Every year, hundreds of women in Nepal succumb to preventable deaths from excessive bleeding and high blood pressure, a new report by the National Statistics Office showed.

More alarmingly, a significant number of maternal deaths, during pregnancy or after childbirth, are occuring due to a non-maternity cause, suicide, which also is preventable.

Of the 611 maternal deaths on which the study was based, 67 percent occurred during and after childbirth, according to the report.

“Although the report shows a significant decline in the maternal mortality rate, hundreds of women throughout the country continue to die due to excessive bleeding and high blood pressure,” said Nisha Joshi, a public health officer at the Family Welfare Division of the Department of Health Services. “We have been unable to prevent these preventable deaths.”

The newly unveiled report shows that in every 100,000 live births, 151 women died from maternity-related complications.

Nepal had reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 births in 2016—for which the country even received a Millennium Development Goals award. The report showed 88 maternal deaths were prevented in every 100,000 live births between 2016 and 2021. The study was carried out in 2021.

Nepal missed its own targets of reducing maternal deaths in 2020 and 2022.

The country needed to limit maternal deaths to 125 per 100,000 births in 2020 and to 116 in 2022.

For years, excessive bleeding after childbirth, also known as postpartum haemorrhage, and pre-eclampsia (pregnancy-related high blood pressure disorders) have been identified as chief causes of maternal deaths in Nepal, according to experts.

The census report shows 33 percent of the total maternal deaths occurred during pregnancy, six percent died during childbirth and 61 percent during the postpartum stage.

Of the total maternal deaths, nearly a half (47 percent) occurred in Lumbini and Madhesh provinces.

The report shows that 10 percent of the victims were 15 to 19 years old. Fifty-seven percent of the deaths happened in health facilities and 26 percent at homes. Of the total maternal deaths, 412 (53 per cent) women paid four antenatal care visits, and of the 173 women who died between seven to 42 days, 45 percent had received postnatal care.

As part of its efforts to reduce maternal deaths, the Health Ministry has made it mandatory for women to make eight antenatal care visits and three postnatal care visits.

Of the total maternal deaths, six percent (37 women) had undergone abortion or suffered a miscarriage. The report shows that 62 percent of the women took maternity services at state-run health facilities whereas 38 percent gave birth at private health centres.

The report shows family members of 83 percent of women, who died during or after childbirth, tried to get hospital care. Forty-eight percent of those who did use hospital services did not deem it necessary to seek institutional care, according to the report.

Delay in finding appropriate health facilities (57 percent), delay in reaching appropriate health facilities (33 percent) and delay in getting appropriate health services (40 percent) are three major causes of maternal deaths, the study shows. Of the total maternal deaths, 17 percent were attributed to all three aforementioned causes and 74 percent to at least one of three causes.

The report suggested improving the quality of services and the referral system, and making ambulances available for emergency calls as possible ways for identifying the risks on time. The report also suggested carrying out maternal death surveillance on a regular basis for reducing preventable deaths.

Health ministry officials admit that all the causes of maternal deaths pointed out by the census report are preventable.

“We have to do a lot to cut down preventable maternal deaths and there are many areas of improvement,” said Joshi. “Even if the report shows an improvement in maternal health, hundreds of women are still dying from birth-related complications. No one should die from preventable causes.”

The Ministry of Health and Population has launched various programmes, including free institutional delivery service, and travel allowances for those opting for institutional delivery and antenatal visits. The ministry has also distributed misoprostol, a medication used to treat postpartum bleeding in new mothers, through female community health volunteers.

Nepal’s target under the UN’s Sustainable Development Goals is to reduce the maternal mortality rate to 75 per 100,000 births by 2030.