In many low-income countries, such as Nepal and Indonesia, maternal deaths are not reliably recorded. The estimates of maternal mortality in Nepal are one in 338 pregnancies, while in Finland the rate is one in 33,333. As women in Nepal have more pregnancies, the lifetime risk of dying during pregnancy may be as high as one in 50. The low maternal death rate in Finland, Australia, and other developed countries indicates that the majority of maternal deaths are avoidable.
Maternal deaths occur because of three delays in the provision of effective care:
1. A delay in the family realising that a woman is in difficulty and taking action:
2. A delay in transport to a health facility;
3. a delay in the provision of care on arrival at the health facility.
To reduce maternal mortality, the solution must address all three delays concurrently, as any alone is able to lead to the death of the woman. Laureate Professor Roger Smith has led work in the development of interventions to address these delays including the successful use of singing to improve knowledge regarding antenatal care, as well as working with the Nepalese Government to fund and introduce a helicopter retrieval program for women with obstetric emergencies.
Evidence of Impact in Addressing Delay 1
Intervention 1: The Successful Use of Singing to Improve Knowledge Regarding Antenatal care
In Nepal, singing is a popular folk medium. To capitalise on this, Laureate Prof. Roger Smith led the creation of a singing program within rural Nepal to raise the awareness of villagers of the needs of pregnant women. The songs addressed the first delay: decision-making at the village level. The intervention succeeded in significantly raising the awareness of villagers as to the importance of seeking antenatal care and were especially effective for raising the awareness of illiterate villagers. Moreover, awareness among the villagers remained significantly improved at follow-up 12-months later.
Graph: Knowledge of antenatal care
American Journal of Obstetrics and Gynecology: A first step to improving maternal mortality in a low-literacy setting; the successful use of singing to improve knowledge regarding antenatal care
Read above manuscript contents here
VIDEO: Pathways to Improving Maternal Mortality in Rural Nepal
Photo: Students submitting the songs they have written to address the 5 key song competition
Photo: Village mistrals singing songs about antenatal care
Photo: Male village elder dancing to songs about the importance of antenatal care
Photo: Villages dancing in the fields while singing along with the mistrals to songs about antenatal care
Education Poster: Designed to be easy interpreted, including by illiterate persons
Graph: Knowledge gain in awareness of the importance of antenatal care as a result of the singing intervention
Photo: Nepal elder explaining that she wishes the program had been implemented earlier
Evidence of Impact in Addressing Delays 2 & 3
Intervention 2: The Successful Use of Helicopter Retrievals for Women with Obstetric Emergencies
To address the second and third delays, Laureate Prof. Roger Smith worked with the Nepalese Government to introduce a helicopter retrieval program for women with obstetric emergencies. The program, funded by the Nepalese government, has repurposed military helicopters for the retrievals and links villagers in remote and inaccessible regions to hospitals able to supply emergency care, such as blood transfusion and Caesarean section.
As of March 2021, the program, which commenced December 2018, has successfully evacuated 175 women experiencing obstetric emergencies in remote districts and transferred to hospitals. Within the Gandaki province, 36 air retrievals have translated into saving the lives of 35 mothers (97%) and 34 (94%) newborns. Of the total 175 pregnant women retrieved, local health officials estimate that >60% would have died without helicopter retrieval, with death rate of the newborns being even greater.
This program is a highly visible commitment of the Nepalese government to the wellbeing of pregnant women. The arrival of a helicopter to rescue a pregnant woman in a remote village has enormous symbolic significance to all the villagers, making a clear statement that the lives of women matter.
- "Helicopter Rescues Pregnant Women" in Jajarkot - The Himalayan Times | 6 Sept 2019
- "Helicopter Rescue the Only Chance of Survival for Pregnant Women in Remote Areas of Karnali" - Kathmandu Post | 24 Nov 2019
- "Nepal Still Has a Long Way to Go to Lower Infant and Maternal Deaths" - Kathmandu Post | 2 Jan 2020
- "Helicopter Rescue Programme for Pregnant Women Effective in Gandaki Province" - Kathmandu Post | 11 Mar 2020
- "Pregnant Woman Airlifted to Kathmandu After Excessive Bleeding" - eAdarsha.com | 28 Mar 2020
- "Birth and Death During a Pandemic" - Nepal Times | 17 June 2020
- "Pregnant Woman Rescued by Helicopter" - Nepal e Khabar.com | 18 Jul 2020
- "Pregnant Mother Rescued by Army Helicopter" - Nepal Page | 22 Jul 2020
- "Helicopter Rescue for Pregnant Women Effective - 16 Rescues in 8 Months" - Rising Nepal Daily | 31 Jan 2021
Video: Television Special - Gandaki Maternal Care Program “A Helicopter saving Mothers giving Life” Dr. Binod Bindu Sharma
ABC News Nepal - ABC Discourse with : Laureate Professor Roger Smith, Annie Smith & Dr. Binod Bindu Sharma
Photos: A pregnant woman being airlifted from Burtibang, Banglung to Pokhara
Photo: Laureate Professor Roger Smith meets with Hon. Minister for Women, Children and Senior Citizen, Mrs Tham Maya Thapa
Photo: Laureate Professor Roger Smith and the team at the ABC Nepal Television channel with a TV presenter
Intervention 3: Improving the Access of Girls to Education through the Provision of Sanitary Pads
In Nepal, there are extensive taboos surrounding menstruation that severely impact on the ability of girls to gain secondary education. Chhaupadi is a form of menstrual taboo that prohibits Hindu women and girls from participating in normal family activities while menstruating, as they are considered "impure". During chhaupadi, women are banned from the house and are required to live in a cattle shed or a makeshift dwelling, known as a menstruation hut, for the duration of their period. This is a life-threatening practice, especially in a Himalayan winter. The community attitude to menstruation makes it exceedingly difficult for girls to continue to attend school after they begin menstruation. This curtails their educational achievements, reduces their employment and economic opportunities, increases the likelihood of marriage at a young age and birth of children as teenagers.
To improve the access of Nepalese girls to secondary education, Laureate Prof. Roger Smith lobbied the Nepalese government to provide free sanitary napkins to all schoolgirls. In the 2019 Nepalese budget, $6.4M annually was allocated for the provision of napkins to each schoolgirl. The sanitary napkins are being made in Nepal using washable cotton material with a Gortex inner layer to provide a barrier against leakage.
Photo: Visit to local women with disabilities producing washable sanitary napkins
Photo: Meeting with local females entrepreneurs
Photo: Meeting at Social Development Ministry