The birth of a child in Nepal’s Far Western region is often referred to as “Jatkal Basnu.” This term, rooted in local culture, translates to preserving life amid death. It shows the immense courage of a mother who nurtures life within her womb and defies the odds to bring a child into the world.
While childbirth is a universal phenomenon, in the past, it was fraught with immense pain and peril, especially in remote areas without medical assistance. There are no detailed records from those times to tell how many mothers lost their lives or how many survived through sheer endurance.
Divide between urban and rural maternal health
Today, Nepal has made significant progress in healthcare, particularly in maternal and child health, earning recognition even on an international level. Yet, the reality in rural areas paints a different picture, one where maternal and child safety remains precarious, especially in remote regions like the Far West and Karnali provinces.
The disparity between urban and rural healthcare becomes glaringly apparent when venturing into Nepal’s countryside. While maternal health has improved considerably in urban centers, the fear of maternal and infant mortality still looms large in these isolated areas. For many women in these regions, safe motherhood remains uncertain, and the challenges they face continue to reflect a broader healthcare inequality.
Nepal’s maternal mortality rate has declined over the years. Health facilities have expanded, and skilled healthcare professionals are more accessible than before. The government has also initiated air rescue programs to save mothers and infants in critical conditions in remote areas.
As a result, the maternal mortality rate has dropped from 239 per 100,000 in 2016 to 151 per 100,000 in the 2021 census. However, the goal of reducing the rate to 70 by 2030 appears challenging. Stakeholders believe that the current pace of progress may not be sufficient to meet this ambitious target.
Challenges faced by pregnant women in rural Nepal
The challenges pregnant women face in Nepal’s remote regions are stark. In the Far West, the tragic stories of women like Khina Bohara and Draupadi reveal the harsh reality. Khina, from Bajhang, succumbed to excessive bleeding after giving birth on her way to the hospital. Similarly, Draupadi from Darchula lost her life after labor pains struck while she was miles away from the nearest health post.
In both cases, the lack of timely medical attention proved fatal. Another woman, Saritadevi Jaishi from Achham, died due to excessive bleeding after giving birth on her way to the hospital. These are not isolated incidents.
In the Sudurpaschim province alone, nine pregnant and postpartum women lost their lives last year, alongside 79 newborn deaths.
Despite improvements in infrastructure, such as roads, birthing centers, and healthcare facilities in many remote districts, accessing these services remains a challenge. In hilly districts, many women still have to walk long distances to reach a hospital.
According to health officials, only 80 percent of deliveries take place in hospitals, falling short of the 90 percent target. The remaining 20 percent of women, often delivering at home without medical assistance, face life-threatening risks.
Child marriage is another significant factor contributing to maternal mortality. In the Far West, 13 to 14 percent of women are still married before the age of 20. Early pregnancy increases health risks, as the bodies of young girls are often not ready to bear the burden of childbirth.
Additionally, a lack of awareness exacerbates the problem. Many communities still view pregnancy and childbirth as routine events that require minimal intervention. This cultural mindset delays seeking medical help, often until it is too late.
Even in areas equipped with trained health workers and birthing centers, many women fail to utilize these services due to poor awareness and traditional practices. Dr Nawaraj Joshi, an obstetrician and gynecologist at Bajhang District Hospital, explains that one common myth is that labor pain should not be disclosed until the final stages.
This belief, coupled with inadequate means of transportation, delays hospital visits and puts lives at risk.
Need for awareness
The situation is further complicated by a lack of resources for families to care for postpartum mothers properly. Many women are expected to resume strenuous work within days of giving birth, leading to fatal consequences. One woman died merely five days postpartum while cutting grass in a field. These stories underline the pressing need for better postpartum care, including access to nutritious food and proper rest.
In an effort to address these challenges, the government introduced air rescue procedures in 2020 to assist pregnant and postpartum women in life-threatening situations. Under this program, women can be airlifted to hospitals if they experience prolonged labor pains, complications during delivery, or other critical conditions.
However, the system is riddled with inefficiencies. A lengthy bureaucratic process involving multiple levels of approval delays rescue operations, and weather conditions often render airlifts impossible. The program’s impact, while potentially life-saving, remains limited due to these logistical hurdles.
Doctors and healthcare workers emphasize that public awareness is crucial to reducing maternal and infant mortality. The role of local governments and community leaders in spreading awareness and facilitating access to healthcare is critical.
Women’s health volunteers have been instrumental in educating rural populations, but more needs to be done. Training programs, nutritional support, and proper counseling for pregnant women are essential steps to ensure safer childbirth.
Families also play an essential role in improving maternal health outcomes. Pregnancy should not be treated as a normal and solitary journey. Emotional and physical support from family members can make a significant difference. Encouraging women to seek timely medical help, providing transportation to healthcare facilities, and ensuring postpartum care can save countless lives.
Monitoring and evaluating the effectiveness of government programs is another vital aspect. Initiatives aimed at providing transportation, nutritional aid, and financial support for pregnant and lactating women must be closely scrutinized to ensure their efficacy. A collaborative effort between the central government, local authorities, and healthcare providers is necessary to bring about lasting change.
The stories of women like Khina, Draupadi, and Saritadevi should not be mere statistics; they should serve as a reminder of the urgent need to bridge the gap between policy and practice. Every life lost is a tragedy, and every child born is a testament to resilience.
In honoring the spirit of “Jatkal Basnu,” the preservation of life amid death, it is imperative to create an environment where motherhood is celebrated, not feared. With collective effort and unwavering commitment, Nepal can hope to ensure safe motherhood for all, even in its most remote corners.
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