More pills, still no magic—maternal health care in the hills of Nepal

Late last year I returned to Chimling Village in Sindhupalchowk district, in Nepal, to follow up on maternal health issues. I was impressed and disappointed at the same time.

Late last year I returned to Chimling Village in Nepal’s Sindhupalchowk district to follow up on maternal health issues. I was impressed and disappointed at the same time.

I first visited the cluster of tiny cement houses at the top of a steep, rocky and rutted dirt road in March 2021. My goal was to trace an essential drug called misoprostol, which is used to stop bleeding after birth (also known as post-partum haemorrhage). There was a major shortage of the drug in 2020, so Nepal’s Ministry of Health had requested help from the international community.

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“He said he could get another wife (instead) for 50,000 rupees”

Kathmandu-born epidemiologist Dr Lhamo Sherpa says that early in her career she began questioning the treatment of women in Nepal

Working at a community hospital in Bouddha, Kathmandu soon after graduating with a medical degree exposed Dr. Lhamo Sherpa to situations that made her reassess the lives being lived by women in Nepal. For example, “there was this childless couple who came for advice. After all the investigations, when I told him the price for in-vitro fertilization… the husband said that he could get another wife (instead) for 50,000 rupees.”

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Maternal health of Rohingya refugee women improving despite huge challenges

Maternal health in Rohingya refugee camps in Bangladesh continues to make gains despite huge logistical, financial and cultural impediments

A mother and children in a refugee camp in Cox’s Bazar, Bangladesh. PHOTO: UNFPA

Twenty years ago I visited what were commonly called ‘Bhutanese refugee camps’ in southeastern Nepal. (In fact, they were camps of tens of thousands of Nepali-origin people living in Bhutan who had been brutally evicted from that country, with the tacit assent of regional superpower India. But that’s another story.) The tiny bamboo huts where people had to make their new lives were laid out in regular grids on the beaten earth of Nepal’s Tarai or plains region.

So when I imagined the Rohingya refugee camps in Cox’s Bazar, Bangladesh, that image of rows upon rows of tidy, tiny, bamboo buildings came to mind. It couldn’t be further from the truth. The massive Rohingya camps (housing close to 900,000 people) are located on hilly terrain. Because the Bangladesh Government refuses to recognize the Rohingya — who fled similar ethnic cleansing in neighbouring Myanmar — as official refugees, their ‘homes’ are not uniform buildings but a collection of irregular huts covering the hills.

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Updates to Nepal’s rape law erased

Revising Nepal’s rape law is a priority but reducing cases of this violent act requires a societal shift

Activists in Kathmandu protest rising numbers of rape and sexual assault cases, October 2020. PHOTO: Courtesy of Ajhai kati sahane?

Almost one year ago, in January 2021, the Government of Nepal updated the country’s rape law. The changes were incomplete, partly because agreed revisions like widening the definition to include men and boys as victims were deleted at the last minute, but it was an improvement.

Changes that were agreed included increasing jail time for those found guilty and criminalizing any attempts to ‘settle’ a rape case outside of the courts, which is a regular occurrence.

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Right this wrong done to women

I really appreciated this editorial in The Kathmandu Post on Wednesday, 21 July. It linked two things I care about—human rights and maternal health.

A community health unit and a birthing centre were established in Dhiri four months ago but the number of service seekers is minimal. Prakash Baral/TKP

I really appreciated this editorial in The Kathmandu Post on Wednesday, 21 July. It linked two things I care about—human rights and maternal health.

It noted that the United Nations Human Rights Council has just released a statement calling on governments worldwide to ensure that women’s right to sexual and reproductive health is ensured, among other things. The paper linked that with its recent reporting about women in remote areas of Nepal giving birth at home and even in sheds!

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No magic pill for Nepali women who give birth at home

A lifesaving drug cannot fix the sorts of systemic maternal health issues that I saw on a trip to one village

A screenshot from the Nepal Now podcast episode on misoprostol.

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.

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A healthy diet includes social and economic support

I’ve been reading about social determinants of health for some years now, but I had to see this phenomenon in practice before I truly ‘got it’.

A nurse describes the importance of drinking milk at a recent class for guardians of malnourished children at the Nutrition Home in Kathmandu. ©Marty Logan

It’s one thing to understand an issue or fact intellectually, another to experience it first-hand. That’s been made clear to me twice recently concerning health care here in Nepal and what are sometimes called ‘social determinants of health.’

One of my current projects is reporting about malnutrition during Covid-19. I contacted the Nutrition Home close to Kathmandu hoping to speak to the guardian of a child who had been admitted because they were malnourished.

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Nepal’s revised rape law a setback

Advocates for women were excited late in 2020 when they heard that changes were coming to Nepal’s rape law, which has long been criticized as ineffective. For example, youth activists who had met with the attorney general and other lawmakers were energized and excited by the process, as reported on my podcast, Nepal Now.

But when the ordinance containing the revisions was signed by the president, not all of the rumoured improvements were there. Left out was removal of the statute of limitations that says a rape charge must be filed within one year and broadening of the scope of victims of rape to include men, boys and persons of other genders.

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Childhood: another casualty of Covid-19

Girl facilitators in a meeting organised by UNFPA in Udaypur District. ©UNFPA.

Child marriage has risen in many countries since the world started locking down earlier this year. In fact, the UN Population Fund (UNFPA) is predicting that if conditions don’t change, the pandemic will contribute to an additional 13 million marriages of children (mostly under 18) in the next decade.

The causes of child marriage are many and complex — economic, social and cultural. In Nepal, girls are often seen as a burden: raised by their parents only to be sent away to live with their husband’s family, and on top of that a girl is usually expected to carry with her a dowry for the groom’s family, which can amount to a huge amount of cash and goods, big enough to put her family in debt for many years.

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Premature births, stillbirths rise in Nepal during pandemic — Lancet

A report in the journal The Lancet Global Health has confirmed initial figures: child deaths are rising in Nepal as anxious, pregnant women avoid health facilities during the Covid19 pandemic.

A pregnant woman undergoes a checkup at Baitadi District Hospital in June 2020 © Ganesh Shahi/ UNFPA.

This article was published in Nepali Times online, 14 August 2020.

A report published online in the journal The Lancet Global Health this week revealed that the COVID-19 pandemic has caused 50% fewer women in Nepal than usual to give birth in hospitals, resulting in higher risks for premature births, stillborn deliveries and newborn deaths.

The study, conducted in nine hospitals across Nepal found that the stillbirth rate at hospitals and birthing centres increased from 14 per 1,000 before the lockdown to 21, and the neonatal mortality increased from 13 per 1,000 livebirths to 40.

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