KALIKOT, Dec 9: A woman from Budhinanda Municipality in Bajura gave birth to a child on the way to a health facility on Tuesday. Pansara Rokaya, 31, of Kuru in Budhinanda-4, gave birth to a baby girl on the way to the health post after experiencing labor pains.

Rokaya was on her way to the health post in Kuru alone after going into labor and a daughter was born on the way, said Dharma Chadara, health worker at the health center. She said, "When I was going to the health post, I saw Rokaya in labor pain on the way and helped her."

Chadara said that she was rescued from the road and taken to the health post for treatment as she was having excessive bleeding after giving birth. Rokaya said that the newborn is her third child. She said that she gave birth to all three children on the road.

The case of Rokaya is not the first of its kind, many women of Bajura are compelled to give birth on the road. A few months ago, Ujjali Sunar, 32, from Kanda also gave birth to a daughter on the road.

Bhagya Chadara, 21, of Majhpali of Gaumul Rural Municipality-3, Nani Rokaya of Bandhu of Himali Rural Municipality-1, Parbati Budha, 23, of Natikhola of Himali-2 and Kartika BK, 35, of Muktikot of Swami Kartik Khapar Rural Municipality-1 are a few of those to name who delivered babies in the road while on their way to a health facility, according to Bimala Pandey of Rugin Health Post.

Health workers say that some of the mothers died while giving birth at a young age, being away from health facilities, lack of nutritious food, and unsafe deliveries at home.

Janpura Shahi, 23 of Tilagufa-7, Mathibadi, Kalikot, was in the midst of labor pains. After she had to walk for half a day to reach the nearest health center, preparations were made for her to give birth at home. She was unable to give birth even after about 13 hours of labor pain. She was then rushed to the health post when she gave birth to a son on the way. 

She reached the health post along with the baby. She said, "Initially, I thought that she would give birth at home." After a lot of trouble, we prepared to take her to the health center which was a long way. Before she could reach the health post, she gave birth to a child. Thank god, both of them were safe.”

Some time ago, 41-year-old Jaukala, wife of a 56-year-old visually impaired Kalse Nepali from Khatyad-3, Mugu, had labor pains. Kalse, who was living in Gamgagdhi, decided to take his wife to the district hospital on foot. While on their way to the hospital, Jaukala gave birth on the street in front of Mugu District Court. Jaukala's first pregnancy was a miscarriage. The son born from her second pregnancy died less than a month later.

Last week, a 32-year-old woman from Jarimtola, Khaptad Chededah Rural Municipality-1, Bajura went to Bayalpata Hospital in Achham after she experienced labor pains.

While examining her health, the doctor at the hospital told her that the period of having a baby has exceeded two weeks and that she should undergo surgery.

While returning home after refusing to undergo surgery, she collapsed on the road of Panibhuwa, Budhiganga Municipality-1. She gave birth to a child on the way with the help of Assistant Health Worker Sarjan Sarki of the same ward.

There is a compulsion to give birth on the road and at home due to the lack of easy access to health facilities in remote areas. The incidents mentioned above are representative cases of the challenges faced by pregnant women and new mothers in remote areas, particularly in the villages of Karnali, where geographical difficulty, scattered settlements, distance from health institutions, poor economic conditions, carelessness, and the belief in home childbirth result in these challenges.

Katak Bahadur Mahat, Public Health Officer at the Health Service Office, Kalikot, mentioned that the number of people opting to give birth in health institutions has risen following the initiation of providing transportation expenses. He stated, "Initially, women preferred giving birth at home. However, after the introduction of incentives for those delivering in health institutions, more people started choosing health facilities. Nevertheless, the challenge of giving birth on the way persists due to geographical difficulties and transportation issues, and unfortunately, there is no official record of such incidents."

He said that in some cases, the lives of both the mother and the child are at risk when women from rural areas are brought to health institutions as a final recourse.

According to the Karnali Province Health Services Directorate, only 23.6 percent of families in Karnali can access health institutions within half an hour. 

Among the 10 districts in Karnali, Humla is still not linked to the national road network. Karnali Province houses 359 birthing centers, but considering the geographical conditions, this quantity appears insufficient. Dailekh boasts the highest number of birthing centers at 72, while Dolpa has the fewest, with only 14.

According to the directorate, lately women in Karnali are developing the idea that they should go to a health institution and give birth. In all 10 districts of Karnali province, 33,160 pregnant women in 2020/21, 30,007 in 2021/22 and 29,587 in 2022/23 received maternity services from health institutions.

Similarly, in Karnali, 20 people died in the fiscal year 2020/21, 17 in the year 2021/22 and 16 in the year 2022/23 due to excessive bleeding after childbirth.

Pregnant woman dies on the road

On July 14, 2021 Harishova BK of Tilagufa Municipality-11, Kalikot was stricken with labor pains. She succumbed to labor pains and passed away on the way to the hospital. Shortly before that, Binda Luwar, 20 of Raskot Municipality-7 gave birth at home. She also died on the way to the hospital due to profuse bleeding.

In the Himalayan districts of Karnali, such as Humla, Jumla, Kalikot, and Dolpa, women in labor pain face challenges due to geographical difficulties and lack of access to rural-level health services. Many lose their lives on the road or at home, unable to reach health facilities.

Katak Bahadur Mahat, public health officer and information officer of the Health Service Office, Kalikot, highlighted the challenges, stating that transporting patients from the impoverished areas of Kalikot to the hospital/health post takes hours. Often, people delay seeking medical attention, leading to fatalities even when attempting to reach the hospital.

Although there are health centers in the rural areas of Karnali, there is a shortage of skilled doctors, equipment and medicines. Deepa Bohra, a women's rights activist, says that pregnant women suffer due to health institutions that are not connected to the road network, lack of skilled health workers, difficult geography, and stereotyped society. 

It typically takes 2 to 4 days to reach the district hospital from the most remote parts of Karnali, while village health institutions lack essential facilities.

Senior assistant health worker Janmarishi Neupane, who works at the health post in Dhaulagoha of Palanta Rural Municipality in Kalikot, said, "There is no transport facility to send the patients from the village to a place with facilities immediately. The lack of timely air services has resulted in cases where pregnant women and those in labor lose their lives on the way, exacerbated by the prevalent notion of opting for birthing at home.”

While the government's announcement to construct a 15-bed hospital in every municipality is noteworthy, it is yet to be implemented. According to the Ministry of Social Development of the Karnali Provincial Government, 55 out of 79 municipalities lack operational hospitals, indicating that access to health services has not effectively reached rural areas. The reduction of maternal mortality faces challenges, given the scarcity of specialist doctors and office assistants in the hospitals operated by the municipalities.

 
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