Who will save Nepal’s poor new mothers?

25-year-old Batu Chadara, from Dandabasa village, Pandusen was nine months pregnant and was going to return rooster she had borrowed. Picture: Rojita Adhikari

Recently four new mothers lost their lives in Bajura district in remote in Far-Western Nepal. All of them died inside health facilities.

Rejiya Nepali, 31, was one of them. A mother of four little children from Chhatara village, she died at its health post on 2 November after five hours in labour to give birth to a baby boy.

Rejiya was taken to the nearest health post by her husband and relatives, a 25-minute walk from her home the previous day at 11 pm.

There was no one at the heath post at that time, and Rejiya was taken to the house of a Auxiliary Nurse Midwife (ANM). That took one hour, and Rejiya gave birth in a stretcher and died on it.

 

Although Nepal has made vast improvements in maternal health with the mortality rate dropping from 539 per 100,000 live births 25 years ago to 230 today, tragic stories like that of Rejiya are still common. An estimated 2,000 new mothers still die in Nepal every year  — most of them unnecessarily. 

According to the target set by the UN’s Sustainable Development Goals, maternal mortality rate (MMR) should go down to 70 per 100,000 in the next ten years. Nepal has already failed to meet the interim target of reducing MMR to 125 by this year.

Rejiya’s 80-year-old mother in law, Deuma Nepali, is now taking care of her four children aged six, four, two and the two month old baby. She says: “I am old, I cannot see properly and cannot cook. My son has been drinking a lot since he lost his wife. We have milk for the baby.”

 

In Gotri village of Bajura, another new mother Pulti Rawal lost her life within a few hours of giving birth. A 32-year-old mother of four also gave birth to a baby girl on the way to the local health post.

“This pregnancy was not like earlier ones, my wife was in pain and was weak. After she went to the health post, I thought she would be fine,” recalls husband Ambre Rawal.

Bajura district hospital recorded two maternal death within a month: 21-year-old Basanti Nepali from Jhilli village and Nirmala Bohora, 35, from Pandusain village.

Basanti died an hour after a caesarian delivery, and her husband Krishna blames the hospital. “I was in Kuwait when I heard my wife and baby died. I could not get leave, so I quit and bought my own ticket to fly home,” he says.

Rupchandra Biswokarma, the physician in charge of Bajura District Hospital said Basanti could have been saved if the facility had an Intensive Care Unit and an ultrasound machine. The hospital carried out 300 deliveries last year, with 15 caesarians.  

“Most mothers are brought here right at the end,” says Biswokarma, “First, they try to give birth at home, if they cannot then they go to the nearest health post, and they refer them to us. Forget about the well-equipped maternal ward or ICU or gynecologist, we don’t even have a skilled birth attendant or trained doctor here. Actually, God is saving new mothers here, not us”

Pandusain Health Post, one of the busy heath posts in Bajura district delivers up to 15 babies a month. It has neither an ultrasound machine not a skilled birth attendant for ante-natal checkups.

Basanti Bohora, 29, a new mother with a one month old baby, had experienced terrible labour pain. She first went to Pandusain health post but health worker asked them to go to the district hospital which is 4 hours drive away on a very bad road.

When she reached the district hospital the health worker said the case is critical, they can’t do anything and referred her to Bayalpata hospital in Accham that is run by the non-profit Nyaya Health.

“All the way I thought I would die, it is a miracle that both myself and the baby are alive today,” she says, playing with her baby boy.

There are many women in rural Bajura who know their pregnancy is complicated but are forced to ignore it. Like Lali Nepali, 26, who is now six months pregnant and in pain and was told to deliver in Byalpata or Dhangadi.

“But I cannot afford it, so what happens will happen,” she says.  

This is not just the story of one woman, one village and one district. It is happening across Far-western Nepal, says Bikash Guachan, Healthcare Director of Balyapata Hospital which delivers 90 babies every month from Achham, Doti, Bajura and Dailekh districts. Most of them are referral cases from local health posts.  

“If the case is seriously complicated we cannot even treat it here as we don’t have a blood bank and ICU,” says Gauchan. “The main problem is that most mothers do not go through proper checkups, like ultrasound exams.”

Many foetus also shows signs of anencephaly caused by the lack of adequate nutrition and frequent births. Many women suffer life-threatening obstructed labour.

“Doctors and nurses call me when they find ruptured uteruses in district hospitals and many times I have just run there otherwise that woman will surely die,” says Gauchan. 

The Nepal government is about to finalise a 10-year roadmap to reduce maternal deaths and meet  the SDG target with a focus on home visit delivery. “The health worker will visit the home to home to see the pregnant woman and follow their conditions,” explains Punya Poudel at the Family Welfare Division of the Department of Health Services.

Former Health Secretary Kiran Regmi argues that until health posts around villages can provide full antenatal checkup facilities it will be difficult to reach the 2030 target. He says ultrasound scans and antenatal tests would save many lives of mothers who now have to rely on miracles.

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