Nepali Times Asian Paints
Sixty minutes


There can be nothing quite as brutal as when a birth brings death, instead of life. Yet this is exactly what happens across South Asia. Every hour of every day 22 mothers die in child birth in the subcontinent-lives that matter, deaths that matter, leaving orphaned babies who in turn face a much greater risk of death themselves.

This is a region bursting with potential but held back by cruel contradictions, where despite the global financial crisis that has bruised the region's economy, growth continues and there are world class medical institutions. Yet every single minute three newborn babies die across the region, the highest neonatal mortality in the world.

Linked to this tragedy is another. South Asia has more child marriages than anywhere else in the world, nearly half of all women between the ages of 20 and 24 were married before they turned 18. Early marriage leads to early motherhood and early motherhood can lead to early death of baby and mother.

When children themselves have children, their babies' risk of dying in the first year of life shoots up by 60 per cent compared to an infant born to a mother older than 19 years. If that baby does survive he or she is more likely to be undernourished and uneducated.

Mothers die in child birth, slowly, painfully bleeding to death because they do not get help when they need it. Women often have no say. In Bangladesh and Nepal about half of all women reported their husbands make all the decisions about their healthcare.

In Afghanistan, astonishingly one in eight women risk death by having a baby, the second highest rate in the world. Women there will not see a male health worker, yet due to the country's recent history, there is only 28 per cent female literacy and a massive scarcity of female trained birth attendants or midwives.

To end this horrible pattern, there is no need to wait for a scientific breakthrough. We know now what needs to be done and we know it needs to be done now. Waiting is not an option.

A shining example in South Asia comes from Sri Lanka. In spite of three decades of ongoing civil conflict and the devastating effects of the 2004 tsunami, the country has slashed the number of women dying in childbirth from 340 per 100 000 live births in 1960, one of the world's highest at the time, to 44 per 100,000 in 2005. Latest figures show just 8 newborns dying per 1,000 live births: similar to a developed country.

The reason for Sri Lanka's success: since the 60s the country invested in educating girls who were then in no hurry to get married early. Education was free for all. Training of midwives was a priority and they went out to where it mattered, got women to plan the births of their babies, go to health centers and hospitals to give birth, told them how to eat well and significantly, to breastfeed exclusively and right away. Today, 95 per cent of births in Sri Lanka take place in hospitals with a skilled nurse, midwife or doctor attending and immunisation coverage is almost universal.

There are bright sparks of hope stretching across South Asia from Kathmandu, Karachi to Colombo. Nepal has done some great things by making health services free for mothers and has cut child mortality by two-thirds. India gives cash transfers to mothers to give birth in institutions, Bangladesh has cut deaths of its newborns from tetanus down to just one death in 1,000. And in Pakistan 'Lady Health Workers' map and monitor mothers-to-be and their babies in their communities.

UNICEF and its partners in government are behind many of these initiatives and we pledge to make even greater strides for mothers and their babies. South Asia will rise or fall on investing and caring for mothers and their newborns. This is the bedrock of any society. Making mothers and their newborns count adds up to a society that matters, a nation that flourishes and a region that starts to reap the rewards of its labour.

Dan Toole is the UNICEF Regional Director for South Asia

Safer deliveries
Nepal with its mountainous terrain, difficult weather conditions and the scarcity of roads presents very unique challenges in the delivery of maternal health services. This is further compounded by poverty and a lack of skilled human resources. Not surprisingly only 19 per cent of deliveries are aided by a skilled birth attendant and only 18 per cent of mothers delivered their babies in institutions. This is why Nepal's mortality ratio is at a high 281 per 100,000 live births.

But motherhood is getting safer, and is likely to get even more so with the government's ambitious new initiatives. Two years ago, the government started providing transportation costs to women who travel to hospitals or health care centres for child delivery.

This month, the government announced free delivery services in all district hospitals, primary health care centres, health posts, and sub health posts. More staff are now being given training to become skilled birth attendants at 24-hour birthing centres and plans are afoot to equip hospitals at district levels with equipment and skilled service providers to provide emergency maternal care services.

Hopefully, no Nepali mother should die due to not being able to access, afford and receive quality health services.

(11 JAN 2013 - 17 JAN 2013)