Free bus rides driving safer births for Nepali women

The Aama Surakshya, or ‘protection for mothers,’ program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk. (AFP)
Updated 17 July 2018
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Free bus rides driving safer births for Nepali women

  • The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal
  • A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey

RAMECHHAP, Nepal: As a teenager Meera Nepali was terrified as she went into labor with her first child at home in a remote village, miles from a hospital with nobody but her mother-in-law to help.
“I was a scared, but that was the norm. We didn’t have doctors close by,” Nepali said of her three-day labor in Khadadevi village in Nepal’s hilly Ramechhap district.
This year however, she delivered her second child in a rural health center thanks to a small cash incentive that is getting pregnant women to hospital by paying their bus fares.
The Aama Surakshya, or “protection for mothers,” program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk.
The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal, where the risk of dying in childbirth is higher than anywhere else in South Asia except Afghanistan.
A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey, as well as the paucity of clinics in many parts of the country.
“We found that one of the main reasons rural women did not go to a hospital during childbirth was because they did not have hard cash to pay for transportation,” said Suresh Tiwari, one of the original architects of the scheme.
The program was started in 2005 with British aid money but has since been taken over by the Nepal government.
Today, it covers not just transport but medical costs for mothers and babies and includes a cash bonus for attending antenatal check-ups.
2017 marked a milestone for the program: more Nepali women opted for hospital births over home deliveries for the first time on record, official figures show.
“The free service and transport incentive have been very effective in bringing women to health centers and hospitals where they can be saved in the case of complications,” said Tara Nath Pokharel, head of the government’s Family Health Division, which now runs the program.
Nepali, one of the beneficiaries, paid nothing for her three-day stay at a clinic in Ramechhap district, east of Katmandu, in January.
She was discharged with 1,000 rupees ($9) for transport plus a 400 rupee bonus for attending four antenatal appointments.
“I returned home in an ambulance. We hardly had to spend anything. I am really grateful for this facility,” Nepali said, cradling her young son in her arms.
The scheme is also saving lives outside the maternity wards, in part by tackling cultural obstacles.
Deeply patriarchal attitudes and traditional preferences for home births also see hospital visits dismissed as an unnecessary expense for poor families.
Sita Khatri went into labor weeks before her due date and, unable to walk the three hours to the nearest health center, gave birth to a healthy boy at home.
But the 27-year-old suffered a retained placenta, a painful and potential fatal complication of childbirth, and had to plead with her husband to take her to hospital.
“He said we don’t have money. I insisted, saying there are government facilities, we won’t have to spend too much,” Khatri said.
“It is better to go the hospital than to die at home.”
Eventually Khatri’s husband relented, and she was treated for free at a nearby clinic. The couple were also given 1,000 rupees to pay for transport.
But some women cannot be reached by road and must be carried, while others encounter poorly equipped facilities once they arrive, said Niliza Shakya, a doctor at a health center in Ramechhap.
“Some women still don’t have the decision-making power to say they want to go to a hospital, and health posts like ours are not equipped enough,” said Shakya.
Nepal managed to reduce maternal mortality by 71 percent between 1990 and 2015 — just missing out on an ambitious Millennium Development Goal to reduce the rate by three-quarters.
But it has a long way to go in improving the overall quality of its health care, said Binjwala Shrestha, a charity worker from the Safe Motherhood Network Federation of Nepal.
“Reaching the hospital alone is not enough,” she said.


El Salvador court frees woman jailed for delivering stillborn

Evelyn Hernandez (C) is surrounded by activists after being released from the women's Readaptation Center, in Ilopango, El Salvador, on February 9, 2019, where she was serving a 30-year-sentence for aggravated homicide after her baby died at birth. (AFP)
Updated 16 February 2019
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El Salvador court frees woman jailed for delivering stillborn

  • Even women who abort due to birth defects or health complications risk jail sentences of up to 40 years in El Salvador

SAN SALVADOR: A Salvadoran court on Friday freed Evelyn Hernandez, who was sentenced to 30 years in prison after she gave birth to a stillborn baby at home.
After serving 33 months for aggravated homicide, 20-year-old Hernandez smiled as she was reunited with her parents and a brother in the capital San Salvador.
The court in Cojutepeque, east of the capital, ruled that she will be retried but while living at home. A hearing has been set for April 4, with a new judge, her lawyer Angelica Rivas said.
El Salvador has an extremely strict abortion ban. Hernandez gave birth in the makeshift bathroom of her home in the central Cuscatlan region. She was 18 years old and eight months pregnant.
She said her son was stillborn but was convicted of murdering him, abortion rights group ACDATEE said.
ACDATEE cited a pathologist’s report which it said indicated the baby had choked to death while still in the womb.
Prosecutors argued Hernandez was culpable for not having sought prenatal care, ACDATEE said.
The group said Hernandez had not known she was pregnant and gave birth on the toilet after feeling abdominal pains. She got pregnant as the result of a rape, which she did not report out of fear because her family had been threatened.
Even women who abort due to birth defects or health complications risk jail sentences of up to 40 years in El Salvador. Campaigners say some have been jailed after suffering miscarriages.
The country’s abortion law made international headlines in 2013 when a sick woman was forbidden from aborting a fetus which developed without a brain.
Under a ruling by the Inter-American Court of Human Rights, the Salvadoran state eventually authorized her to undergo a cesarean section. The baby died shortly after the procedure.