KATHMANDU, NEPAL -- Tirtha Rai, 21, struggles to get out of her hospital bed. She is in bed 25, in unit three at Prashuti Griha, a maternity home in Kathmandu. Her body is clad in blood stained clothes. Her eyes fill with tears and beads of sweats are dropping from her face.
In this small room, which lacks proper ventilation, seven women lay on separate beds. Rai begs Bir Bahadur Rai, her husband, to take her outside for some fresh air, but he pleads with her not to move from the bed.
Rai is from Lele, a village in Lalitpur, a central district of Nepal, which is about 25 kilometers from Kathmandu. In the ninth month of her pregnancy Rao says she began to feel uneasy, so she traveled on foot to the nearby Bajrabarahi health post. Medical workers examined Rai and informed her that her unborn child was already dead.
The small health post, staffed by only a few moderately trained workers, did not have the proper equipment to deliver the child. They told Rai to go to Prashuti Griha. Rai and her husband urgently boarded a bus to the capital and when she arrived at the maternity home, doctors delivered the dead child and saved her life.
Rai, like many women in rural Nepal, worked throughout the entirety of her pregnancy. She said she carried heavy buckets of water and baskets of grasses from nearby meadows to her house everyday. While poverty remains a major factor in infant and maternal mortality, a general lack of awareness about prenatal healthcare also plays a role in Nepal’s high mortality rates.
Rai says she never visited a doctor during her pregnancy and that she was unaware of the fact that it was unsafe to perform hard labor during pregnancy. “In our village no pregnant woman goes to the doctor, and everyone works during pregnancy. I did the same thing, but my child did not survive,” Rai says.
Surveys from local and international organizations show that most women in rural Nepal run a high risk for losing a child during pregnancy and dying during childbirth. According to the Family Health Department of the Government of Nepal, the maternal mortality rate in Nepal is 539 deaths per 100,000 live births. UNICEF published a report last year, The Situation of Children and Women in Nepal, which estimated that every year 48,000 women, out of 900,000 live births, died during pregnancy or childbirth. And in late 2006, the United Nations Populations Fund ranked Nepal as the country most affected by infant and maternal mortality in South Asia.
In recent months the government of Nepal has taken new steps to develop programs geared toward helping pregnant women. One program offers financial incentives to women if they give birth in health posts or other medical facilities. Public Health Officer Bhogendra Raj Dotel says the government is providing money to women in all 75 districts of Nepal in hopes of attracting pregnant women to deliver in safer conditions. Women are given different amounts according to the region where they live in and the distance and difficulty required to reach a health post. Women from the Himalayan regions get 1,500 rupees, about $21, while women from the eastern part of Nepal get 1,000 rupees, about $14, and women from the Terai region, the plains in the southern part of Nepal, earn 500 rupees, or $7. Throughout Nepal there are 27 hospitals capable of providing comprehensive obstetric services and a few thousand health posts capable of providing basic or emergency obstetric care.
But for many women, a financial incentive will not increase their likelihood of seeking medical assistance during pregnancy. Dil Maya Gurung, 41, from the Dandabasa village of Dhading, a central district of Nepal, is the mother of five children. Gurung said she never went to a health post during any of her pregnancies. During the ninth month of her last pregnancy, she says she suddenly had a terrible pain in her stomach. “I did not share my pain with anyone until I could not bear it. After I could bear it no longer I asked my husband to take me to a big hospital,” she says.
Gurung comes from a poor family in a remote area. The nearest health post is about eight kilometers from her home. After she told her husband of the pain in her stomach, he took a loan of 3,000 rupees, about $43, to prepare for the medical costs and then carried his wife on foot to the Dhadingbesi health post — a four hour walk from their residence. But the health workers were unable to help Gurung and suggested she go to Maternity Hospital in Kathmandu. “By the time we reached the big hospital I had already fainted. I have no sense of what happened to me in the hospital,” Gurung says. “When I opened my eyes the doctors informed me that I had lost my child even before it was born.”
Dotel acknowledges that government efforts to decrease infant and maternal mortality are not sufficient. “The government is providing a service but the women cannot reach the health posts,” Dotel says.
Rajan Adhikari, an information support coordinator of the family health division of Support to the Safe Motherhood Program, says that although many organizations are working to reduce infant and maternal mortality in Nepal, the lives of mothers and children are still in danger due to the geographic structure of the country. “At some places it takes about four to five hours [on foot] to bring [a] pregnant women to health posts and some die on the way,” says Adhikari. “It is possible to construct a good hospital, but we cannot change the geographical structure of the country.”
For Dr. Sarita Upadhyaya, who has been working as a maternity health consultant for the last two years, there are many factors, in addition to the lack of health posts in the country, that increase the mortality rates in Nepal. “The trend of not seeing a doctor during pregnancy, the lack of trained midwives in attendance during delivery, [and common problems like] a lack of oxygen to the mother when the child is born, cutting the umbilical cord incorrectly, [and] giving the child a bath too soon after its birth are the main reasons for the increased number of infant mortalities [sic] in Nepal,” Upadhyaya says.
Dr. Jyoti Sharma, the senior women’s health specialist of Tribhuvan University’s teaching hospital, says that to decrease the mortality rates of mothers and children, it is important to have at least four check-ups during pregnancy. However, according to UNICEF’s 2006 article, 51 percent of women in Nepal do not visit the doctor even once during the pregnancy. Only 14 percent of women say they have as many as four check-ups during pregnancy.
While the number of women who seek medical care during pregnancy is low, the number of women who get medical help during and after delivery is even lower. According to the annual Department of Health Survey (2005–2006), among the total number of women who become pregnant only 20 percent deliver under the supervision of medical workers. Infant and maternal mortality in Nepal is still the highest in South Asia.
Back at the Prashuti Griha maternity home in Kathmandu, Januka Thapa, 28, is lying in bed 145. Her face was pale as she received a blood transfusion. She too lost her baby. Like the other women, Thapa didn’t have the information or the access to health care that could have saved the baby’s life. “When I was in my village none of my family members suggested [that I] see a doctor. I did not know anything about it. After I came to Kathmandu, I wanted to go to the doctor, but I didn’t have money for that and I could not get to a doctor on time,” she says.
Originally published 2008 PIWDW
