Thirty-two-year-old Ganga Karki died on Friday due to postpartum complications. She had delivered a stillborn baby about two weeks ago and her health had steadily deteriorated since, leading her to be airlifted to Kathmandu from Sankhuwasabha. She died at the Paropakar Maternity and Women’s Hospital in Thapathali after failing to be admitted to a hospital with a functioning ventilator.

Alongside Karki, at least 24 women have died due to birth-related complications in the last two months, according to the Family Welfare Division of the Department of Health Services. This is an almost 200 percent increase in maternal mortality rate since the lockdown was enforced on March 24. A total of 80 women died from birth complications in the last fiscal year.

"Even more women could have died of birth and pregnancy-related complications, as the data from the division is collected from some major maternity hospitals,” said former health secretary Dr Sudha Sharma. "The real picture could be much more alarming."

Nepal has already missed its own 2020 target to reduce 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 lockdown—which has meant prohibitions on public movement and all non-essential transport, and a drastic limitation on health care services as hospitals focus on Covid-19—only made things worse, say experts.

The institutional delivery rate, which was already low at around 59 percent, has declined further. A complete halt to public transportation has meant that more women are compelled to give birth at home. Numerous health facilities have also stopped providing services due to fears of Covid-19 transmission.

Antenatal and postnatal visits have all but stopped due to a lack of services and public transportation. Even postnatal care provided by the Health Ministry via trained nursing staff who visit the homes of new mothers has stopped due to Covid-19.

Haemorrhages, infections and pre-eclampsia are the major reasons behind maternal deaths. Karki, the woman who died on Friday, was suffering from pre-eclampsia. Nepal has been promoting institutional delivery to prevent such complications, with the government making delivery services free at state-run health facilities.

"But what is more alarming is that women are dying even in health facilities,” said Sharma. “Due to a lack of easy access to transportation, pregnant women are reaching health facilities in late stages, sometimes only after developing severe complications. Doctors too can’t do anything when patients’ conditions become severe."

An official at the family welfare division told the Post that more women are dying in health facilities due to hospitals refusing to admit them without a Covid-19 test report.

“It takes at least 24 hours to get a polymerase chain reaction test report, and until then, critical patients do not survive,” said the official who spoke on condition of anonymity. "No one is paying heed to those serious problems."

Former health secretary Sharma said that the Health Ministry needs to ensure that pregnant women and those with serious medical issues have easy access to transportation if more deaths are to be prevented during the lockdown.

"More people could die of other ailments when we are focussed on Covid-19,” said Sharma. “The government needs to direct all agencies, including the police and the army, to provide emergency transportation to the emergency case."