Karnali grapples with high maternal, child mortality

By Rajani Yogi,Surkhet, Apr. 21: Bhawana Bista, 27, of Narharinath Rural Municipality–8 in Kalikot, died during treatment. She had undergone a caesarean delivery at the Provincial Hospital, Surkhet, on April 13. 

Although the first operation was successful, her condition became critical following a second surgery performed on April 15 after blood clotting complications were detected.

As her condition deteriorated, her family spent approximately Rs 860,000 to airlift her to Kathmandu. 

She was flown to the capital by a chartered helicopter with medical personnel on April 17. However, doctors at Mediciti Hospital declared her dead shortly after arrival.

Similarly, on September 17, 2023, Janaki Regmi of Panchpuri Municipality–2, Surkhet, also died at the hospital. 

She had been admitted to the maternity ward of the Provincial Hospital after experiencing labour pains. Although no complications were initially observed, she died two days after delivery, according to the hospital.

Both incidents are of a similar nature. In Karnali Province, several postpartum mothers have been dying even after reaching hospitals. Every year, maternal deaths continue to be reported in the region. 

While some women die after arriving at health facilities, others lose their lives before they can access medical care.

Not only mothers, but infant mortality is also equally concerning. The maternal and neonatal mortality rates in Karnali remain alarmingly high. Each year, many mothers and newborns die due to various causes, including excessive bleeding, embolism, uterine rupture, and eclampsia. The number of such deaths appears to be increasing rather than declining.

According to the National Census 2021, Karnali Province still records a maternal mortality rate of 172 per 100,000 live births, which is higher than the national average and other provinces. 

In line with the Sustainable Development Goals, the government and various non-governmental organisations claim to be working to reduce this rate to 70 by 2030. 

However, despite Surkhet hosting relatively well-equipped health facilities and trained personnel, a significant number of women continue to die even after reaching the Karnali Provincial Hospital.

The lack of blood bank and intensive care unit (ICU) facilities in health institutions has been identified as a major factor contributing to maternal mortality during delivery. 

Delays in blood supply often prove fatal. In many hospitals, the absence of uterotonic drugs, which are essential to control postpartum haemorrhage, further complicates treatment.

Under the government’s Safe Motherhood Programme, free health check-ups, travel allowances, and the “warm clothes package” are provided to pregnant women. 

However, the effectiveness of these initiatives remains questionable. According to Shobha Yogi, an Auxiliary Nurse Midwife at Chhepadi Health Post in Aathbiskot Municipality–9, Dailekh, maternal deaths occur at home, on the way to hospitals, or during referrals between health facilities.

Public health expert Dr. Sharad Wonta attributes these deaths to a lack of essential medicines, insufficient specialist doctors, inadequate training for medical staff, and the absence of well-equipped maternity wards in many hospitals. 

He also noted that a lack of community awareness about safe delivery practices leads to delays in seeking medical care, often resulting in fatal outcomes.

Meanwhile, relatives of pregnant and postpartum women frequently accuse hospitals of negligence in such cases.