More than 200 birthing centres operating across the country lack skilled birth attendants as the government didn’t allocate a budget to retain the nurses.

Officials at the Ministry of Health and Population say that a lack of trained nurses at birthing centres not only affects the service delivery but also increases the risk of maternal deaths.

“We could not hire over 200 skilled birth attendants this year due to a budget crunch,” Nisha Joshi, an official at the Family Welfare Division, told the Post. “More than 35 percent of the annual budget has been slashed this year, which has impacted multiple programmes of healthcare.”

With the government announcing free institutional delivery service in 2009 at all state-run health facilities, more than 2,800 birthing centres have opened across the country. The institutional delivery rate, which was around 18 percent then, has increased to around 80 percent at present.

Travel allowances offered by the government and allowances for antenatal care visits are among the reasons credited for the increase in the institutional delivery rate. The health ministry imparted skilled birth attendant (SBA) training to staff nurses and hired them at birthing centres to prevent possible deaths during or after child delivery.

Maternal health experts say terminating the contracts of nurses trained as birth attendants on the pretext of budget cuts cannot be excused. They say that maternal deaths, which in the past were caused by even minor causes, start to repeat.

“All the achievements we made over the years from huge investments and efforts in maternal health sectors will be lost if concerned authorities don't rethink their decision of not retaining SBA-trained nurses,” said Dr Kiran Regmi, a former health secretary.

“The authorities concerned should instead think of increasing additional services to prevent maternal deaths.”

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.

A report on maternal mortality carried out by the National Statistics Office in 2021 showed that in every 100,000 live births, 151 women still died from maternity-related complications.

Of the total maternal deaths, 24 percent occur during or after childbirth and 19 percent in the postnatal period.

Experts say authorities should introduce programmes to address excessive bleeding after childbirth, also known as postpartum haemorrhage, and pre-eclampsia (pregnancy-related high blood pressure disorders), which have been identified as chief causes of maternal deaths in the country.

“The authorities must find ways to improve the quality of services and the referral system,” said Regmi. “Maternal deaths are occurring in health facilities also and we are not able to stop some preventable ones. We should make ambulances available for emergency calls to refer the emergency cases to big hospitals.”

Various programmes, including free institutional delivery service, and travel allowances for those opting for institutional delivery and antenatal visits have been initiated to reduce maternal deaths. The health 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.