My paper examines the intersection between structural violence, health, healthcare and the daily lives of women living in the mountain villages of Jumla.  Structural violence, a theoretical perspective first described by Galtung (1969) and recently championed by Farmer (1996; 2004), is a contested frame for understanding the causes and effects of poverty and social injustice on the most disadvantaged (Schleper Hughes and Bourgois, 2004).

However, the framework of structural violence has rarely been applied to Nepal and the usefulness of the concept has not been adequately evaluated (Basnyet, 2015; Kohrt, 2009).  In particular, the voices of women engaged in subsistence agriculture, living outside district capitals have been absent.  Women living in remote areas, burdened by life and work, can be invisible to researchers leading to unhelpful generalisations about their capabilities, lives and experiences.

My paper addresses the concept of structural violence and analyses its value for understanding the concepts of health and healthcare in the lives of women in Jumla.  Jumla is one of the poorest, most remote and most poorly served districts, with HDI rank of 68 out of 75 districts of Nepal.   Natural impediments of steep mountains, variable water supply and harsh winters are compounded by limited access to secondary healthcare and education.

As part of a public health project I performed in depth semi-structured interviews with 17 women and a larger quantitative survey of 519 women.  All of the participants are subsistence farmers living in villages outside the district capital.  The main focus is on their experience and understanding of health and healthcare for themselves and their children.  I compare my findings with the theoretical literature on structural violence and studies using the theoretical framework of structural violence done in other low income settings.

I argue that the lived experience of these illiterate, impoverished village women is rich and nuanced,   overcoming the stereotype of the powerless that is offered by the frame of structural violence.  Although living in absolute poverty in a traditional patriarchal Hindu culture they are powerful, resilient and hopeful.  Jumli women are able to manoeuvre at the margins of their cultural context, there are overwhelmingly pragmatic regarding health and healthcare, seizing autonomy where possible and embracing change.

In conclusion, the detailed examination of Jumli women’s own voices offers a new understanding of the way in which village women negotiate their structural and cultural landscape, particularly in relation to health and healthcare.  The theory of structural violence, expedient for understanding the causes and effects of poverty, offers an incomplete and partial truth, too imprecise to appreciate the elusive experience of the remarkable women of Jumla.

[1] The architect of the winning design Abishek Mananda Bajyacharya stated its objective to memorialize the anonymous heroes of the country and to reinforce a sense of unity (Interview, 19 April 2012). Another design uses height to emphasize victory over the monarchy, another uses organic forms to suggest freedom from autocracy and another provides a rolling landscape that suggests peace and allows people to choose meaning for themselves. A seminar was held on 28 April 2009 to discuss the designs and it was commonly agreed that the designs presented lacked elements that promote [national] unity (
[2] E.g. Monumental Molehill. The Kathmandu Post. 2009 May 30.
[3] The architect Abishek Mananda Bajyacharya described how he was asked to redesign the memorial without the Gallery hall. Perhaps revealing an uncertainty about what should be displayed there. (Interview 19 April 2012)
[4] Gooneswardena on Sri Lanka where the Sri Lankan National Monument was commissioned in 1989 and has never been built (2004). She believes that this is because of the abstract nature of the design itself – perceived not to show unity, but fragmentation.