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Challenges to improving maternal health in rural Nepal.

  • Thapa, S
Published Article
Lancet (London, England)
Publication Date
May 04, 1996
PMID: 8622462


In the remote village of Martadi, in Bajura district of western Nepal, the total fertility rate is 7. 20% of newborns die before they reach age 1. Temporary migration, mainly to India, is common due to the inability of the rugged and rocky terrain to supply enough food. The existence of temporary migration and a high frequency of remarriage suggest a high rate of sexually transmitted diseases. The relatively new hospital is very much under used (e.g., only 35 patients in 1995). The office in Kolti that supplies vaccines to Martadi has gone at least six months without receiving any new child immunization drugs, despite the presence of an air service. During and after delivery, no one, not even family members or traditional birth attendants, can touch a woman, who is confined to a cow-shed to deliver and care for her child and herself alone. Yet sick animals receive care. A new mother also is required to bathe herself, often requiring a walk of many hours. Women often identify access to water as their top priority. Pregnant or postpartum women are forbidden from eating green vegetables because of the belief that they cause diarrhea. Sanitation is better now in Martadi than in the past. Diarrhea and vomiting were once very prevalent. The international organization, CARE, along with the Ministry of Local Development operate the Remote Area Basic Needs Project, which revolves around community organization, agroforestry, rural infrastructure, and primary health care. The project has helped villagers construct low-cost toilets. It provides training in basic hygiene. Households have kitchen-gardens. Many families are now eating green vegetables regularly. Fruit trees are being introduced. Villagers recognize the value of child immunization. Some small-scale drinking water systems are operating. Villagers are trained in repair and management of these systems. About 33% of women aged 15-49 want no more children. A first-ever outreach program for female sterilization services is planned for Martadi and Kolti.

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