Only around one fourth of women are seeking maternity services at Kathmandu Model Hospital after the lockdown started.
Over 60 to 80 women used to visit the hospital’s out-patient department every day prior to the lockdown but now only 15 to 20 women are visiting, according to Dr Aruna Karki, consultant gynecologist at the hospital.
"Only those having emergencies are visiting our hospital," Karki told the Post. "Due to their small number, we are attending patients from 9 am to 1 pm only."
Elsewhere too, only very few pregnant women are visiting health facilities for consultation. Due to the lockdown imposed to prevent the spread of Covid-19, maternity services have been obstructed throughout the country, putting the lives of pregnant women at a great risk.
"Institutional delivery rate has declined across the country," Dr Punya Poudel, chief of the Safe Motherhood Unit at the Family Welfare Division, told the Post. "The numbers of deliveries updated at health facilities are very few, which shows that women are giving birth at home."
According to the Nepal Demographic Health Survey-2016, 239 women per 100,000 live births die during or after childbirth. The country has committed to reducing the maternal mortality rate to 125 per 100,000 births by 2020, which seems impossible in the present context, as no progress has been made so far since 2016.
Moreover, due to the halt in public transportation services, women in labour pain are compelled to give birth at home, putting their and the newborn’s lives at risk.
Health facilities of 61 out of 77 districts lack misoprostol, a medication used to treat postpartum bleeding, to be given to new mothers through female community health volunteers.
"Institutional delivery rate is already low in our country and the ongoing lockdown has compelled women to give birth to their babies at home," Poudel added. "We are worried that female community health volunteers of only 16 districts across the country have misoprostol."
Excessive bleeding after childbirth, also known as postpartum haemorrhage, is the most common factor leading to the death of new mothers in the country. Misoprostol helps uterine contractions and has been used to prevent postpartum haemorrhage for a long time, officials at the division said.
Apart from institutional delivery, antenatal and postnatal services have been hampered by the ongoing lockdown. Pregnant women are unable to reach the health facilities to examine their pregnancies.
They are also deprived of iron supplement tablets and tetanus toxoid vaccines, which are supposed to be taken during pregnancies.
Doctors suggest at least four antenatal check-ups and three postnatal visits after childbirth.
Of the total number of maternal deaths, 24 percent occur during or after childbirth and 19 percent in the postnatal period. The ongoing lockdown, which has forced women to give birth to babies at home, has made matters worse.
Even the postnatal care provided at home by sending trained nurses has been halted due to the fear of infections, according to officials at the division.
Meanwhile, the division has been working to set up free hotline services to provide suggestions related to maternal health.
"It is not possible to bring pregnant women to health facilities like before the Covid-19 outbreak," an official at the division said. "We are working to assist pregnant women via telephone."
Nepal reduced the maternal mortality rate from 539 in 1996 to 239 in 2016 for which the country received the Millennium Development Goal award. The country has to reduce maternal mortality rate to 75 for every 100,000 births by 2030 to meet the UN's Sustainable Development Goals target."
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19? Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19? Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from? The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territoriesaround the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe? The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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