Women in the area had a custom of tying a railway ticket on the waist of the delivering women with the belief that it speeds up the delivery process
Two in every 10 Nepali women (19%)give birth at home with no help from a skilled birth attendant (SBA), according to the most recent Nepal Demographic and Health Survey-2022.
The situation is life-threatening in the rural areas of Karnali Province (27%), while the case is even worse in Madhesh Province of the country (32%). This condition has been identified as one of the major contributing factors leading to the high maternal death and disability in Nepal.
Officials from government agencies, donors, I/NGO workers and implementing partners, upon receiving the findings in the dissemination seminar, said, "This is the most tragic situation of Nepali mothers. We need to do something to improve the situation."
A follow-up study conducted some years back in the mountainous region of Karnali Province showed that deliveries were conducted in a dark room or in a cowshed with the help of family members.
The placenta, which comes from the mother's womb after the baby is delivered, was handled very un-hygienically. The umbilical cord that connects the baby to the mother was cut with any tool that was available in the home even if not clean.
They did not know that diseases such as tetanus could be contracted through a filthy tool and animal excreta in the cowshed. They did not even have an idea that light was necessary to check the condition of the mother from time to time during labour.
They were more concerned about the culture where a cowshed is considered a sacred place, and, thus, delivering there ensured immediate purification of the newborn baby.
They were also of the view that delivering in the cowshed protects the residence from being littered with the filth during delivery. Keeping in mind the mess created during delivery, they said that it is unclean to have the delivery conducted within the house.
Women in the area had a custom of tying a railway ticket on the waist of the delivering women with the belief that it speeds up the delivery process. Some of them mentioned that a ball of hair is put into the delivering woman's mouth in order to cause a vomiting sensation that would help her push the baby out.
They also reported that once the labour started women tie their hands onto a branch of a tree and start pushing.
Some mothers said that they deliberately fill the delivery room with smoke so that the mother chokes, and the resulting discomfort helps her push the baby down the birth canal. Such misconceptions, beliefs and practices could be detrimental to the life of both the mother and her unborn baby.
In the mountainous communities of Karnali Province with a harsh weather, mothers felt uncomfortable being in the hospital as it was too cold, and they could not have a fire burning as in the homes. Mothers in group interviews mentioned that management of a fire was necessary to massage and warm up the mother before, during and after delivery.
"Massaging with warm mustard oil on the mother's head is done to protect her from giddiness, on the abdomen to manipulate the unborn baby's head for it to come first in the birth canal, on the legs and hands to protect from getting swollen, on the back to put extra pressure and strength from outside, and on the vagina to lubricate the birth canal for quick delivery," they said.
"But in the hospital all these are not allowed, nor is there any provision of making the room warm. We, therefore, would like to avoid going to the hospital as long as we can tolerate the labor pain."
These findings are revealed from a national level survey of NDHS-2022 and from other follow-up studies, which were commissioned by New ERA, a non-government, non-profit research organisation of Nepal, for USAID/ Nepal. Information for these studies was gathered after conducting individual interviews, using appreciative in-depth inquiries and group discussions among mothers with recent childbirth in the area, and informed consent was taken from them before taking the interviews.
Findings from the above studies can be used as guidelines for immediate action, as it has explored underlying barriers that hindered the people to go to a health facility during labour. Understanding the reasons for home delivery among mothers or not visiting a health facility during labour is useful, because it could provide basic guidance for the programme managers on how to overcome these barriers in the local situations and replicate the measures to increase their involvement in seeking modern midwifery services during childbirth.
Results from these studies could also provide guidance for the frontline workers to convince the mothers about how their neighbouring friends from similar socio-cultural settings were able to act upon the same barriers to visit a health facility during labour.
It is also useful to understand the nature of the hindering factors leading to non-use of institutional delivery among the local people, as it could provide a strong base for the assessment of whether these barriers are to be acted upon with local resources or are to be addressed with the support from outside.
Basnet is founder member of New ERA
A version of this article appears in the print on July 7, 2023, of The Himalayan Times.
