Pregnancy, childbirth, and maternal deaths Spruce up health care mechanism

It has all the trappings of a good headline as sex, blood, injustice, suffering of the defenseless and guiltless. However, it does not attract much media attention despite the availability of advanced communication technology in Nepal after the success of popular people’s movement in 1990. This is not an exciting story but a tragedy of big dimension. The tragedy is about the thousands of women who die prematurely every year in the country during pregnancy, childbirth or after giving birth to a child.

Why is it that the immense suffering that women go through while trying to fulfill their reproductive and social obligations raise no interest in the news media but the sensational or uninspiring stories of phony social workers and politicians dominate the headlines? It is quite regrettable that the press does not bring successful and inspiring achievements of Nepalese which can be analyzed to prevent the almost “doom and gloom” situation in the country brought in by the so-called progressive revolutionary politicians. But, that is another facet.

To gain insight into why women die during pregnancy transcends beyond

the number of deaths or the realisation of the incidence of maternal death, it is to know what causes the deaths and how they can be prevented. It is for all service providers in maternal health sector to know how such deaths could be prevented by improving the quality of health care.

Successive governments, especially after the1990 successful popular people’s movement, have tried to come up with commitments to improve maternal and neonatal health. It was in 1991 that Safe Motherhood was identified as a priority programme in the National Health Policy, followed by national Safe Motherhood Policy in 1994 then the Skilled Birth

Attendant (SBA) policy from 2004. Though SBA care cannot aim to copy the developed countries’ concept of care, but it is the best in view of our social and economic status.

Till date, the government has not been able to provide adequate SBAs who could cater quality maternal and newborn health care services according to the national standard and

protocol. It comes as discouraging news that not more than 18 per cent of the deliveries in the country are attended by health workers.

The situation is further complicated by a distribution bias in delivering medical care, the focus being the urban or middle and upper class of the population rather than the rural populace who need it most. One burning example is the free delivery service provided by the Maternity Hospital in the heart of Kathmandu which is nothing but a populist program of the previous government. The fund for such could have been used where health services are inaccessible that is the rural and remote parts of the country. The most glaring example is Jajarkot and neighbouring areas where hundreds have died due to cholera and are dying every day due to the lack of safe water and sanitation.

To save women’s lives during pregnancy the government should first of all ensure the availability, access to and utilization of skilled health care to avoid complications at birth and following it. For this, poverty alleviation has to come first thereby improving socioeconomic status, nutrition and general health of women. This would raise awareness among women to seek basic care. It is true that poverty cannot be decreased overnight, but there should be a policy of equal distribution of development benefit to the urban and rural

areas, males and females, without any form of discrimination. The compulsory provision of reproductive health care is essential.

Contraceptive use must be encouraged. Obstetricians and professional bodies have to offer the supporting hand that is so vital in seeing that women’s health is properly looked after without any exception. The lawmakers have to come forward with their concern for women’s health care needs thereby exhibiting appreciation for women’s social and biological function and their contributions to the national economy.

Maternal mortality has decreased in the country following reduction in complications that occur during pregnancy, childbirth or postnatal stage, but definitely not to the desired level . Women must have access to emergency obstetrics care (EOC) for basic care to avoid complications including obstetric hemorrhage which can kill women in hours. When EOC is accessible or closer to women’s residence, there will be less probability of complications arising from hemorrhage, obstructed labour, eclampsia, unsafe abortion and puerperal sepsis, the major causes of maternal death. If such an initiative is made countrywide, maternal death can be significantly reduced thereby helping in achieving the millennium development goal as targeted by the government. Then we can celebrate and say why our women are not dying during pregnancy, childbirth or after childbirth. With healthy women to look after the nation, a bright future can be assured.