Mothers at risk

Improving Maternal Health is the fifth objective of the Millennium Development Goals. Nepal stands as one of the 189 countries obliged to meet this objective i.e. reducing its Maternal Mortality Rates to 213 per 100,000 by 2015. To meet the target, the Government of Nepal has fostered many supportive health sector reform plans and agendas for reducing maternal mortality and protecting the reproductive health rights of women.

Some of these government plans include the Second Long Term Health Plan, the Three Years Health Plan, Safe Motherhood Programme, the National Safe Motherhood Plan (2002-2017), and the Neonatal Health Long term Plan (2006-2017), among others. Simultaneous strategies have been developed for the implementation of these plans and programmes which include the establishment of health posts, sub-health posts, primary health care centres, providing Comprehensive and Basic Emergency Obstetric Cares (CEOC and BEOC) facilities, 24 hour delivery services in 75 districts, Mothers Safety Programmes, Birth Preparedness packages, and the provision of incentives to encourage institutional delivery.

Counting such efforts as well as accumulating the achievement in maternal health, Nepal was bestowed the MDG award for 2010 by the United Nations. The World Bank report and Nepal Millennium Development Goal Progress Report 2010 depicts how far Nepal has been successful in bringing about results. The report reveals that the Maternal Mortality Ratio (MMR) has dropped significantly and will reduce a further three quarters by 2015. Data reflects that in the present context, MMR has reduced to 229 per 100,000 live births as compared to 835 when the UN Human development report was first introduced. The percentage of women receiving at least one antenatal visits and at least four visits has increased. These achievements are, of course, laudable.

However, many women are still dying of risks during pregnancy. For instance, in March 2011, a case of maternal death occurred with pathetic news that a woman in the Far-Western region of the country died being due to the unavailability of immediate medical services in her home district. Several factors, including the hike on airfare impeded her travel to emergency medical facilities in Nepalgunj, and she suffered for four days with acute labour pain and stillbirth. This case attracted the attention of the whole country. However, many other cases of maternal death nationwide go unnoticed every year. Although the overall data reflects that maternal mortality has decreased we still see mothers dying from having too many children, lack of family planning knowhow, hesitating to use birth control, and the burden of having to give birth to a male for inheritance purposes.

To assess such cases, services provided by the government are in need of yardstick measurement. Planning does not independently support implementation unless fostered by fundamentally developed infrastructures such as hospital buildings and surgical machines. But most importantly, are doctors and other assisting human resources for health. In absence of such infrastructure, consequent results are observed. For example, obstetrics which can be very essential for the prompt saving of people’s lives have been lacking in health centres, sometimes causing death.

Lack of the availability of health professionals or staff at the health post, sub health posts, primary health care centres should be matters of concern for the government. Well-equipped infrastructures as well as well trained teams are an essential part of obstetric care.

Other factors that directly correlate with health have to be taken into account as well. For example, transport facilities have to be extended rapidly to all far-off areas. People must have access to roads that can sustain vehicles. Relying on air services is not always easy for the Nepali people whose income is far less than the standard per capita set by the UN to measure human development. Though women may have learned about reproductive health and safe motherhood practices, the practical aspect is lacking, which causes maternal deaths. It has to be surveyed and the media should be mobilised such that the right to reproductive health and safe motherhood topics are broadcasted more.

The medical human resources to the remote parts of our country are very few in comparison to the demand of health personnel. Moreover, supplementary posts are often vacant as the deployed personnel do not stay at the designated centers for many reasons. For example, Bajura district with a population of 126,267 has a district hospital with three doctors and 117 health workers where only two doctors and 101 health workers work, as per the data presented in the INSEC’s Human Rights Yearbook 2011. Therefore, the supply side regarding human resource for health has to be increased with effective monitoring regarding the presence at placements.

Various multi-donor agencies are funding the health sector to strengthen health services in Nepal. It is necessary that apart from providing technical assistance, the sector should also focus on developing the infrastructure construction of hospital buildings and supply of equipment in remote areas.

To conclude, it is commendable that the Nepali government has succeeded in addressing many maternal health issues and reducing the maternal mortality rates. However, many women in rural areas are still dying because of maternal health problems despite admirable health services available. Thus, more effort has to be invested to get this message across and make maternal health in Nepal sustainable. Ultimately, the right to health is a fundamental social right of every citizen.