[The government of Nepal has also taken initiatives to reduce maternal deaths by 2015. A Safe Motherhood Plan (2002-2017) has been launched to speed up safer motherhood interventions throughout the country. Other complimentary policies and strategies are also formulated in order to meet the overall goal of reducing maternal mortality. However, women living in mountain areas are still lagging far behind to exercise their universal right of having safe childbirth and successful motherhood. More than 90 percent women like Tilu are still giving birth at home without any skilled attendants. The outcomes of such births are often not reported in the media. Without developing reliable information system in the remote rural areas to report facts on maternal mortality, it is hard to accept any government figures including maternal deaths in Nepal.]
By Sabitra Kaphle
Ms. Tilu had a dream to enjoy her motherhood with first born on her lap in some remote village of Mugu district in Nepal. Last summer, she bid farewell to her husband who was heading out to some Indian city for some-kind of job. Manoj, Tilu’s husband, was restlessly awaiting to return home and see his new born baby after he received the message from home that he had become a proud father of a baby boy. Unfortunately, Tilu died because of the complications on her 4th postpartum day leaving behind her newborn all alone. If she had not died, Tilu had a chance to walk for three days from her remote village of Mugu to get to the district hospital where she could have received only basic services. She would have to walk another half day to get to the local airport if she needed blood transfusion. Sadly, Tilu died of the cause which could have been averted, if she were somewhere in some bigger town or city in the country.
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| A mother enjoys with her children in a remote village of Mugu district. Photo WUNRN |
Manoj decided not to return home after he heard his wife's death. The motherless baby also ended his life after few days of his mother’s death. Tilu represents the women forced to die unnatural death in because of complications during postpartum period , there are other 6 women dying everyday due to obstetric reason in Nepal. Similarly, maternal mortality reports that 536,000 women die due to complications developed during pregnancy, childbirth and postpartum period each year and 10 million more suffer from debilitating illnesses and lifelong disabilities around the globe.
It has been evidenced that nearly all these lives could be saved if affordable, good-quality obstetric care services are available 24 hours, 7 days a week in rural areas also. Most of these deaths are caused by haemorrhage, obstructed labour, infection (sepsis), unsafe abortion and eclampsia (pregnancy induced hypertension). Making emergency obstetric care services available to the community is considered as the best approach to manage these complications and prevent unnatural deaths of women like Tilu. However, the reality is that it is like a dream, which can't happen in real life, for women living in remote mountain areas of Nepal. The women in remote Nepal have no access to services, basic supplies and transportations also. It is also agreed internationally that social causes of maternal deaths should be taken seriously in order to minimize the complications during pregnancy and childbirth
Discrimionation against women:
Furthermore, chronic social ills of women such as: discrimination rampant in the society has hindered their opportunity for safe childbirth and successful motherhood. Women involve themselves in countless hours of work. They do not get enough food during their pregnancy and postpartum period. They conceive the baby without being aware of their first menstruation. Their cycle continues getting pregnant one after another within which they have to experience several miscarriages or losses of their pregnancy. Their pregnancy cycle ends either in death or in early menopause. If they have been able to give a live birth during this cycle, they have to grieve the loss of their newborns without giving any name to them. No matter where the world is moving on their health care system, women in remote mountain districts of Nepal are still forced to spend their immediate postpartum in cowshed or in the corner of their house in the name of ‘birth pollution’. There are no health workers at the nearby health centers to support them during any complications. The only option is to walk for three-four days to the district hospital before the term, which seems not justified to those women having responsibility to look after family and also the work in their field.
During my recent visit to one of the remote villages of Mugu, some women questioned me how do I think that they could walk for three days to go to the hospital to deliver a baby ? Yes, I was wrong to ask them why they don’t go to hospital given the distance they need to travel and the burden they have at their homes. This issue has not been seriously at the national level. The access to basic health services is almost non-existant in remote areas of Nepal.
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| Mugu district, Nepal |
Over the past two decades, the international community has repeatedly declared its commitment to reduce high level of maternal mortality in developing countries, starting with the Safe Motherhood Conference in Nairobi in 1987, setting the Millennium Development Goals by the United Nations in 2000, celebrating 20th anniversary of the launching of the Safe Motherhood Initiative in 2007 and organizing the Women Deliver Conference in Washington DC, last June this year. Many more initiatives have been taken giving priority for reductions of maternal deaths. The government of Nepal also signed the commitment and reformed the health care system to ensure access from disadvantaged communities. Saving maternal lives is one of the eight Millennium Development Goals (MDGs) which the world leaders endorsed 10 years ago. Similarly, the safe motherhood is one of the priorities of Ministry of Health and Population of Nepal. Nepal government has set the target of reducing maternal mortality ratio down by 134/100,000 live births from the existing 539/100,000 live births. The Demographic and Health Survey Report 2006 presents dramatic reduction in maternal mortality ratio to 281/100,000 which is still debatable. There is only five years left to go, to reach the MDG target of three quarters reductions in maternal mortality and the progress is not that satisfactory.
The government of Nepal has also taken initiatives to reduce maternal deaths by 2015. A Safe Motherhood Plan (2002-2017) has been launched to speed up safer motherhood interventions throughout the country. Other complimentary policies and strategies are also formulated in order to meet the overall goal of reducing maternal mortality. However, women living in mountain areas are still lagging far behind to exercise their universal right of having safe childbirth and successful motherhood. More than 90 percent women like Tilu are still giving birth at home without any skilled attendants. The outcomes of such births are often not reported in the media. Without developing reliable information system in the remote rural areas to report facts on maternal mortality, it is hard to accept any government figures including maternal deaths in Nepal.
There are many layers that women have to cross to exercise their rights of giving birth to a healthy baby. You might see giving birth is a natural phenomenon, however the deaths by this phenomenon may seem insignificant but still it is great concern today. I think this is the time that national and international communities should rethink the approach which can best fit into the context where women can’t even dream of the world beyond the walls of their houses. To do so, we really need to address the root cause of women’s oppression and 'ignored reality' in order to make them able to access the services they so need. If you are celebrating the childbirth at utmost pleasure in your family, remember that there are many families mourning the deaths of their loved ones because of the same cause.
* The author is PhD Student in Maternal Health, Flinders University, Australia
