To officials who rarely set foot outside Kathmandu Valley, it is difficult to understand how the conflict is affecting the health of women.
Going by the child and maternal mortality figures at the number crunchers in the capital, the health status of Nepalis is improving dramatically. Government officials are in a state of denial. I have often heard them say: "Our health programs are progressing on schedule, maternal mortality and morbidity rates have been reduced and our grassroots level health workers are doing a fantastic job."
The reality is very different. The conflict has unleashed a population of internally displaced people who, because they are far away from their home districts, do not have access to regular care. The highway blockades and bandas have made access to medical care the biggest worry for maternity cases. It is not just that women with complicated pregnancies can't be taken to hospitals, but health workers aren't able to travel to remote health posts.
One auxiliary nurse and midwife in Achham told me: "A few years ago, I used to go to different areas assigned by my health post. People would call me to help deliver babies but I can't do that anymore. I know the people need my services but I am afraid about my own security."
Most health posts don't have medicines and health workers themselves work at great personal risk. Medicines, even if they arrive at the district headquarters, are barred from being taken out to VDC health posts for fear they will get into the hands of the rebels. The Maoists have their own channels to bring in essential drugs but these are mainly for treating their own wounded cadre and not for the general population.
Many nurses and midwives have abandoned their posts. Two years ago, we organised a health camp in Doti but had to wrap up early because of a curfew. Many women had walked for days and couldn't be treated. I still remember the pain on the faces of those mothers. We offered money to some of them so they could go down to the Nepalganj Medical College for treatment but they were reluctant fearing they'd be stuck if the highway was blocked and there would be no one to take care of their children, livestock and farms.
In the evening, army officials came and questioned us. One woman was hospitalised and we had to give them her full description, problem and address. "This is how it is here, we are always tense," the nurses told us. "We haven't been able to send medicines to many health posts." In the midwest, the tradition of cutting the umbilical chord with a rusty sickle makes tetanus a serious killer of young mothers. But it has been years since tetanus injections have been dispatched to health posts.
There are frequent reports of women dying in childbirth because a banda or blockade prevented access to medical help. Sometimes, these women do reach hospitals or health posts but there is no one to provide service. Just when Nepal was beginning to make some headway in meeting basic primary health care needs, the conflict has taken us back several decades.
Dr Aruna Uprety is a women's health and reproductive rights activist.