Although pregnancy is a hopeful period in a woman’s life, it is regrettably a tragic experience for many Nepali women. Across the country, Nepali mothers continue to risk their lives while giving birth. While Article 38 of the Constitution of Nepal asserts that every woman shall have the right to safe motherhood and reproductive health, Nepali women are nowhere close to fully exercising their reproductive rights. This failure to ensure safe motherhood is yet another reminder of the country’s perpetual neglect in protecting the rights and lives of its women.

In Nepal, safe motherhood was identified as a national priority with the launch of the National Safe Motherhood Programme in 1998. Later, the country even received the Millenium Development Goals award for bringing down its maternal mortality rate (MMR) from 539 per 100,000 live births in 1996 to 239 in 2016. However, progress in maternal deaths has since stalled. In the fiscal year 2023-2024, at least 190 women from 51 districts died of complications during childbirth, as per the data from the Family Welfare Division under the Department of Health Service. In the previous fiscal year, 191 maternal deaths were recorded across 49 districts.

Although the country has committed to reducing the MMR to 70 per 100,000 births by 2030 in order to meet the Sustainable Development Goals target, given the current trends, this appears ambitious. Nepal has already missed its target of reducing MMR to 125 per 100,000 live births by 2020. According to experts, postpartum haemorrhage and pre-eclampsia (pregnancy-related high blood pressure disorders) are the chief causes of maternal deaths in Nepal. To identify the number and causes of fatalities, maternal and perinatal death surveillance programmes are imperative. However, instead of full scale implementation of such a fundamental programme, these are being conducted in only 51 districts due to inadequate budget. Such miscalculation can create considerable knowledge gaps related to maternal mortality and care, the knowledge that is vital for introducing targeted interventions.

Since the adoption of federalism, the country’s health system management has been delegated to provincial and local governments. Local governments can now implement health offices and facilities. However, this hasn’t produced satisfactory results as many health posts and primary health centres are just buildings, with a severe lack of medical supplies and skilled health workers. Although the government has prioritised maternal health-related programmes and policies, which are on paper progressive, they need to be locally relevant and require routine monitoring and revisits. For instance, lack of competent, Skilled Birth Attendants (SBA) is still a major issue, even though the country formulated the SBA policy in 2005. The long-term strategy to educate and deploy better trained midwives is yet to materialise, leading to the ongoing training of Auxiliary Nurse Midwives, basic nursing cadres, as SBAs.

This state of affairs is untenable. Infrastructure accessibility and quality healthcare availability should go together during policy implementation. Many people in remote areas still seek faith healers during childbirth and only consider medical services in emergencies. So introducing facilities without communicating their importance to the people is not enough. Additionally, the government must prioritise marginalised communities while ensuring birth preparedness, financial incentives, free delivery services, abortion care and community-based partum care programmes. Further empowerment of local governments and improved coordination between the federal and provincial levels would also help. The failure to ensure good health for our young mothers puts the future of upcoming generations and, by extension, the country’s future, in jeopardy.