TAKING ACTION FOR Nepali Women’s HealtH
May 25, 2022
As All Hands and Hearts marks International Day of Action for Women’s Health, we would like to draw your attention to Nepal; a country steeped in history, an everlasting mountain range and, according to a UN survey, the happiest nation in South Asia. Yet, there is an ominous challenge the women of Nepal have faced for decades and continue to face today: maternal mortality (death due to complications from pregnancy or childbirth).
Since 1990, the maternal mortality rate (MMR) has declined rapidly from 850 to 186 deaths per 100,000 live births. Though an achievement, this is still the highest rate of maternal mortality outside the continent of Africa and has recently been amplified as a result of the COVID-19 pandemic. The department of health found that 258 women died as a result of pregnancy or childbirth between March 2020 and June 2021. In the year before March 2020, the country recorded 51 maternal deaths.
Nepal has committed to help reach Sustainable Development Goal (SDG) target 3.1; reducing the global MMR to less than 70 maternal deaths per 100,000 live births by 2030. This ambitious target can only become a reality if Nepal reduces its MMR by at least 7.5% annually.
Thanks to the generosity of our Board and the AHAH UK Trust, all donations to our Nepal Relief Program from May 26th, 2022 until June 26th, 2022 will be matched dollar for dollar up to $50,000.
AHAH has worked tirelessly in Nepal since the 2015 Gorkha earthquake through response and long-term recovery, specifically the reconstruction of schools. When COVID-19 gripped the world, AHAH supported a school-turned quarantine center in the district of Sindhuli. While working at the quarantine center, a health post was identified nearby. We learned that in Dudhauli, a municipality within Sindhuli, the health post was responsible for serving a community of approximately 40,000 from a facility with the space and WASH infrastructure (Water, Sanitation and Hygiene) to support about half that number. Moreover, the area was in need of family planning and ante/post-natal facilities. AHAH decided that we could and should draw on our in-depth experience in Nepal and the power of community which we’ve found throughout Nepal, to plug in our dedicated staff and volunteer teams and build a path to better health outcomes for Dudhauli.
While the two existing buildings are structurally sound, there is limited space to treat patients. The rooms have been subdivided to create makeshift spaces to treat more people, yet the conditions are inadequate, uncomfortable and do not allow for social distancing.
Since January 2022, we have been constructing a family planning, sexual health and birthing center to meet the demand of the local communities and lessen the burden on these existing facilities. Specifically, we have constructed two additional disaster resilient buildings that will house:
- Ultrasonography, to check the progress and development of the baby
- Family Planning, to provide information and advice for those who wish to start or extend their family
- Adolescent Sexual & Reproductive Health, to ensure the young population of Dudhauli and its surrounding communities have a safe place to seek information and help
- Labor room, for mothers before the delivery of their baby
- Delivery room
- Post-delivery room, where families can be together in the hours after the birth of the baby
Furthermore, to support the increase in patients and visitors, AHAH has constructed additional WASH facilities at the health post. These include bathrooms with showers attached at each new building, as well as an additional three-pan toilet block and drinking fountain to serve the larger health post.
To ensure effective and comprehensive strengthening of health and reproductive services, AHAH is working with partners NATAN and Relief Nepal to conduct training focused on increasing the quality of care given by the health post as well as increasing awareness and improved practices within the local community. Together we’re providing training in reproductive health, WASH knowledge and skills, and public health promotion. As the new ultrasonography and x-ray equipment is installed, the health post’s nurse-midwives are also receiving hands-on training with the equipment that will allow them to further serve the community with this technology.
Pramila is an Auxiliary Nursing Midwife (ANM) at Dudhauli health post. She is 55-years old, and a mother to 5 children (4 daughters and 1 son). When Pramila first arrived in Dudhauli, the community lacked basic infrastructure such as roads, electricity or water. Although Pramila has seen improvements at the health post since she first started her career, she also recognizes there is still a need for improvement, especially in terms of maternal care. The COVID-19 pandemic affected all members of the community; however, Pramila saw pregnant women and new mothers facing the greatest challenges. Many pregnant women and new mothers were fearful of visiting the health post and those who did lived in constant fear of contracting COVID-19. Pramila shared that during this time she saw “the health system crumble” and the unfortunate effects of this resulted in an increase in preventable maternal deaths.
The work being done to improve and expand both structural and technical services of the Dudhauli Health Post while also working with community members to access information about healthcare will build up the availability of care alongside local trust in these institutions. Pramila is hopeful for the expansion of the health post. She shares:
“The two maternity buildings undergoing construction would help address the current problems like the lack of sufficient infrastructure and competent health professionals to look after the maternity cases. Moreover, we as a health professionals and I personally, are very much thankful for the efforts AHAH has put in – whether it is building the maternity wards or providing Community Health Workers with much needed training in areas such as: reproductive health promotion, psychosocial, ultrasonography, first aid and maternal care training. We are truly enthralled by the idea of having two separate pre-birth and post-birth buildings.”
Furthermore, Pramila shared the importance of empowering women and breaking cultural barriers and patriarchal stereotypes.
“I was deeply struck when I happened to observe female volunteers going toe to toe with their male counterparts. We do have gendering of the roles even in health sectors, as the nursing sector, has almost been occupied by women. But to see female volunteers in the construction work, which is highly regarded as a male domain, is something that AHAH has done praiseworthy and it’s a great message to the community. I advocate the idea that women, when educated or trained and allowed to trade those skills or education, can be self-reliant or financially independent- which is the first promise to realize women’s empowerment. My heart fills up with joy when I observe the female mason trainees working on the site for training.”
By working together, we can act now to decrease the number of preventable maternal deaths, build good health systems and provide health services ensuring the mother and expectant mothers of Dudhauli are provided with quality health care.
