Editorial»
Reproductive health and responsibility
JAN 16 - Health has become a major issue for the
general public. Considering this fact,
the Ministry of Health adopted a National Health Policy in 1991. The main objective of this policy is to bring about an improvement in the health condition of the general people. The International Conference on Population and Development (ICPD), held in Cairo, the capital of Egypt, in 1994, defined reproductive health as not only a state of absence of diseases and infirmities but also as a condition of complete physical, mental and social well-being.
The Nepalese government has formulated a twenty-year Second Long-Term Health Plan (1997-2017) for implementing the reproductive health programme as an approach rather than as a new programme in a cost-effective manner. The government has also been implementing the Safe Motherhood Project. It has prepared a comprehensive document ~ ~ from the Second Long-Term Health Plan for Safe Motherhood Plan (SMP) for the period 2002-2017. The main objective of the SMP is to reduce the maternal mortality ratio from 539 to 250 by 2017. Ultimately, reproductive health programme strengthens the existing safe motherhood, family planning, HIV/AIDS, sexually transmitted diseases (STDs), child survival and nutrition programmes with a holistic life cycle approach.
Reproductive health problems have become a burning problem, especially for the rural women of Nepal. The maternal mortality rate of Nepal is the highest in this region, indicating that a large number of mothers die due to causes related to childbirth. Hence, strategies have been adopted by the government for effective and efficient provision of quality reproductive health services in Nepal. The maternal mortality rate for Nepal is 539 in 0.1 million births. More than 4,500 women die every year due to maternity related problems. To reduce the maternal mortality rate, we should change our behaviour for preventing three delays: delay in seeking care, delay in reaching care and delay in receiving care. Different groups of people or audience are involved in different ways in each type of delay. For example, husbands play a crucial role and health workers play a smaller role in delaying the decision for seeking maternal care. Alternatively, health workers play a significant role, and the husband play a smaller role for delaying the delivery care for mothers.
Many women, their husbands and mothers-in-law do not know about safe motherhood practices. Similarly, there is no practice of the pregnant woman letting her husband know about the changes happening to her. They do not think there is need for antenatal or postnatal care. In Nepal nine out of every ten births occur at home. Many women deliver alone. Most of the deliveries occur with the help of relatives or friends and few deliveries occur with the help of either trained or untrained traditional birth attendants (TBAs).
Traditional healers are usually consulted when problems arise. These people use non-sterilised instruments for cutting the umbilical cord, which poses a high risk of infant mortality. The other reason for the delay in seeking care is women’s shyness.
Use of clinical services is clearly low because of the delay in accessing care. Unfavourable cultural factors in some societies and lack of easy access to health centres negatively influence the use of clinical services. The quality of service in health centres has been found to be very poor. Obviously, the third reason that worsens the safe motherhood practices is the delay in receiving care by pregnant women. The care that a pregnant woman receives in a late stage has no meaningful impact.
There are different factors that affect the maternal mortality ratio. One factor, for example, is the early age of the expecting mother. Other factors include the gap between the births of children, number of childbirths and giving birth at a late age, such as after 35 years of age. Maternal mortality is generally calculated in four stages. Based on the projected population data for 1996, 16.6 per cent of the maternal mortality occurs within 24 weeks of pregnancy, 11.4 per cent occurs just after 24 weeks of pregnancy, 9.9 per cent during delivery and the remaining 62 per cent at the postnatal stage. A study has shown that less than four out of ten women have access to transportation. Similarly, only 8 per cent of all deliveries in Nepal take place in health facilities. As for the place of deaths of mothers, 67.4 per cent occur at home, 11.4 per cent during travel to hospital to seek care and the remaining 21.2 per cent at healthcare centres.
Half of the pregnant women receive antenatal care at least once, with 28 per cent receiving care from a doctor, nurses, auxiliary nurses or midwives. The antenatal care receivers, the pregnant women, go to a caregiver relatively at a late stage in their pregnancy and do not follow the recommended number of four antenatal visits. Out of seven pregnant women, only one visits doctor four or more times for their antenatal care during their entire pregnancy period. Also, only 13 per cent of deliveries are performed under the supervision of trained medical professionals. Similarly, one-fourth of the births occur in the presence of TBAs. The available data show that only 17 per cent of mothers receive postnatal care in Nepal.
The government has endorsed a legal abortion right. Women with unwanted pregnancy are more likely to seek abortion and are at high risk. Untrained health personnel generally perform abortions in unsafe and unhygienic conditions. The joint effect of provision of family planning services and legalisation of abortion will have a positive role in the decline of maternal mortality rate. The major causes of maternal mortality are abortion (5.4 per cent), infection during delivery (11.8 per cent), eclampsia (14 per cent), obstructed labour (16.1 per cent), bleeding during pregnancy (5.4 per cent), and bleeding after the birth of the child (46.2 per cent).
The low level of contraceptive practice and high preference for sons have negative consequences for women’s reproductive health in Nepal. The role of contraceptives is vital in reproductive health. It prevents unwanted pregnancy at early and late ages. It also prevents pregnancy before marriage. Similarly, it helps to widen the birth spacing of infants. Birth spacing is quite low in Nepal.
Nepalese society is not aware of the fact that there is a high chance of maternal mortality during pregnancy, delivery and post-delivery. Hence, the special and worst situations of pregnant women in Nepal should be identified. The private sector, non-governmental and governmental organisations should disseminate the information available and educate the public.
It is necessary to educate all family members about the reproductive health rights of women for making their lives more comfortable and guaranteed. Reducing maternal mortality is a complex issue. However, a vision is needed in terms of where Nepal needs to reach in the future. So, consolidated action has to be initiated by the authorities concerned.Posted on: 2004-01-17 04:11
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