Maternity services ineffective in Karnali ProvinceLack of awareness and geographical remoteness lead women to deliver their babies at home instead of visiting health facilities, health workers say.
On Monday, Bindu Thapa had to be taken to the Provincial Hospital in Surkhet after having delivery complications. The 21-year-old from Dullu in Sarkedard Rural Municipality, Humla, had earlier been admitted to the health post of her village for child delivery but she could not deliver even after 12 hours of labour and was referred to the Provincial Hospital.
On February 1, 2020, Gita Budha, a 21-year-old woman from Gopka in Kharpunath Rural Municipality died due to excessive bleeding during child delivery at the local health post. Eight months ago, a pregnant woman from Namkha Rural Municipality also died due to delivery complications.
Although 24 maternity centres have been established in Humla, maternity care is still not as accessible as expected.
“There are no maternity centres in Limi and Sarkegard. Pregnant and postpartum women from remote areas of Humla and Dolpa have to be rescued via helicopter if they face delivery complications. Even minor health problems cannot be treated here,” said Chief District Officer Chiranjibi Giri.
In the running fiscal year, 10 women have already died due to delivery complications in Karnali Province. Among them, seven died in health institutions whereas the remaining three died while being taken to health facilities for child delivery.
In the last fiscal year, delivery complications claimed the lives of 21 women in the province. According to the data of the Ministry of Social Development in Karnali Province, 123 women in the province died while giving birth in the last seven years while 63 died in the last three years.
“The child and women mortality rate has not decreased in Karnali, as many women still opt to deliver their babies at homes,” said Basantaman Shrestha, the public health officer at the Karnali Health Directorate. “Most women in remote areas have to deliver at home, as the nearest health facilities are located far from their houses. This has increased the risk of maternal deaths.”
Poor road conditions in remote locations have also created obstacles for child delivery in Salyan. Bimala Budha, a resident of Kalimati Rural Municipality in Salyan, said 15 women from her village delivered their babies on the way to the hospital last year.
“Critical patients and those having delivery complications have to be taken to Nepalgunj or Surkhet for further treatment,” she said.
According to Thalaraj DC, coordinator of Safer Motherhood Programme at the District Health Office in Salyan, it is difficult to take pregnant and postpartum women to health institutions due to the geographical remoteness of the region.
“Women are taken to health facilities only when they face complications. Pregnant and postpartum women are at risk due to a lack of awareness among villagers,” DC said.
However, the number of women delivering at health facilities is gradually increasing in the last few years, according to the directorate. In the first six months of the current fiscal year, 16,265 women delivered their babies in health facilities. The data showed that 67 percent of the total expecting mothers delivered their babies in health institutions in the fiscal year 2017-18 whereas 73 percent did so in the fiscal year 2018-19.
To encourage more pregnant women to visit health institutions, the Karnali government provides Rs 4,800 to each woman who delivers her baby at such facilities.
“This includes encouragement and transportation allowances as well,” Shrestha told the Post. “From the last fiscal year, the provincial government has started distributing an additional Rs 2,000 as nutrition allowance for postpartum mothers who deliver their babies in health facilities.” The government had allocated Rs 40 million for the programme in the last fiscal year.
The data of the directorate showed that 473 infant deaths and 568 under-five children deaths have been reported in the province since the fiscal year 2017-18. However, Minister for Social Development in Karnali Province Dal Rawal said that the provincial government has launched various programmes for safe motherhood.
“We have started a nutrition programme and hired gynaecologists in all 10 districts of the province. In the current fiscal year, the province has allocated Rs 80 million to upgrade 304 birthing centres,” said Rawal.
Since the fiscal year 2018-19, the federal government has been rescuing pregnant and postpartum women of mountainous districts under the President’s Women Upliftment Programme. But many such women are still at risk, as helicopters cannot always reach mountainous districts due to bad weather.
Man Kumari Gurung, the senior community nursing officer of the directorate, said 33 pregnant and postpartum women in the province were rescued via the air lifting service in the last fiscal year.