Safe Motherhood Programme
Reduction In Maternal Mortality

By Jhabindra Bhandari

MATERNAL mortality is still a leading cause of death among women of reproductive age between 15 and 49, in most developing countries. According to a joint statement issued by WHO, UNICEF, UNFPA and the World Bank, nearly 600,000 women die every year as a result of the complications of pregnancy and child birth. And this huge social tragedy, unfortunately, leaves many others with serious and life long health problems.

Unbelievable

Of central importance to note here is that South Asia is home to 22 per cent of the world’s population but accounts for 50 per cent of world’s maternal deaths. The magnitude of the problem in the region is unbelievable. This explicity pinpoints a social injustice—as most such deaths are avoidable. And, this reflects the lack of value placed on a woman’s life by society.

The first international conference on safe motherhood was held in Nairobi in 1987. This is regarded as a major landmark in the history of innovative efforts to reduce maternal mortality and morbidity and improve maternal health in poor developing countries—where the pressing needs are emerging significantly in the recent years.

Maternal mortality is one of the highest in Nepal. Family Health Survey in 1996 estimated Maternal Mortality Ratio (MMR) at 539 per 100,000 live births. This clearly indicates an urgent need of accelerated action to improve the present situation of maternal health. It is necessary to achieve significant improvement in the way maternal health care is presently provided.

The history of national attempts to reduce maternal mortality and morbidity is not so long. In 1993, the government initiated national safe motherhood programme, (NSMP) with the support from bilateral, multi-lateral agencies including national and international non-governmental organisations (I/NGOs). This further gained momentum with the formulation of National Safe Motherhood Plan of Action (NSMPA) for the period 1994-1997. The plan largely focussed on the need of inter-sectoral collaboration and multi-sectoral approach.

The new health policy (1991) and 20-year long. Second Long Term Health Plan (1997-2017) has also given high priority to the reduction of maternal mortality and morbidity among many other public health problems. According to annual report of Department of Health Services—1999/2000, the target of this long term plan is to reduce maternal mortality rate to 250 per hundred thousand births by the end of 2017.

Recognising that every pregnancy is at risk, the NSMP has been mainly adopting two major strategies. First, to provide twenty four hours essential obstetric services—either comprehen-sive or basic. Second, to ensure the presence of skilled attendants at deliveries, especially in home setting.

The annual review of the programme has identified some problems. For example: low coverage of antenatal, post-natal care and delivery services. Much more important is that there is lack of trained services providers—especially in the remote district hospitals and peripheral health facilities. Focus is now on capacity building of Maternal and Child Health Workers (MCHWs) at the sub health posts to provide basic maternity services.

In order to support the national safe motherhood programme, the role of external development partner has been crucial. It is encouraging to note that reproductive health programmes are operational in different districts of the country with the support from Department for International Development (DFID), UNICEF, UNFPA, GTZ and active participation of many other national and international NGOs in the country.

One of the important objectives of the NSMP is to strengthen essential obstetric care through improvement of facilities, provision of essential drugs and equipment, and to develop the capacity of service providers at district hospitals. On the other side, there is crucial need to establish functioning referral between peripheral health facilities and district hospitals.

In addition to this, education that empowers women to make decisions about their lives and health is key to reducing maternal mortality. So, community education and mobilisation are very important to increase access and utilise the EOC services at district hospitals and the peripheral health facilities. Sadly, these strategies have not reached the remote parts of the country effectively. After all, the purpose of community mobilisation is to ensure that appropriate health seeking behaviour becomes part of local social norms.

In order to overcome the social, economic and cultural barriers, empowering communities by providing access to information, education and communication is extremely important—in terms of raising community awareness on danger signs of pregnancy, importance of emergency funds and community support for local transport to reach the health facilities without any delay.

Other important issues related to maternal mortality are the early marriage and pregnancy, unwanted pregnancy and abortion. Millions of women around the world risk their lives due to unwanted pregnancy and abortion. Safe motherhood programmes should include promotion of family and community support for delayed marriage and child bearing, timely and planned pregnancies and education for all women.

Maternal mortality is increasingly being recognised as a violation of human rights to survive pregnancy and child birth. Interestingly, the governments of Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lankan share a strong commitment to human rights, including the rights of women and children. This commitment has been made explicit through ratification of the Convention on the Rights of Child (CRC) and Convention on the Elimination of All forms of Discrimination Against Women (CEDAW).

Until women are empowered and their human rights to quality services and information during and after pregnancy and child birth are fully realised, the impacts will be minimal. And also true that safe motherhood is vital social and economic investment as its impact on individuals, families and communities are potentially large.

Challenge

As women’s overall health influences their maternal health, making safe motherhood a reality in the years to come is a strong challenge of policy makers and planners of both national and international communities. Facing such a daunting challenge of reducing maternal mortality calls for strong political will and commitment. Inter-sectoral collaboration and multi-sectoral response are key to achieve the goal of safe motherhood programme.

Looking At Gormu-Lhasa Railway

By Nishchal Nath Pandey

THE construction of the 1,118 km Gormu-Lhasa railway link is perhaps one of the costliest railway constructions that the Chinese government has ever undertaken and, above everything else, it will link Lhasa, the Tibetan capital, to Shanghai and even Beijing. For us in Nepal, this plan will have ample positive effects as far as augmenting our ailing economy is concerned. Initiated this summer and planned to be in operation tby 2006 the single track metro gauge railway extends from Gormu in Qinghai province of the People’s Republic of China and reaches Lhasa penetrating even the stupendous Kulun Shan ranges. With 30 tunnels and bridges, the total estimated budget of this mighty construction is roughly US $ 2.30 billion.

Total Capacity

Beijing has been concentrating and unifying efforts to modernise Tibet so as to bring it upto the level of other provinces of China that are fast moving into the highway of prosperity. In 1977, the first state-funded geo-thermal power generating unit went into operation in Yangbajiin. In just over a decade, the total installed power generating capacity had reached 25 thousand kw, becoming the largest geo-thermal power station in the whole of the country.

At present, Tibet has more than 41 communication stations with 28 thousand lines to half of the counties of the autonomous region. One sector that has especially seen a definite germination with the opening of Tibet is its tourism .

Following the construction of the Damxung airport in 1956, the Gonggar and Bamda airports were built operating scheduled flights to bigger cities like Chengdu, Xian, Lanzhou, Shanghai and Guangzhou. Kathmandu is the only foreign city, which has direct flights to and from Lhasa. Today, nearly 50 thousand tourists visit Tibet annually.

Although criticized as a "politically driven project" and feared in military terms as having "raised the capability of the Chinese army to mobilize upto 12 thousand soldiers in a month" by some Indian defense analysts (India Today, Sep. 17th 2001), its economic consequences for Nepal will definitely be with aplomb.

Already, cheap Chinese goods from far away cities like Guangzhou are making extensive success in the Nepalese market. Kathmanduites that had to bitterly chew their desires by refraining from Japanese products like VCDs, TV sets and watches are more than happy to find very low-priced Chinese alternatives. With increased efficiency, customers opine that those products are found to be more lasting as well. Till now, Nepalese traders have been purchasing electronic items, batteries and electrical appliances, toys, watches, even cell phones, radio and VCR cassettes and CDs either from Khasa, or straightly in cities like ‘Guanghzhou and importing them by truck to Khasa which is roughly a 10-day journey. Come 2006, this traffic will obviously modify itself to embody highly competitive items like tractors, bicycles, motor cycles and possibly cars. Already vehicles both for passengers and commercial/industrial purposes are manufactured in the numerous joint venture outlets in China-from Volkswagen to Fiats, from road rollers to mini buses. There have been arguments that perhaps China could supply Nepal with oil in addition to the numerous other items.

One area where Nepal has to conduct a very befitting homework is how and to what extent the Indian market will be affected by virtue of this shift in commerce. It is a truism that a considerable number of Chinese products do eventually enter the Indian heartlands of U.P and Bihar after a brief stopover in the numerous outlets in Kathmandu. There has been uneasiness especially in the Indian business sector with regards to Nepal’s facilitation of passage of Chinese goods into India. India’s own trade barriers with China will go down which is expected to join the WTO this year. By 2006, one can sincerely hope that Indo-China cooperation in the fields of bilateral economic growth coupled with the settlement of the land-boundary question and other issues related to security will have been affirmed. Therefore, Nepal can only gain and not have to be excessively anxious regarding doubts from the Indian side because Sino-Indian trade relations itself is making a rapid progress.

On the contrary, with Tibet’s gigantic leap forward towards economic advancement, Nepal will have to seriously mull over the repercussion that it will have on the poverty-stricken areas in the bordering towns and villages on its own side.

Obviously, the development of Tibet owes a great deal to the efforts of the mainland, which is evident by the fact that from 1951 to the end of 1996, it had invested more than 40 billion yuan in Tibet. The economic growth rate exceeded the national average for the first time in 1996. Today, even in the remotest village of Tibet, dwellers boast of modern amenities that their Nepalese neighbours who are connected by religion, caste, race and even by marriage can only dream of. It is a regular custom for Nepalese in Dolpa, Humla and Mustang to periodically visit their kith and kin across the border.

Extra Effort

Nepal must make an extra effort to modernising border districts, as these are susceptible to anxieties emanating from the developmental strives in the neighbouring village across the border. This anxiety, taken as an inspiration can have positive effects if we learn to activate it in our own favour for our own economic progress.

King Tribhuvan And His Times

By Guna Dev Bhattarai

AFTER the termination of the Praja Parishad episode, all the Ranas inspite of their strong government were at their wit’s end because of the sudden and formidable development of the said political consciousness though limited to some revolutionaries. Since then they began to be more cautious as to the activities of the suspected enlightened youths and the members of the royal family in particular. On the other hand, King Tribhuvan and the members of his family girded up their loins to go against the Rana regime.

The king had greatly appreciated the contributions of the members of the Praja Parishad and particularly that of Tanka Prashad Acharya, a true revolutionary, from the core of his heart. The king under the then prevailing circumstances was placed in a very helpless position to save the lives of the martyrs. Neverthless he was determined to take every possible risk to bring the Rana regime to an end. The majority of the people in Nepal then were not politically conscious but were oppressed and supressed so they did not openly support the Praja Parishad. However, in the source of time, it became successful in imparting an impetus to the development of a large scale struggle against the Ranas. In short the Praja Parishad episode proved to be a milestone in the history of Nepalese politics.

The Ranas, with a view to keep their power and position intact, had already courted matrimonial relations with the members of the royal family. Crown Prince Mahendra, and Princes Himalaya and Vasundhara were married to Indra Rajya Laxmi, daughter of Hari Shumshere, Princep Shah and Helen Shah, daughters of Nara Shumshere respectively. By courting matrimonial relations with the members of the Royal family the Ranas had hoped that their daughters might be helpful in exposing the activities of the royal palace. Man proposes, God disposes, goes an adage. The royal brides would not or did not kill their conscience by revealing the ins and outs of the palace affairs to the Ranas. Once an attempt was made to wipe out the Ranas when most of the high ranking Ranas were invited to a dinner party but it was aborted.

There was a lull for a few years in the history of revolutionary activities in the country. During the premiership of Juddha, some reforms pertaining to roads, postal system, cottage industries and their exhibitions, banking system, paper currency, construction of bridges and the like were made. King Tribhuvan was against the policy of the Ranas who wholeheartedly supported the policies of the British and provided military assistance during the Second World War (1939-45 A. D.)

At the last stage of his premiership, Juddha repented for his past behaviour towards the king. He tried to impress the king by showing reluctance to punish the members of the Praja Parishad but he was compelled to suppress them because of the pressures of some of his sons and those of Chandra Shumshere. In order to appease the king, Juddha permitted the former to go on pilgrimage to India. During his sojourn in India the king secretly came to contact with the exiled Ranas and other politicians who had taken part in the Indian independence movemen. In the meantime, the king was enlightened by some of his trusted associates as to the secret political activities of some intellectuals of Kathmandu, after his return from India.

It was stated that Juddha under pressure from the other Ramas and particularly influenced by Resunga Baba became determined to renounce his premiership and go to Ridi and handed over power to Padma Shumshere.

Padma Shumshere was fickle minded. He wanted to be popular among the masses by saying, I am the first servant of the state’. He had no concret plans to please the people. In the initial stage of his premiership some enlightened intellectuals began to found non-political societies so that the people might be conscious as to the prevailing condition of the country. The government suppressed them suspecting the said societies to be involved undergound political activities.

In 1946, the Interim Government was formed in India prior to India’s achievement of independence, a new wave of enthusiasm flooded the Nepalese to launch movement against the Rana regime.

The formation of the Nepali Rastriya Congress by the exiled Nepalese, the discontent of the famine stricken people of the Terai, compounded with the strike of the Biratnagar Jute Mill workers and the arrest of Biseswor Prasad Koirala, Girija Prasad Koirala, Balchandra Sharma and others urged the Congress workers to launch a Civil Disobedience Movement from April 13, 1947 A.D. Demonstration of the students of Kathmandu and Satyagraha movement in some parts of the Terai forced Padma Shumshere to introduce some political reforms. The Nepali Rastriya Congress decided to call off their political activities as Padma promulgated on January 26, 1948 the Government of Nepal Act, 2004 B. S.

As Padma Shumshere was not a man of firm determination to cope with the die-hard Ranas, he desired to go to India on the pretext of medical treatment. At last, he submitted his resignation to the king, Consequently, Mohan Shumshere succeeded him.