“It’s all worked very well and I feel safe here.”
This is the verdict of Sangita Chaudhary, following the birth of her baby at the newly built Dhakdhai Health Post in a remote, rural area of Nepal. Any hospital would be happy with such a reaction from a new mother, but it is all the more meaningful here in Nepal where women are 30 times more likely to die during childbirth than women in the UK.
A safe environment
Thanks to UKaid from the Department for International Development, the government of Nepal is saving the lives of mothers like Sangita by allowing them to give birth in a safe environment with a trained midwife.
“After I learned the dangers of home deliveries using traditional midwives – including the risk of bleeding and infections – I was scared to have my baby at home so I came to the health post,” says Sangita.
At another maternity ward, in Baglung District Hospital, Sarasitu Bhatta has become the proud mother of twins. “If I had had these twins at home I don’t think I would have survived,” she says. “The doctor had already told me I would be taking a big risk but I wasn’t going to take any chances and I was right – when I was giving birth I had confidence in the team.”
Sarasitu Bhatta, proud mother of twins. Photo: Chandra Shekhar Karki
Although many of the traditional “techniques” of childbirth (such as suspending a hammer from the placenta to remove it) are becoming increasingly rare, the fact remains that seven out of ten babies in Nepal are born at home without a trained doctor or midwife in attendance. This leaves both the mothers and the new-born children vulnerable to many life-threatening risks. On average, a young mother in Nepal dies every four hours and a new-born baby dies every 20 minutes.
Making a safe birth affordable
Like other mothers in Nepal, Sangita was given free care at the health centre and also received money to cover her travel costs which, in remote areas, can be a considerable burden on poor families.
“Affordability, including the cost of transport to health facilities, is key to safe motherhood in Nepal,” says Homnath Subedi, an advisor to the government of Nepal’s Support for Safe Motherhood Programme (SSMP), co-funded by DFID. “For a normal delivery, including transport, it can cost about £47. Most poor families have to borrow this from moneylenders – pushing them further into debt – so most give birth at home. If there are complications, the costs can be twice as high.”
Improvements in maternal health across Nepal
However, there is light at the end of the tunnel. Despite high levels of maternal mortality, the situation has improved dramatically over the last 10 years or so, thanks to the introduction of free delivery and other support through the SSMP. Over the decade leading up to 2006, there has been up to 46% reduction in the number of women dying in or around childbirth.
Moreover, since 2001 the number of women giving birth in a government health facility has doubled to 18%. DFID expects this figure to rise to 40% by 2015, saving the lives of about 800 mothers and 11,500 newborns every year. The proportion of women having at least one antenatal checkup has also increased from 42% to 74%.
Several factors beyond offering free deliveries have played a critical role in achieving these improvements. For example, more than 100 new birthing centres and emergency obstetric care facilities have been built or upgraded in remote, impoverished areas of Nepal, nearly 1,700 skilled birth attendants have been trained and promotional campaigns have helped to raise awareness.
The bigger picture on maternal health
Nepal is not alone in dealing with high levels of maternal mortality. Every year, more than a third of a million women die due to complications in pregnancy or childbirth. The vast majority of those deaths occur in developing countries in sub-Saharan Africa and South Asia. When a mother dies in childbirth, there is a high chance her child will die within a few months too.
In addition to improving access to health services – particularly for people living in remote areas – and increasing the number of trained midwives and doctors, education also needs to be addressed. Research has shown that women who complete secondary education are two-thirds less likely to lose an infant than average. Educated women also have fewer children, reducing the likelihood of maternal mortality.
Meeting the need for family planning
Access to contraception and family planning are vital in reducing the numbers of mothers dying and empowering women to take decisions about their own future. Every year 20 million women seek unsafe abortions and 70,000 of them, many still girls, die as a result. 215 million women around the world who want to use modern contraception don’t have access to it.
The UN estimates that satisfying the unmet need for modern family planning would reduce unintended pregnancies by 53 million every year, the greatest reduction being in low income countries.
In the words of International Development Secretary Andrew Mitchell:
“Our ultimate goal is always to empower women in their own lives. That goal is simply non-negotiable and I promise you here and now, that Britain will be placing women at the heart of the whole of our agenda for international development.”