The first delivery room I saw atop the lush, rounded hills in eastern Nepal as a 20-year old made an indelible impression. It was empty, dark, dirty, and housed a homemade-style delivery table carved from wood covered only by a plastic sheet stained red, readied for eventual re-use. The sight stirred one of those moments of exaggerated empathy – where you have a true visceral reaction to the thought of a loved one being placed in that position before your eyes. For me, the thought of my own mom delivering in such a vulnerable environment was far too difficult to imagine, for the environment itself seemed to assist death as an all too possible outcome.
Yet the relatively modest number of Nepali mothers that do have the opportunity to give birth in health facilities (most are out of reach of a facility altogether and instead deliver at home), often endure equivalent environments across the country.
Where we at Nyaya Health currently work in Achham District, in the more angular and arid hills of Far-Western Nepal, the idea that giving birth is too often a death sentence is well documented. A few years prior, it was estimated that 1 woman’s life was claimed for every 100 births. This equates to one of the highest maternal mortality rates in the world and places mothers in Achham at 200-fold higher risk of maternal mortality compared to those in the United States. Nepali filmmaker Subina Shrestha visited Achham District while pregnant herself in 2010 to reveal the struggles of these mothers (see that video on AlJazeera here).
Yet, the message of encouragement this Mother’s Day is that concurrent gains in dignity and the safety of delivery are possible. At Bayalpata Hospital, a facility Nyaya Health operates and manages in partnership with the Nepali government, the rate of increase of hospital-based deliveries has been dramatic. Before June 2010, there were only 6 hospital deliveries per month. In the time since, the number has tripled to over 18 deliveries per month (an average difference in 144 deliveries per year). And the trend line is continuing up and to the right.
Well, investments have been made in financial incentives (June 2010 is when financial incentives for antenatal visits and in-hospital deliveries started through the Government’s Safe Motherhood Program). Yet our own interviews with expecting mothers, as part of an upcoming study, show this financial incentive as only one small piece of the determinant puzzle. The number one determinant of delivery location is in fact the safety and quality of the health facility, with the distance required for travel coming in a close second. Another important notable difference is that Nyaya Health pays community health workers (almost all of whom are mothers) to bridge the emotional, educational, and literal distance with pregnant mothers in these communities in irreplaceable ways.
This Mother’s Day, let the story of what is happening in one of the regions of highest maternal mortality in the world be telling of a truth that ought not be strewn with complication – women do not have to die in delivery, and the most thoughtful and impactful way to make this happen is to deliver on our collective ability to bring quality, safe facilities close to their homes.
Mark Arnoldy is the Executive Director of Nyaya Health (www.nyayahealth.org), an organization committed to doing whatever it takes to build transparent, data-driven health systems for Nepal’s rural poor. Nyaya Health is hosting a Mother’s Day campaign to bring employment and safer delivery to mothers in Far-Western Nepal at mom.nyayahealth.org.