Almost exactly one year ago Nepal’s health department called an urgent meeting of its partners working in maternal health to ask if any of them could supply misoprostol, a drug used to stop excessive bleeding after childbirth. The Covid-19 lockdown had strangled supply and women in rural Nepal were reportedly dying for lack of the drug.
It took nearly six months for a 1-year supply of misoprostol to arrive via the UN Population Fund and an international non-profit, One Heart Worldwide (OHW), again as a result of the pandemic battering global supply chains. I read about this emergency and wanted to track the pills to their end users—women living in Nepal’s villages who were likely to give birth at home without a skilled birth attendant.
Thanks to the generosity of OHW, I visited Chimling Village in Sindhupalchok district, just a half-day drive from the capital Kathmandu. We talked only to two mothers and two community healthy workers, so I am careful to not generalize what I learned but in short, I was reminded that keeping a woman—and her child—safe during delivery requires much more than a pill like misoprostol.
As I described in the first part of this article, I had long known about the social and economic factors that affect people’s health, the so-called ‘social determinants of health.’ But it’s a completely different thing to see them in action.
What I found in Chimling Village, and described in an episode of the Nepal Now podcast, were numerous barriers to ensuring the good health of pregnant and post-partum women, including:
- Fear of unnecessary, and expensive, treatment at area health facilities
- Shame at being seen in pain by strangers
- Lack of training of community health workers
- Failure of the local health system to adhere to norms for caring for new mothers.
I’m encouraged to see that the issues I identified after my trip are echoed in Nepal’s new Safe Motherhood and Newborn Health Roadmap: 2020-2030. The challenge, as always, will be to ensure that they are translated into action on the ground.
Nepal was already lagging behind in reaching the targets for maternal health in the Sustainable Development Goals—Covid-19 is only going to make that challenge harder to meet.