The push to reduce maternal mortality in the remote regions of Nepal

Karnali, Nepal — Samjhana Salami pressed the sonogram lightly against a pregnant woman’s belly, and on the screen, the black-and-white image flickered: a heartbeat. However, the two women only had a second to marvel at the new life in front of them for the hospital was busy that day, and outside a queue of women waited to be seen.

It wasn’t always like that. When Salami started working as a nurse here 10 years ago, women coming for antenatal checkups were few and far between, she said. In the mountainous Karnali province of Nepal, most of the villages serviced by the rural municipality Naumule’s primary health care center are accessible only by foot; often, women have to walk for hours to attend antenatal checkups or deliver their babies. Most did not bother, choosing instead to give birth at home, leaving them at greater risk of complications.

However, a push to decrease maternal deaths by improving access to care in Nepal’s remotest regions has changed that. In 2005, the government launched an incentive program that partially reimbursed women for the cost of transportation to health facilities, with women receiving up to 1,500 Nepali rupees depending on the region they live in. Four years later, the government eliminated fees for giving birth in a health care facility, with hospitals reimbursed expenses from the government’s health budget.