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Jul 6, 2014

The Tragic Tales Of Birth In Nepal

The first time I witnessed any child birth was 3 years ago. And that in my capacity as a med-student in my teaching hospital well equipped with the maternity services. Despite the optimum care, you smell anything wrong; and then emergency C-section is ready to come as your saviour! The same hospital taught me in later days: high maternal and perinatal mortality and morbidity are the burning obstetric problems grappling the developing nation like ours. But sitting in my cozy hostel room in Bhairahawa where facilities are just a stone’s throw away, I had failed to visualize the enormousness of that problem. Unless you see things with your own eyes, someone living in the ivory tower can’t be expected to grasp things fully just by simply reading or hearing it.

The day before, I watched Subina Shrestha's short documentary ‘Birth in Nepal’ and it is against this backdrop that I am writing this piece. Herself 5 months pregnant while filming it, this Al Jazeera journalist cum filmmaker sets out to Achham, one of our remotest corners and tracks some women in labor there to explore what it is like to give birth in this part of the country. In the opening scene, Subina herself has her routine ultrasonography (USG) done in one of the private hospitals in Kathmandu. In fact, she has an engaging presence throughout the docu.  And off she sets for her journey, once confirmed that everything inside her is alright. The scenes that follow are upsetting for many reasons. 

Routine USG during pregnancy to detect any complications at the earliest is but a distant dream for Achhamis. The facilities which Subina enjoys in the capital are the prerogatives of the rich. It then hardly needs reminding that what this documentary subsequently presents is more a reflection of ‘social disadvantage’ than ‘health disadvantage’.

Maternal or fetal death in the process of delivery is a tragedy for every individual woman and her society. Achham remains on the brink of this tragedy every single second. But since this tragedy is not an exception but the norm for its people, it is always in a mood to readily endure it. I don’t know how many of these people know that this tragedy is preventable. But many of them have already resigned to their fate. Yes, institutional delivery is encouraged with incentives, but the moment you see the state of road and vehicular facilities, you understand why most of them don’t make it to the health centres. Basanti Sarki and similar other Basantis thus give birth to their children in the absolutely hazardous conditions of their home.  Add to this lone battle- 18 hours a day work, lack of nutritious diet and no care at all during pregnancy and you get the perfect recipes for a disaster. Not to mention the locale’s mindset that filming Basanti will destroy her home. This docu’s 31 year old Basanti, who has already 5 children, luckily survives the ordeal and so does her new-born daughter. But to be brutally frank, this newborn has her destiny already predetermined. The same cycle is going to repeat itself if these same conditions continue to prevail. Because that crucial ‘EDUCATION’ factor is missing from the scene.

The tale becomes even more horrifying when their darlings who had gone to India in search of bread and butter return; for they don’t return empty-handed, they bring with them a deadly virus and transmit it to their wives. The resulting menace of HIV/AIDS has compounded the problem manifold. Forget about family planning, parenthood, adolescent health and so and so stuffs; we have not been able to even save our mothers, instead have conveniently left them to their fate.

But not everything is gloomy indeed. I have read reports on how our maternal health statistics have improved and how Nepal’s success story in maternal health has become an international best-seller. I have read on internet about Nyaya health’s laudable jobs in the Far-Western hinterlands.  So things have certainly changed for the better in the aftermath of this docu. However, despite these good news, what keep me from celebration are the stories of several other Basantis who are not as fortunate as the one in this docu. After all, even if those pregnant mothers manage to make their way to hospitals combating all the odds, what they find is ‘no doctors’ and ‘no facilities’ to deal with complications.

Achham’s story has now got all that publicity it deserved. There is nothing more to talk about. Now is the time to act. It’s time to ensure a safer delivery by getting everything that it takes to birth in hospitals fixed. Or is it really too much to even ask for 24 hours birthing centres in every PHCs ?


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