When will a Nepali leader apologise for the 1,200-plus women who die giving birth yearly?
The headline of this story refers to Nepal Prime Minister KP Oli, who a couple of weeks ago admitted in Parliament that his government had failed to prevent COVID-19 deaths. (As I write this Nepal has four COVID deaths). When the article was published on the Nepali Times website the headline was changed, removing that point. Regardless, too many women, and other Nepalis, continue dying because of the broken health system.
It shouldn’t be surprising that Nepal’s first COVID-19 death was that of a new mother. It was startling to learn that Prime Minister Oli admitted in Parliament on Tuesday that Nepal’s two coronavirus deaths to date represent a failure of his government. This raises the question: when will a leader apologise for the more than 1,200 women who die every year giving birth?
The 29-year-old woman from Sindhupalchok, whose name has not been released, reportedly died Saturday of breathing difficulties 10 days after safely delivering her baby at Teaching Hospital in Kathmandu, then returning home. Tests done after her death revealed she was infected with the coronavirus.
According to her husband, the woman waited seven hours for an ambulance to take her to hospital on Sunday. Unfortunately since the start of the pandemic, ambulance drivers have been refusing to carry passengers with COVID-19-like symptoms, which is understandable given their lack of personal protective equipment. Ironically, one of the reasons far too many Nepali women still give birth unsafely at home is the high cost of ambulances to take them to health facilities.
Huge progress was made — but not enough
Yes, late last century and into the 2000s Nepal made huge progress reducing maternal mortality, and newborn deaths thanks to the Safe Motherhood programme, 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 having pregnant women be healthy is still a government priority it hasn’t been obvious during the lockdown. Reporting has revealed that pregnant women have been too fearful to visit clinics during the lockdown 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. People living with NCDs also deserve an apology from the government.
While NCDs have been misleadingly labelled ‘lifestyle’ diseases, their causes are many and complex. Alcohol abuse, tobacco use, unhealthy diets and lack of exercise are their main risk factors but these are a result of social and environmental factors. How easy is it in Kathmandu, for instance, for the average person to exercise regularly and how many new mothers understand that the ubiquitous shiny packages of Wai-Wai are essentially junk food?
Maternal mortality more easily preventable
Maternal mortality is more easily preventable. Its main causes include post-partum bleeding, unsafe abortions, high blood pressure and post-delivery infection. Abortions aside — because there are still stigmas 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 Programme has used helicopters to rescue dozens of pregnant or post-partum mothers in emergency situations and many local governments have started programmes to cajole or coerce women to give birth in facilities and to 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 because of its exoticism. Yet roughly 15 women have died in chhaupadi in Nepal since 2010, based on reports, compared to nearly 15,000 women who perished 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 PM and his cronies in all parties have been in power — that too deserves an admission of failure, followed by corrective action.