How can motherhood be made safer in Nepal ? More than hospitals are needed

Abstract

The United Mission to Nepal (UMN) has been involved in health work in the Okhaldhunga District of eastern Nepal for more than 30 years. UMN's Okhaldhunga Hospital, which is the only hospital in the district has been providing emergency obstetric services (EOS) since 1979. The Community Health Section of the project has been involved in maternal and child health care, community health education, and nonformal education since 1977. During the last ten years, the absolute number of deliveries presenting to the hospital has increased almost three fold. Yet, the number of women presenting with complications has not increased proportionately, and still only represents a very small percentage of the women in the district who experience obstetric complications every year. The Community Health staff conducted focus group discussions among women attending antenatal clinics and literacy classes to ascertain local beliefs and practices concerning pregnancy and childbirth, and to improve our understanding of why women do or do not seek obstetric care at the hospital.

These focus group discussions revealed that many women in the community know about high risk conditions in pregnancy (eg, prolonged labour, bleeding, breech position), but they still wait 2-3 days before seeking help. Going to the hospital is frequently delayed due to issues of finance, transport, family beliefs and decision making. Most women said that they did not make use of local health resources because they were unreliable and staff were often absent from their posts. Women in all groups said that the first person called for obstetric complications is still a traditional healer. The results of this experience in the Okhaldhunga District display that a limited focus on strengthening hospitals would not be enough
to significantly change maternal mortality and morbidity. People need education about maternal health. Community-level health workers at health posts need training, support and supervision. Functional systems
of transport and referral need to be established if motherhood, and
the health of women, is to be made safer in places like the Okhaldhunga District of Nepal.