Namsara Kami died of postpartum bleeding prepartum hemorrhage on Monday. The 38-year-old mother of five from Turmakhand Rural Municipality-4 of Achham was taken to district hospital after she could not give birth at a local health facility. She died as a result of excessive bleeding.

Her baby had died in the womb before she was brought to the hospital.

Dambari Devi Sahu Kathayat also died of postpartum hemorrhage three weeks ago.

The 30-year-old from Dipayal Silgadhi Municipality of Doti was referred to Seti Provincial Hospital as her bleeding did not stop even four days after giving birth at a local health facility.

According to the Safe Motherhood Unit under the Family Welfare Division of the Department of Health Services, more than 17 women have been dying every month due to birth related complications since the start of first lockdown on March 24.

Namsara and Dambari Devi are part of this grim statistics.

“Death toll from birth related complications reached 141 from the day the country went under a lockdown on March 24 till November 15,” Dr Punya Poudel, chief of Safe Motherhood Unit, told the Post. “Even after the restart of health services in most of the health facilities, maternal deaths have not declined.”

Nepal has already missed the 2020 target of reducing maternal mortality to 125 per 100,000 live births from the country’s current rate of 239 deaths per 100,000 live births.

The ongoing pandemic has made things worse, health experts say.

Poudel said that postpartum hemorrhage and preeclampsia are major reasons behind the ongoing maternal deaths.

The government has been promoting institutional delivery to prevent such complications, with the government making delivery services free at state-run health facilities. But delay in seeking medical care and the lack of trained human resources in health facilities are costing the lives of many pregnant women.

Soon after the lockdown was enforced to contain the coronavirus spread, the country’s institutional delivery rate, which was already low at around 59 percent, started to decline further. Numerous health facilities stopped providing essential medical services due to fears of Covid-19 transmission.

Maternal health experts say the lack of contingency plan for situations like pandemic is a major reason for the rise in maternal deaths.

“We did not have any contingency plan for a pandemic to avoid maternal deaths and we could not make one after the pandemic hit,” Dr Kiran Regmi, former health secretary, told the Post. “I am worried about major setbacks in the achievements we made over the years in the maternal health sector.”

According to the Nepal Demographic Health Survey-2016, 239 women per 100,000 live births die during or after childbirth.

Nepal reduced the maternal mortality rate from 539 in 1996 to 239 in 2016 for which the country received the Millennium Development Goal award.

“To avoid maternal deaths from postpartum hemorrhage, we have been distributing misoprostol tablets in 54 districts through female community health volunteers,” said Poudel, the chief of Safe Motherhood Unit.

Misoprostol helps uterine contractions and has been a go-to drug to prevent postpartum haemorrhage.

Usha Jha, a National Planning Commission member who oversees the health sector, said that the commission as well as the Health Ministry has started planning to avoid further maternal deaths and setbacks in the health sector caused by the ongoing pandemic.

“We have assessed the loss and have started planning to mitigate risks and avoid further deaths,” Jha told the Post.

Nepal has to reduce maternal mortality rate to 75 for every 100,000 births by 2030 to meet the UN's Sustainable Development Goals' target.