When Sannu Devi Yadav was taken to Laxmanpur Health Post on December 16 last year for safe delivery, she had already lost consciousness. The 20-year-old from Narainapur Rural Municipality-7 was immediately referred to Bheri Hospital in Nepalgunj, as her condition was critical. She was admitted to the Intensive Care unit of the hospital but passed away a few days later.

“Yadav was suffering from anemia. We could not save both the mother and child,” said Kashiram, the victim's maternal uncle.

According to Yadav's relatives, she did not visit a health institution even once for a regular test during pregnancy. Her health condition was not known as she never went to get her health checked, they say.

In September last year, Sapana Ale, 22, from Surkhet too lost her life at Bheri Hospital. She fell unconscious after suffering from excessive bleeding while giving birth to a baby. A month after that, 20-year-old Sita Harijan of Janaki Rural Municipality-5 in Banke district too died of pregnancy-related complications at Bheri Hospital. Both the women had never visited a health institution for regular checkups during their pregnancies.

“Many women in rural areas don’t visit health facilities during their pregnancies. This has led to a high maternal mortality rate in the district," said Jayanti Shrestha, a senior nursing officer at Bheri Hospital.

Banke, a Tarai district in Lumbini Province, has hundreds of health institutions that provide maternity health checkups. But the maternal maternity rate is still alarmingly high in the district.

According to the District Health Office in Banke, as many as 83 women in the district died of pregnancy-related complications in the last three fiscal years. Among them, 35 died in the fiscal year 2019-20, 41 in 2020-21 and seven women have died in the current fiscal year. Most of the women died as they were brought to the health institution only after their condition had worsened, health workers say.

There are many pregnant women and postpartum mothers near the Nepal-India border who visit the health institutions in India and die there. The health office does not include the data of those women who die in India.

The high maternal mortality rate in Banke has been a cause for concern for many health officials and workers.

“All the relevant authorities should take the issue of maternal mortality seriously. The government authorities, health workers and the families of pregnant women should work hand-in-hand to address the issue,” said Shrestha. “Maternal mortality rate cannot be decreased until and unless the family members of pregnant women and postpartum mothers are aware about the importance of safe pregnancies and motherhood.”

According to her, government authorities should raise awareness on the importance of safe motherhood, regular health checkups during pregnancy and timely treatment of women with critical health conditions.

Health workers say that the relevant authorities did not pay much attention to safe motherhood during the first and second waves of Covid-19.

“The lives of many pregnant women and postpartum mothers could have been saved if the authorities had launched an effective awareness programme during the Covid-19 pandemic. During that time, many women opted for home births fearing Covid-19 infection at the hospital and died for want of timely treatment,” said Basundhara Gyawali, a health worker at Bheri Hospital.

Teenage pregnancies and a lack of regular health checkups, nutritious food and awareness among family members are the leading causes behind the high maternal mortality rate in Banke, according to health workers.

Besides the high maternal mortality rate, the infant mortality rate is also high in Banke. According to the District Health Office, 111 infants died in the fiscal year 2020-21 while the figure was 197 in the fiscal year 2019-20.