3 Nepali mothers still die daily at childbirth

It should not be surprising that Nepal’s first COVID-19 death was a new mother. What was surprising was to hear Prime Minister K P Oli admitting in Parliament on Tuesday that Nepal’s coronavirus deaths represented a failure of his government.

Three Nepalis have died with coronavirus since the pandemic hit Nepal. But that is the number of mothers who died every day across Nepal at childbirth. Despite dramatic strides in reducing the maternal mortality rate, 1,200 mothers still die while giving birth every year.

Government statistics show that this number has risen dramatically in March and April, as women avoid hospitals because of the COVID-19 scare, as well as because of the lack of transport during the lockdown.

The 29-year-old woman from Sindhupalchok, whose name has not been released, died on 16 May of post-partum sepsis and a coronavirus infection 10 days after safely delivering her baby at Teaching Hospital in Kathmandu, then returning home. There were delays in taking her to hospital after complications because the family could not find an ambulance.

Even before the COVID-19 crisis, one of the reasons far too many Nepali women still give birth unsafely at home was the high cost of ambulance to take them to health facilities.

Nepal has made progress in reducing maternal mortality and newborn deaths thanks to the Safe Motherhood program, for which it received global recognition. But that improvement was nowhere enough to conclude that the job was done and the country could rest on its laurels.

Figures show that in 1990, 901 women died per 100,000 births. That number was slashed to 239 per 100,000 live births in 2015. Yet the target for 2030 under the global Sustainable Development Goals is less than 70.

If the health of pregnant women is still a government priority it has not been obvious during the lockdown. Pregnant women have been too fearful to visit clinics for crucial antenatal checkups, but by now arrangements should have been made for them to do so safely — or alternatives put in place — and those plans communicated to women.

Of course, post-partum mothers are not the only Nepalis dying because of the broken health system. Non-communicable diseases  NCDs) are now the cause of most deaths in the country, led by heart disease, lung disease and stroke, but an NCD Multisectoral Action Plan spanning 2014-20 has yielded no visible results.

The main causes of maternal mortality include post-partum bleeding, unsafe abortions, high blood pressure and post-delivery infection. Abortions aside — because there is still stigma attached to having one and a lack of knowledge about their legality — the other causes are treatable.

Some initiatives have been taken. The President’s Women Uplift Program has used helicopters to rescue dozens of pregnant or post-partum mothers in emergency situations and many local governments have started programs to cajole or coerce women to give birth in facilities andto properly care for themselves and their newborns in the crucial days following delivery. But too many health facilities that should be providing services to pregnant women remain under-staffed, ill-equipped and short of medicines, and there is no visible national action plan, certainly no sense of urgency.

Contrast media coverage of deaths of new mothers with those of women and girls practising chhaupadi in far western Nepal. Temporarily exiled from their homes during menstruation or after giving birth, they are at risk of snakebite, asphyxiation in tiny, windowless huts, and rape and physical assault. While outlawed, the practice continues.

In recent years chhaupadi has been reported widely in Nepal and garnered numerous headlines in major global media. Yet, while roughly 15 women have died in chhaupadi in Nepal since 2010, there have been 15,000 women who died in that time from causes associated with giving birth. For much of the media, death during pregnancy has become too routine to deserve coverage.

The prime minister was right to admit failure over the COVID-19 deaths to date: his government has had ample time to craft a much more effective response, and has not  The deficits in the health system overall have been evident, and discussed, throughout the decades that the prime minister and his colleagues in all parties have been in power. That deserves an admission of failure, followed by corrective action.