As part of its strategy to prevent maternal deaths, the government has established free birthing centres with skilled birth attendants across the country. It has also arranged for encouragement and transportation allowances, and mobilised an army of female community health workers who traverse difficult and remote terrains across the country to advise women about safe and healthy births and even administer life-saving drugs. However, women still deliver their babies at home instead of visiting health facilities.

In Karnali Province in mid-western Nepal, 10 women have already died due to delivery complications this fiscal year. Three of them died on their way to health facilities, and seven others while giving birth at birthing centres. According to the Ministry of Social Development in Karnali Province, 21 women lost their lives due to delivery complications in the last fiscal year. Data from the 10 districts in the province also shows that 123 women died in the past seven years.

Geographical challenges and poor road conditions aside, things can also worsen if critical patients and those with delivery complications are referred to hospitals in Nepalgunj or Surkhet for further treatment. Often, pregnant and postpartum mothers only show up at health facilities when they face complications. It is a complicated situation that continues to threaten mothers and their newborns, and calls for a sustainable plan of action to save lives and ensure safer births.

The ministry’s data also shows that Karnali Province continues to record home births at a higher percentage. According to the Nepal Family Health Survey Report of the province, only 36 percent of births occur in health facilities. Access to medicines, including life-saving drugs and health infrastructure, is also not up to the mark. Effective policies and equitable budget allocation must follow these surveys that reveal an alarming situation in the province and across the country.

According to the Nepal Demographic and Health Survey, the maternal mortality rate has dropped significantly from 529 deaths per 100,000 live births in 1996 to 239 in 2016. But there is a need for targeted efforts and more investment to increase the country’s overall primary health care capacity to save lives and attain the country’s goal of reducing the maternal mortality rate to 75 for every 100,000 births by 2030 to meet the United Nations Sustainable Development Goals.

We must learn from our progress which shows the way forward. The pandemic has shown how easily our health system can collapse. Without strengthening primary health services in the country, our goal to save lives and reduce maternal mortality will not be possible. To reduce the maternal mortality rate, the government needs to expand its programmes, especially in the remote regions where the nearest birthing centre could be a day’s walk away.

The government needs to launch receptive awareness campaigns to counter superstitions and educate the people that home births are not safer. Simultaneously, it must expand road networks to increase access to the nearest hospitals and enhance the capacity of the existing birthing centres to handle pregnancy and delivery complications.