At least 20 healthcare facilities, including a district hospital and four birthing centres, were destroyed in the November 3 earthquake that killed at least 154 in Jajarkot and Rukum West districts.

This deals a severe blow to maternal health in the two districts where the institutional delivery rate is around just 50 percent, meaning that almost half of the babies are born at home.

It could further increase home delivery rate, heightening the risk of maternal and newborn deaths, maternal health experts say.

“The institutional delivery rate in our district is already low and the damage that the earthquake inflicted on public buildings and health facilities could further lower the rate,” said Pratiksha Bharati, an official at the Health Office Jajarkot. “Though we have set up temporary birthing centres, people may not seek institutional delivery services as they are still in trauma.”

A report on maternal mortality carried out by the National Statistics Office in 2021 showed that for every 100,000 live births, 151 women still died from maternity-related complications. Similarly, the institutional delivery rate has reached around 80 percent. Maternal death rate and home delivery rate are very high in remote areas.

Officials from the Ministry of Health and Population said that they are aware of the risk of a rise in home deliveries, which poses a threat to maternal and newborn deaths.

“We have discussed the issue with our officials and other stakeholders,” said Nisha Joshi, an official at the Family Welfare Division under the Department of Health Services. “We have decided to send winter kits to new mothers and their babies, big tents to set up temporary birthing facilities and ready-to-eat nutritious food in the affected health facilities.”

Maternal health experts say expecting mothers will face hurdles in visiting their doctors regularly during pregnancy, which could risk the lives of mothers and their babies. Along with the institutional delivery rate, the number of antenatal and postnatal visits could also go down due to the effects of earthquakes, which means an increase in the risk, according to them.

“The first priority should be saving the lives of mothers and their babies,” said Dr Bhola Rijal, a maternal health expert. “Special programme should be launched to prevent maternal and child deaths. Women who are at risk of possible complications during delivery should be referred to advance centres at the earliest.”

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, around 18 percent then, has increased to an average of around 80 percent across the country. However, far-flung areas like Jajarkot and Rukum West have only around 50 percent institutional delivery rate.

The health ministry also provides travel allowances for antenatal care visits, imparts skilled birth attendant (SBA) training to staff nurses and hires them at birthing centres to prevent possible deaths during or after child delivery.

Nepal had cut 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.

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.