender Power Relations at the University of Sydney, Australia.
Looking back, I can see that my path towards doctoral research began long before I formally studied gender. It began when I listened to the stories of women whose experiences challenged my assumptions, when I questioned why pregnant women needed permission to seek care, and when I struggled to sustain a service I believed women deserved.
My understanding grew through a continuous process of witnessing, questioning, learning, and acting. What began as a commitment to women's health gradually developed into a deeper intellectual and professional engagement with the relationship between gender, power, and sexual and reproductive rights.
For me, gender was not simply a concept to be learned. It became a lens through which I could understand the experiences I had witnessed, question the inequalities I had once struggled to explain, and pursue a more informed and sustained contribution to the lives of women and girls.
