<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f29c7e80680e0b288djpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Photos: UNICEF NEPAL</figcaption></figure>Despite periods of political and economic instability, Nepal achieved dramatic progress in maternal and child health in the early 2000s becoming an international model.It took great strides in reducing childhood malnutrition, in particular, reducing stunting from 57% in 1996 to 33% in 2016. Maternal and Infant mortality rates also similarly declined, only for much of these successes <a href="https://www.nepalitimes.com/banner/nearly-half-of-nepali-children-still-malnourished/" target="_blank" rel="noopener noreferrer">to stall in the recent years</a>. And this trend has been made worse by the Covid-19 pandemic, states a new UNICEF report.Titled “<a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">Nutrition in Nepal: Three decades of progress for children and women</a>”, the report brings together a set of nine original articles that examine the drivers of success and identify where greater policy and programmatic action is needed to achieve the Sustainable Development Goal (SDG) nutrition targets.“Optimal maternal and child nutrition is the basis for developing a resilient society,” says EU Ambassador to Nepal, H.E. Nona Deprez. “The decline in the number of malnourished children, improvements in health facilities and services, and the multisectoral approach used in Nepal over the past three decades are a testament to the Government of Nepal’s commitment to reducing all forms of malnutrition.”A <a href="https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1" data-saferedirecturl="https://www.google.com/url?q=https://onlinelibrary.wiley.com/toc/17408709/2022/18/S1&amp;source=gmail&amp;ust=1642768390008000&amp;usg=AOvVaw2Qo1HoClES2POc3Qyp2i-7">special supplement of the Maternal and Child Nutrition Journal</a> published on Thursday lists some of Nepal’s biggest nutritional achievements. Between 1996-2016, the early initiation of breastfeeding saw an increase from 18% to 56%, and complementary feeding increased from 54% to 77%.During the same period, women taking sufficient iron and folic acid supplements during their pregnancy rose from 6% to 71%. This was combined with earlier and more frequent antenatal care visits.Consistent administering of Vitamin A has saved the lives of an estimated 45,000 Nepali children under the age of five, between 2002 and 2015. Similarly, households using adequately iodised salt doubled from 35% to 77% from 1998 to 2016.Much of this progress can be credited to improvements in household wealth, parental education, and <a href="https://www.nepalitimes.com/banner/toilet-trained/" target="_blank" rel="noopener noreferrer">sanitation</a>. But equally important was increased coverage of health and nutrition services undertaken by successive governments.Nepal Government utilised ground-breaking research to test interventions and overcome challenges, it is also committed to enforcing mandatory legislation such as salt iodisation, writes the journal supplement.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111410114/637204f69c7e80680e0b288ejpeg.jpg" alt="" width="1500" height="1001"><figcaption></figcaption></figure>Mobilisation of <a href="https://www.nepalitimes.com/latest/enlisting-female-health-volunteers-to-fight-covid-19/" target="_blank" rel="noopener noreferrer">Female Community Health Volunteers</a> (FCHVs) across Nepal villages and towns have improved the health of mother and children, so has an investment in sectoral programs including education and sanitation.But there are now new challenges to achieving national and global targets on nutrition, which also threatens to undermine past gains.“The learning from the past 25 years that are incorporated in the supplement will inform and contribute to future improvements. However, we must act now, given the impact that the pandemic has had on the nutritional health of mothers and their children,” says Elke Wisch, UNICEF Representative to Nepal.During the pandemic, most households experienced job losses or reduced income. With the <a href="https://www.nepalitimes.com/here-now/3rd-wave-in-2-years/" target="_blank" rel="noopener noreferrer">Omicron-led third wave</a> spreading across Nepal, the pandemic’s ensuing socioeconomic crisis is long from over.This means reduced dietary intake among children and mothers. School closures will deprive many children of getting one decent meal a day. All this will add to <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">childhood malnutrition</a> which continues to be a major cause of death and retarded mental and physical development among younger populationsAs such, UNICEF has recommended the government to improve the general public’s access to nutritious, safe, affordable, and sustainable diets. It also suggests integrating essential nutrition services into the existing service delivery platforms like family planning, antenatal, delivery and post-natal care and well-child and sick-child care and continuing to mobilise FCHVs to reach more women and children.To disseminate factual information, advice and counselling on infant and young child feeding, <a href="https://www.nepalitimes.com/here-now/3rd-covid-wave-infects-nepals-frontliners/" target="_blank" rel="noopener noreferrer">healthcare workers</a> can also use multiple communication channels such as radio, TV or social media.But perhaps equally if not more important is strengthening local levels so that they can plan, implement and monitor nutrition programs and services, and maintain Nepal's commitment to generating data, information, and evidence to assess progress and inform decisions.

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Covid undermines Nepal's mother-child gains

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110161144/636d1d0e9c7e80680e0af390jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Photo: PRATIBHA TULADHAR</figcaption></figure>Tara wanted to understand why she had been so angry all the time. But she could make no sense of <a href="https://www.nepalitimes.com/opinion/anger-management-for-nepali-women/" target="_blank" rel="noopener noreferrer">her anger</a>—anger that burst from within her like an inferno.Most days, she would wake up in the morning and go back to sleep. She could not comprehend what made getting out of bed so hard. Maybe the fear of having to face the world. Or just having to step out of bed—the act of moving her feet from underneath layers of bedclothes to the floor. Just the act. She would sometimes replay it in her head in repeat before actually doing it.Most days, she had zero courage to move her feet. But by mid-morning, she would usually make do.Read also: <a href="https://www.nepalitimes.com/opinion/no-direction/" target="_blank" rel="noopener noreferrer">No direction</a>, Pratibha TuladharSome days Tara worried about having to talk to Ama. Ama was constantly angry, too. Either angry or afraid. When she wasn’t one of the two, she would only talk about her grief.Ama saw the strangest details in everything around her. Even in pigeons shitting. She would say they must be having a bad stomach. Now, how on earth could she know what was going inside a pigeon’s belly! But she vouched for it. The pigeon. Diarrhetic.She would scoop out details in everything.Whenever Ama met some new fabric for the first time, she would pull the garment up to her eyes, looking through her glasses like they would bleed into the details. Even as she was going blind. Ama!Ama is stuck in between times. She has her ideals, and little else. Most of all, she has no money. Without money, ideals aren’t easy to sell to others. You can only use it as dinner table rants with Tara, who she was brought up to be just like her-- moralistic, semi-arrogant, awkward and afraid at the same time. Yet, every day, Tara promised herself she would never allow herself to become anything like Ama!Read also: <a href="https://www.nepalitimes.com/opinion/sita/" target="_blank" rel="noopener noreferrer">Sita</a>, Pratibha TuladharBut every day, Tara felt a part of her slide through the loophole of her promise. She was gradually turning out to be just like Ama. She had even started laughing like Ama and wheezing like her during asthmatic attacks.The change was so gradual, it did not escape either of them. Tara, now Ama’s spitting copy. Not in image. But in doing. That is who mothers and daughters are—they are each other. Without ever wanting to be.Some days, Tara is not so angry. And on those days, she reaches out with her hands to warm up Ama’s hands. Ama’s hands are a prettier, older version of Tara’s. But they are firm—calloused from years of caring.“Not a rupee for all the care work we do, us housewives!” yells Ama sometimes, after reading an article in the women’s column. After flinging the newspaper aside, off she goes and bends over the kitchen sink again.Ama.Some nights, when it rains, Tara is really cold. And she thinks it is the perfect excuse for her <a href="https://archive.nepalitimes.com/article/editorial/the-republic-of-insomnia,3311" target="_blank" rel="noopener noreferrer">insomnia</a>. In the morning, she will tell Ama she did not sleep because it was too cold.Last night was cold. It rained like mad, like the rain would sweep away all of Kathmandu. Tara regretted not having enough bedclothes. Tara reminded herself that she must get her quilt out in the morning.When she woke up this morning, timorous rays of the sun had begun to steal into the house. Tara asked Ama where her quilt was. She said she had put it away.Read also: <a href="https://www.nepalitimes.com/opinion/letter-to-a-nepali-aunty/" target="_blank" rel="noopener noreferrer">Letter to a Nepali aunty</a>, Anjana RajbhandaryIt irritated Tara to think she would have to go through the ordeal of digging up through a pile of bedclothes to find her quilt. Because Ama had the habit of stowing everything within sight, away. She thought of it as a way of cleaning up the house. And memory.It was a while before Tara dug up her quilt.“I hate the sight of that thing,” Ama said, when her daughter finally managed to pull it out.The quilt, you see, was among the things Ama had bought Tara as her wedding presents. In those days, she was still young and strong so the two had walked through nooks and gallies of Ason, finally deciding on the quilt and then lugging it home all the way to Siuchatar, jumping on and off public vehicles.The cover had massive red and green floral prints. While Tara was married, it had kept her warm—in matrimony and in her loneliness. <a href="https://www.nepalitimes.com/opinion/nepals-unequal-marriages/" target="_blank" rel="noopener noreferrer">Marriage can mean many things</a>. It can be a trail of sighs, hours of tears, punctuated by laughter. Who knows what stays with one when trials are actually over. Not the words, but the essence of experiences.So, when Tara’s marriage ended, bundles of things that belonged to her were sent back to Ama’s home. The quilt was one of the things.Tara wanted to carry it to the terrace and spread it out, so it could soak some sun. But when she carried it up to the terrace, Ama was already there.“I hate the sight of it,” Ama murmured.“It’s alright. It’s mine. You don’t need to deal with hating it.”Tara walked past Ama to the corner of the terrace where pansies and petunias were still in bloom. So unlike this time of the year, Tara thought. Ama’s flowers, just as mad as her. The overnight rain had tampered with them. But they were still there. Withering away, but swaying gently every time the softest, post-rain breeze gathered at their stems.And Tara thought, “We are in spring.”Suburban Tales is a monthly column in Nepali Times based on real people (with some names changed) in Pratibha’s life.

Pratibha Tuladhar

Of anger and love

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221110141132/636cfdb39c7e80680e0a0bfcjpeg.jpg" alt="" width="3000" height="2000"/><figcaption>Photo: WWF NEPAL</figcaption></figure>As the Covid crisis pushes <a href="https://www.nepalitimes.com/banner/the-real-cost-of-nepals-second-wave/" target="_blank" rel="noopener noreferrer">millions of Nepalis back below the poverty line</a> affecting their nutritional status, the UK government is funding supplemental food for mothers and children affected by the monsoon and Covid-19 pandemic in Nepal.The additional £788,000 (Rs130 million) will allow the World Food Programme (WFP) to support 100,000 mothers and children with specialised nutritional supplement 'super cereal' for two months in eight districts in Province 2, Sunsari in Province 1, Jajarkot in Karnali and Kanchanpur in Far West. Mothers in target areas will also receive counselling on Covid-19 and <a href="https://www.nepalitimes.com/editorial/hunger-for-governance/" target="_blank" rel="noopener noreferrer">nutrition</a>.“Natural hazards affect marginalised communities disproportionately, including women and children. Protecting the health of the Nepali people is a top priority for the UK Government,” says Nathanael Bevan, Director of Development at the British Embassy in Kathmandu. “The UK is glad to be supporting WFP’s efforts to make sure vulnerable Nepalis, especially mothers and children, receive proper food and nutrition.”The Covid crisis has reversed Nepal’s gains in poverty reduction and <a href="https://www.nepalitimes.com/banner/nepals-epidemic-of-hunger/" target="_blank" rel="noopener noreferrer">childhood malnutrition</a> achieved in the past ten years.Children as well as pregnant and breastfeeding months in rural Nepal are among the hardest hit by the pandemic. Currently, over 15% of households in Nepal are food insecure, while around 39% of children between 6 to 23 months do not meet minimum dietary requirements.A WFP report earlier this year found that Nepal had up to 1.84 million pregnant and lactating women who were malnourished. This in turn affects the growth of their children as they receive <a href="https://www.nepalitimes.com/latest/the-pandemic-of-hunger/" target="_blank" rel="noopener noreferrer">inadequate nutrition</a> even before they are born.And as newborns they get mothers’ milk lacking in nutrition, leading to a greater risk of dying before the age of five. More than one-third of children under five face stunted growth.Many of the older children also relied on school lunches for a nutritious meals but <a href="https://www.nepalitimes.com/here-now/lessons-not-learned-from-the-pandemic/" target="_blank" rel="noopener noreferrer">prolonged school closure</a> means that they are also deprived of this.In addition to reduced food intake, children and young mothers have been <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">unable to access health services and immunisation facilities</a> for the better part of the last year and a half due to restrictions of the movement.“The pandemic and its socio-economic impact have put unrelenting pressure on Nepali families’ food security. Between December 2020 and June 2021, the number of households experiencing income loss has doubled – from 21 to 45% – making food increasingly out of reach for many,” says WFP Nepal Country director Jane Pearce. “This aid will enable us to reach the most vulnerable mothers and children whose lives have been made harder by Covid and now the monsoon.”Since the start of the first nationwide lockdown on 24 March 2020, and the subsequent widespread disruption to normal economic activity, Nepalis have faced increased strain on household income, directly <a href="https://www.nepalitimes.com/latest/quarter-of-nepalis-still-hungry-during-pandemic/" target="_blank" rel="noopener noreferrer">impacting their food intake</a>.In fact, they have reported increased job losses and a reduction in income over the past year and a half. While in December 2020, 5% of households reported job loss, it was nearly 14% in June 2021. Similarly, 21% of households reported a reduction in income in December 2020 while it was 45% in June 2021.But most families have received <a href="https://www.nepalitimes.com/latest/half-of-nepalis-lost-jobs-in-past-month/" target="_blank" rel="noopener noreferrer">little to no support from the government</a> to tide them over the long months of pandemic and subsequent lockdowns.Moreover, Nepal is one of the most vulnerable countries to <a href="https://www.nepalitimes.com/banner/disasters-in-nepal-come-in-waves/" target="_blank" rel="noopener noreferrer">natural calamities and the impacts of climate change</a>, tens of thousands of people are displaced by the floods and landslides every monsoon in lack of timely preparedness.A part of the contribution will also go to help WFP conduct a new round of cross-country household food security surveys. This funding is in addition to the £4.49 million (Rs678 million) WFP received from the UK Government in December 2020 towards the agency’s response to Covid-19.

UK aid for Nepali mothers and children

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84729c7e80680e067796jpeg.jpg" alt="" width="1500" height="1125"/><figcaption>Rita Khatri, 21, is the only skilled birth attendant in her village of Phediguth of Okhaldhunga district, where she has helped to promote institutional birthing despite the challenges posed by the pandemic. All photos: NARESH NEWAR</figcaption></figure>Unlike many of her nursing colleagues who yearn to go abroad or find a job in a city hospital, Rita Khatri returned to her home village in Okhaldhunga after completing her training as a skilled birth attendant in Kathmandu.It was not easy for the 21-year-old to be taken seriously by her own community in Phediguth village of Champadevi Municpality, she had to earn their trust and respect one safe delivery at a time.But just as families in surrounding villages came to depend on her for vital <a href="https://www.nepalitimes.com/latest/3-nepali-mothers-still-die-daily-at-childbirth/" target="_blank" rel="noopener noreferrer">prenatal care and safe deliveries</a>, the Covid-19 pandemic hit. Now, on top of all the other health challenges in rural Nepal, there is the additional danger of being infected with this contagious new strain of the coronavirus that has spread across the country.Because of its remoteness and lack of connectivity, the pandemic has not affected this scenic district of eastern Nepal as seriously as other parts of the country. Still, there are 90 active Covid-19 cases in the district and a dozen people on average test positive every day.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b84769c7e80680e067797jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>Being a trained midwife, Rita Khatri’s main worry is that restrictions on travel and fears about the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">virus will affect maternal and neonatal health services</a> as most villagers are afraid to visit her birthing centre for check-ups and deliveries.“I am scared that the pandemic will set back all the work we have done here to reduce home deliveries and to improve maternal and infant survival,” Khatri says. “We had finally managed to convince families to opt for institutional birthing, but that might now change.”Staff at the centre are also worried about their safety, since this <a href="https://www.nepalitimes.com/editorial/this-is-war/" target="_blank" rel="noopener noreferrer">second wave is much more deadly</a> than the one in 2020. Last year, Khatri had helped mothers even when most government health posts had shut down in the districts, many staff were afraid to come to work, and if they did were afraid to even touch their patients.But Khatri kept the birthing centre open, and carried out 32 deliveries in 2020, some of them complicated ones where the <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">mothers’ life would have been in danger</a> if they had given birth at home.“Closing down would have meant risking the lives of many mothers,” says Khatri, who has been trying to convince as many families as possible who are under her care that it was safe to visit the birthing centre.https://www.youtube.com/watch?v=ESmZURVRyN4It is much more difficult this year to convince both mothers and staff. Still, Khatri says, “I am also apprehensive about being infected, but I am the only SBA around here, and I want to ensure as many <a href="https://www.nepalitimes.com/banner/infant-deaths-up-during-nepal-lockdown/" target="_blank" rel="noopener noreferrer">institutional deliveries</a> as possible and save mothers and their babies from risking home births.”Khatri says that for her, nursing is not just a job. It is an occupation through which she wished to serve her community where there is no doctor for miles around. There is a steely determination in her thin voice as she says, “I will keep my doors open no matter how bad the pandemic is, this is what I was trained to do.”The community has a new esteem for Rita Khatri because of the dedication and hard work she displayed last year, and villagers are glad that they have her to go to for <a href="https://www.nepalitimes.com/opinion/newborn-deaths-and-a-vision-for-a-post-pandemic-nepal/" target="_blank" rel="noopener noreferrer">safe motherhood</a>.It has not been easy for Khatri to earn this trust. When she first returned home to Okhaldhunga to join Phediguth Health Post, villagers heard that a new ‘doctor’ had arrived. But when they came to visit, they were visibly disappointed that it was just a girl they knew from the village.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847a9c7e80680e067798jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>But within a few months, Khatri proved herself through her profesionalism and ability to handle the most complicated maternity cases at the birthing centre which was upgraded with help from the non-profit, <a href="https://www.nepalitimes.com/banner/what-can-be-more-fulfilling-than-saving-lives/" target="_blank" rel="noopener noreferrer">One Heart Worldwide</a> (OHW).Not every delivery goes right, there are some which need specialist treatment or caesarian sections, others suffer post-partum haemorrhage and some mothers are already in a critical condition because they are brought to the centre too late. When the mother or child cannot be saved, Khatri has sometimes been slapped, kicked and verbally abused by angry relatives.“I could understand their frustration, but I did not let anything demoralise me,” says Khatri. “I was trying to the best of my ability to save their lives.”Today, everyone respectfully calls Khatri ‘Sister’, and some even call her ‘Doctor’. Many also have apologised for mistreating her in the past, and come bearing gifts to show their gratitude. “I refuse to take them because I am just doing my duty,” Khatri tells us.Champadevi Health Post has upgraded its maternity room, but there are many others across Nepal that are struggling with <a href="https://www.nepalitimes.com/banner/this-is-how-to-upgrade-nepals-rural-health/" target="_blank" rel="noopener noreferrer">proper buildings, equipment and staff</a>. The biggest challenge is the lack of nurses trained as skilled birth attendants.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109111144/636b847d9c7e80680e067799jpeg.jpg" alt="" width="1500" height="1125"><figcaption> </figcaption></figure>When Rita Khatri joined the Phediguth Health Post, its birthing centre did not have proper equipment, not even a maternity bed for deliveries. Most deliveries happened late at night without electricity, and mothers were in prolonged labour sometimes lasting 16 hours. Some of Khatri’s patients preferred lying on the floor to give birth because they found the table that served as a maternity bed so uncomfortable.Without electricity, staff had to stumble in the dark during deliveries, and it was difficult to keep the maternity room warm without heaters. Khatri tried unsuccessfully with the local government to get power supply, but it was One Heart Worldwide that installed solar-powered lights. Little by little, the facility was improved to be the clean and bright birth centre it is today.Khatri is modest about her accomplishment: “This is the least I could do for my birthplace, so giving birth is safe."To donate to Phediguth Health Post: Account name: Phediguth Health PostRastriya Banijya Bank, OkhaldhungaAccount number 207000290101

Saving Nepali mothers on Mother’s Day

<figure><img width="1500" height="1000" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022111011114/636cccdf9c7e80680e08bc46jpeg.jpg" alt=""/><figcaption>Photo: WFP NEPAL</figcaption></figure>The Government of Japan is to provide assistance worth $3.47 million to the <a href="https://www.nepalitimes.com/banner/grow-nourish-sustain-together-world-food-day/" target="_blank" rel="noopener noreferrer">United Nations World Food Programme</a> (WFP) Nepal, to support families worst-hit by the loss of income because of the Covid pandemic. The Mother and Child Health and Nutrition Programme will fund projects in five districts of Provinces 1 and 2.
The support is in the long line of the Japanese government’s continued assistance to Nepal to improve the health and nutrition of young mothers and children. Outgoing Japanese Ambassador to Nepal Saigo Masamichi and WFP Nepal Country Representative Susan Jane Pearce signed the grant agreement. 
“This partnership between the Japanese Government, the Government of Nepal, and WFP has the potential to improve the health and nutrition of 19,000 <a href="https://www.nepalitimes.com/latest/the-lost-covid-generation/" target="_blank" rel="noopener noreferrer">children</a> aged 6 to 23 months and 49,700 pregnant and breastfeeding mothers through specialised nutritious food. Community Food Banks equipped with food storage facilities will be set up targeting 25,000 households,” said Masamichi during the signing event.
Jhapa, Morang, Sunsari, Saptari and Siraha districts, prone to annual flash floods and landslides made worse by the climate crisis, are the core project areas. The assistance will also help populations whose livelihood was disrupted by the Covid-19 lockdowns and the economic collapse, mainly in rural locations where agriculture is the primary source of income for families.
A series of surveys by UNICEF Nepal and Sharecast Initiative last year concluded that <a href="https://www.nepalitimes.com/editorial/pandemic-of-poverty/" target="_blank" rel="noopener noreferrer">42% of households in Nepal have no income</a> as an impact of the pandemic. The study also showed that another 19% families have a monthly income of less than NRs10,000.
A separate study by the Ministry of Agriculture showed that nearly <a href="https://www.nepalitimes.com/latest/nepalis-eating-less-due-to-lockdown-hardships/" target="_blank" rel="noopener noreferrer">a quarter of families in Nepal are eating less</a>, and 6% had run out of food following the coronavirus crisis. Province 2 is among the most vulnerable of the districts suffering the impact.
The grant will further boost the ability of 2,500 government officials and health specialists to support health and nutrition services during pregnancy and childbirth, monitor child growth, and provide nutrition counselling at 100 municipal health facilities.
Says Susan Jane Pearce of WFP Nepal: “Covid-19 has had severe impacts. By supporting the production and consumption of locally available and traditionally consumed nutritious food and through shock-responsive community food banks, we hope that this project will increase dietary diversity among the poor and food insecure households and build community resilience to climatic shocks.”

Japan to assist Nepali mothers and children

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b39c7e80680e07367fjpeg.jpg" alt="" width="1500" height="1000"/><figcaption>Children in Gai Jatra procession in Kathmandu on Tuesday even as the risk of COVID-19 looms over the capital. Participants have however taken to wearing masks as mandated by the government while partaking in festivals. Photo: MONIKA DEUPALA</figcaption></figure>Prime Minister K P Oli held a meeting with 20 public health experts on Tuesday to discuss steps to deal with COVID-19, especially in <a href="https://www.nepalitimes.com/latest/heightened-covid-19-risk-at-india-nepal-border/" target="_blank" rel="noopener noreferrer">cities bordering India</a> – a sign that his government is taking a recent surge in cases seriously.The meeting came as Nepal reported 259 new cases on Tuesday, taking the total number so far to 21,009 and the number of fatalities up by one to 58. Kathmandu Valley detected 62 new cases and now has 727 confirmed cases (481 active) with 5 deaths.The government this week put six districts with over 200 cases (Kathmandu, Rautahat, Kailali, Mahottari, Parsa and Doti) in the Red Zone. (see map) In Kathmandu, 72 staff at Nepal Police Headquarters have tested positive and the premises are sealed off.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">Lockdown may</a>be over, but pandemic is not, Editorial<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b69c7e80680e073680jpeg.jpg" alt="" width="1275" height="1650"><figcaption> </figcaption></figure>Speaking at the interaction, Prime Minister Oli said: “We must lower the infection rate to zero, and treat those who are sick. But as long as we keep the border open, there will be more cases ... so we have to test them before allowing them to travel to home districts.”Experts present noted that although the numbers are rising, the World Health Organisation (WHO) still puts Nepal in the ‘cluster spread’ stage, <a href="https://www.nepalitimes.com/editorial/lockdown-may-be-over-but-pandemic-is-not/" target="_blank" rel="noopener noreferrer">where the virus is not showing community transmission</a>. They advise the government against re-imposing a lockdown, saying it was not a long-term solution.Most public health experts favour a ‘smart lockdown’ where localities with cluster outbreaks are sealed off, and tested – while strictly enforcing masks in public places and preventing crowds.Since the lockdown was lifted on 21 July, the rate of infection has increased to 3.37%, indicating rapid spread in districts bordering India where all major cities like Birganj, Bitartnagar, Dhandagi, Nepalganj, Janakpur and Rajbiraj are under curfew.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4b99c7e80680e073681jpeg.jpg" alt="" width="1265" height="822"><figcaption> </figcaption></figure>Officials in Kathmandu Valley are also said to be considering lockdown, but experts say it is more advisable to seal off neighbourhoods rather than a strict blanket closure.Medical experts fear that another shutdown is likely to kill more people than the disease it seeks to control, as people with non-coronavirus ailments cannot get to hospital for treatment, and the economy suffers even more, <a href="https://www.nepalitimes.com/latest/covid-19-leaves-millions-of-south-asian-children-hungry/" target="_blank" rel="noopener noreferrer">lowering nutrition levels</a> of people.Government figures show that there were <a href="https://www.nepalitimes.com/banner/children-are-collateral-damage-in-nepal-lockdown/" target="_blank" rel="noopener noreferrer">30% more child deaths in April-May</a> this year compared to last year. <a href="https://www.nepalitimes.com/here-now/birth-and-death-during-a-pandemic/" target="_blank" rel="noopener noreferrer">Maternal mortality has also gone up</a> because many more mothers gave birth at home instead of going to hospital. There has been a <a href="https://www.nepalitimes.com/here-now/meanwhile-a-measles-outbreak-in-nepal/" target="_blank" rel="noopener noreferrer">spike in measles</a> and other infections because of delays in vaccination campaigns.“A lockdown is not the solution to the coronavirus crisis. We must first analyse why we did not do the previous four months to take measures to control the spread,” says Sher Bahadur Pun of the Ministry of Health, “another lockdown will not make a difference.”Pun adds that uncontrolled movement of people across districts during the lockdown with thousands crossing the Indian border to reach their homes, led to the flare-up in the infection.“It is only going to get worse from here, especially as winter approaches,” predicts Buddha Basnyat of Patan Academy of Health Sciences. “We have to accept this and prepare for it, but another lockdown is only the last resort.”Basnyat says the government has to get on a war-footing to <a href="https://www.nepalitimes.com/editorial/open-and-shut-case/" target="_blank" rel="noopener noreferrer">increase testing in the Tarai districts</a> enforce mask-wearing and physical distancing, and as the number of severe cases rise, develop a treatment taskforce.Hospitals should be better equipped to handle the increase in symptomatic and severe coronavirus cases being seen now, with clear treatment guidelines identifying the most effective drugs and therapies for Nepalis, so there is no expensive over-prescription.As the ICUs get filled up, there is an urgent need for ventilators and oxygen concentrators, Basnyat adds. There are now 36 patients with COVID-19 across the country, with 23 in Bagmati Province, which includes Kathmandu Valley. Birganj is said to have reached saturation in ICU capacity, and hospitals in other Tarai cities are also filling up.Health experts say that while Nepal may not be able to build hospitals in a week like Wuhan did, the government can start mass testing in the high-risk zones, set up tents and ICU beds and stockpile life-saving drugs and medical equipment.<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110914110/636ba4bd9c7e80680e073682jpeg.jpg" alt="" width="858" height="671"><figcaption> </figcaption></figure>Experts are also advocating for regular mass testing in cities with more movement of people. And if there is indeed another lockdown, they say testing in densely populated urban centres is a must.A recent surveillance based on swab samples of 10,000 of the people who entered Kathmandu Valley last week found that 0.7% of them tested positive for SARS-CoV-2. Despite this seemingly low positivity rate, health officials say that the finding is significant because those individuals would have been carriers in their families and communities.More worryingly, there is now a rise in cases with serious symptoms across Tarai districts, unlike in the past when most were asymptomatic or had co-morbidity. Hospitals in the Tarai are seeing a surge of typical COVID-19 symptoms with advanced pneumonia.“Most hospitals and doctors in Nepal are now starting to feel the devastation this virus can cause, as it did in Lombardy, New York and parts of India,” says Buddha Basnyat. “Which is why despite low fatality rate in this part of the world and the concept of herd immunity, there is no time to be complacent.”A rise in influenza in the rainy season could also be a reason for misdiagnosis because flu and COVID-19 have similar symptoms. Experts suggest flu to be tested with COVID-19, especially as winter approaches.But even with all the planning in the world, strategies, drugs and medical infrastructure, the most effective tools against the virus are the three <a href="https://www.nepalitimes.com/opinion/prevention-while-searching-for-a-cure/" target="_blank" rel="noopener noreferrer">simple safety measures</a>: physical distance, masks and hand hygiene.Says Sher Bahadur Pun: “Testing, tracing and treating are important. Government action is crucial. But how strictly Nepalis follow safety guidelines and adapt it into their everyday lives will make the most difference.”

Sonia Awale

Experts caution against extending Nepal lockdown

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221129151140/638619f69c7e80680e0cccd2jpeg.jpg" alt="" width="1500" height="844"/><figcaption>Photo: MARTY LOGAN</figcaption></figure>It should not be surprising that <a href="https://www.nepalitimes.com/latest/the-story-of-nepals-first-covid-19-fatality/" target="_blank" rel="noopener noreferrer">Nepal’s first COVID-19 death was a new mother</a>. 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.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/3rd-month-of-lockdown/" target="_blank" rel="noopener noreferrer">Three Nepalis have died with coronavirus</a> 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 <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" target="_blank" rel="noopener noreferrer">maternal mortality</a> 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 <a href="https://www.nepalitimes.com/here-now/bhaktapurs-covid-19-heroes/" target="_blank" rel="noopener noreferrer">coronavirus infection</a> 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 <a href="https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007" data-saferedirecturl="https://www.google.com/url?q=https://archive.nepalitimes.com/regular-columns/Comment/mothers-in-Nepal-still-dying-at-childbirth,1007&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNHGPAy4FgQc1EbtnlKIZJMxrFl6XA">high cost of ambulance</a> to take them to health facilities.Nepal has made <a href="http://archive.nepalitimes.com/article/nation/people-politics-placentas-child-delivery-complications,3922" target="_blank" rel="noopener noreferrer">progress in reducing maternal mortality</a> and <a href="https://www.nepalitimes.com/banner/born-in-nepal/" target="_blank" rel="noopener noreferrer">newborn deaths</a> 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. <a href="https://www.nepalitimes.com/here-now/kidney-patients-dying-due-to-covid-19-lockdown/" target="_blank" rel="noopener noreferrer">Non-communicable diseases </a> 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 <a href="https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/" data-saferedirecturl="https://www.google.com/url?q=https://www.nepalitimes.com/here-now/who-will-save-nepals-poor-new-mothers/&amp;source=gmail&amp;ust=1590230096851000&amp;usg=AFQjCNEb9E7sQYw1XzmTTnMfGji3UmNybQ">under-staffed, ill-equipped and short of medicines</a>, 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 <a href="https://www.nepalitimes.com/opinion/tipping-point-on-menstrual-banishment-in-nepal/" target="_blank" rel="noopener noreferrer">chhaupadi</a> 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 <a href="https://www.nepalitimes.com/latest/has-nepals-lockdown-just-postponed-covid-19/" target="_blank" rel="noopener noreferrer">has had ample time to craft a much more effective response, and has not</a>  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.

3 Nepali mothers still die daily at childbirth

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8ca89c7e80680e06b30ejpeg.jpg" alt="" width="1214" height="809"/><figcaption>All photos: MONIKA DEUPALA</figcaption></figure>Every year, Mother’s day, also known as Matatirtha aunsi is celebrated by pampering mothers with gifts and delicacies. Those who have lost their mothers pay a special homage by taking holy bath at Matatirtha ponds in the outskirts of Kathmandu and by making offerings for the peace of the soul.However, with the strict lockdown, which has now completed a month, many people couldn't travel far or to their maternal homes, though some still continued the tradition amidst the COVID-19 restrictions.Photojournalist Monika Deupala was in Hanumanghat, Bhaktapur on Thursday morning to capture devotees performing the rituals.<a style="background-color: #ffffff; font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/news.php?id=19215#.XqFqLMgzbIU" target="_blank" rel="noopener">"Thank you, Ma",</a> Eliza Sthapit<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cab9c7e80680e06b30fjpeg.jpg" alt="" width="2048" height="1364"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cae9c7e80680e06b310jpeg.jpg" alt="" width="2048" height="1364"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cb29c7e80680e06b311jpeg.jpg" alt="" width="2048" height="1364"><a href="http://archive.nepalitimes.com/blogs/mycity/2016/05/06/remembering-mothers/">Remembering mothers</a>, Nepali Times<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cb69c7e80680e06b312jpeg.jpg" alt="" width="2048" height="1364"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cba9c7e80680e06b313jpeg.jpg" alt="" width="2048" height="1364"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cbe9c7e80680e06b314jpeg.jpg" alt="" width="2048" height="1364"><a href="http://archive.nepalitimes.com/news.php?id=18187#.XqFp0MgzbIU">Every day is Mother's Day</a>, Ruma Rajbhandari<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cc29c7e80680e06b315jpeg.jpg" alt="" width="1440" height="960"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8cc69c7e80680e06b316jpeg.jpg" alt="" width="640" height="426"><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221109121116/636b8ccb9c7e80680e06b317jpeg.jpg" alt="" width="640" height="427">

mothers