KATHMANDU, Dec 21: Maternal deaths due to postpartum complications continue to occur in Nepal, as the latest data shows that on average, 151 mothers die for every 100,000 live births. According to the Nepal Demographic and Health Survey (NDHA) 2021, 61 percent of maternal deaths occur after childbirth. Among them, 92 percent are due to postpartum hemorrhage, 2 percent during childbirth, and 6 percent are caused by suicide after childbirth, the Family Welfare Division has stated in its report.
According to the Maternal and Newborn Health Section of the Family Welfare Division, the high mortality rate due to postpartum hemorrhage is a result of inadequate postpartum care. Dr Gauri Pradhan Shrestha, chief of the Maternal and Newborn Health Section, explained that lack of proper care within 42 days after childbirth, along with emerging health issues, leads to complications such as hemorrhage, causing many deaths due to failure to manage these issues in time.
According to Dr Shrestha, postpartum hemorrhage is more common when women are sent home within 48 hours without being kept in a health facility, due to factors such as infections and inadequate care. "At least 24 hours should be spent in a health facility after childbirth, but some are sent home earlier," she said. Since hemorrhage can occur at any point within 42 days after childbirth, special care is essential during this period. If bleeding occurs, immediate contact with a health facility is crucial. Dr Shrestha emphasized that delays in reaching a health facility after hemorrhage also contribute to fatalities.
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Dr Shrestha explains that in some communities, the practice of isolating postpartum women and prohibiting others from touching them leads to infections and postpartum complications. When no one helps, the mother cannot take care of herself or the baby, and poor hygiene leads to infections. "Infections cause wounds in the mother's uterus, leading to hemorrhage," she said. "In some communities in the western and Terai regions, the belief that a postpartum woman should not be touched is still prevalent, leading to infections."
According to statistics, the highest maternal mortality rate is in Lumbini Province, with 207 (25 percent) out of every 100,000 women dying after childbirth. Similarly, in Karnali, the rate is 172 (9 percent), and in Gandaki Province, it is 161. Dr Shrestha also points out that the maternal mortality rate is higher among illiterate women compared to educated ones. According to the data, 38 percent of the women who die postpartum are from the illiterate group.
Dr. Shrestha explains that 100 percent of pregnant women with education above the bachelor's level visit health institutions for prenatal check-ups and childbirth services. However, the rate is much lower among uneducated women. Despite Nepal's goal to reduce the maternal mortality rate to 70 per 100,000 by 2030, recent data shows that challenges remain. "If the current situation does not improve, we will not be able to achieve the target," she said.
The Maternal and Newborn Health Section has launched additional programs to reduce maternal deaths and improve health services. To prevent complications from postpartum hemorrhage, an "Anti-Shock Garment Device" has been placed in maternity centers. This device, when used in the uterus after childbirth, prevents excessive bleeding. It helps in transferring the mother from a primary health center to a higher-level facility more easily, where the cause of bleeding can be identified and treated accordingly.
Additionally, to reduce suicides due to mental health issues after childbirth, maternity hospitals have begun offering mental health services starting this year. Dr Shrestha mentioned that this program is expected to expand across the country. She also emphasized the importance of focusing on the cleanliness, rest, and nutrition of mothers and infants after childbirth.
