Nepal: Challenges of maternal health

In Nepal, some 6,000 women and 30,000 infants die of birth-related complications, and 57,000 unsafe abortions are carried out every year. The main reason for such high mortality rates is the lack of use of contraceptive measures and affordable facilities. Nepal has the highest mortality rate in Asia (539/100,000 live births) and 54% of all maternal deaths are due to unsafe abortions.

The case of a Dadeldhura woman should be an eye opener. After having five children she was pregnant for the sixth time. For want of money, she was denied abortion at the local health centre. There are many other women who cannot afford the high price and thus resort to unsafe methods to terminate pregnancy.

Another woman seeking abortion in Sindupalchowk was treated by a quack at the local hospital. There were serious complications and she had to be rushed to the Maternity Hospital in Kathmandu. Luckily, she survived. Yet another woman from Lamjung, who depended on untrained local women to take care of her complicated second pregnancy, paid with her life.

For urban dwellers, these examples might sound like stories. But this is the stark reality in rural Nepal. This should prick our conscience, particularly of the policy-makers. When talking about building a new Nepal, the issues facing women should receive top priority. These examples reinforce the need to concentrate on three important aspects — awareness, affordability and accessibility.

We may look at the issue of maternal health in the context of economic situation and social backdrop of the country. Although the legal age for marriage in Nepal is 18, almost half of the female population gets married at 15-19. There is a huge variation in the level of awareness in rural and urban areas. The rural women are at the lowest rung of the society, most poor and dominated by males. This is especially the case within Dalit and marginalised communities. Though awareness is increasing, a critical mass still lacks accessibility to basic facilities.

Unwanted pregnancy is another reason for maternal death and birth-related complications. Miscarriage and birth complications resulting from early marriage are also to be blamed. Legalisation of abortion in 2002 has played a crucial role in promoting safer motherhood. Health books in Nepali high schools contain general information about safer motherhood, including methods of contraception. But high-school dropout rate of girls, the target community, is very high.

It is important to provide financial aid to those who need it to improve their reproductive health. Establishment of more health posts and sub-health posts close to the vulnerable groups is necessary. There is a strong correlation between availability of health facilities, level of women’s education and household income. The first barrier is lack of awareness among targeted groups. But even when there is awareness, people do not have access to healthcare facilities.

Therefore, a multi-pronged approach that includes sustainable and inclusive programmes

should be taken. We need a more focused approach to this issue. There should be countrywide campaigns on a regular basis with the involvement of the youth and women. Maternal health is the key to the overall health of present and future generations. We cannot afford to ignore it.