Shortages Reveal Low Priority of Women’s Health in Nepal
Chiring Tamang holds the family’s new baby while his wife Priya looks on. She delivered the girl at home in their village in Nepal’s Sindhupalchowk district in February 2021. Credit: Marty Logan / IPS
By Marty Logan
Kathmandu, Nepal, Jul 2021 (IPS) - One year after Nepal’s Ministry of Health (MoH) appealed to international organisations in the country to urgently supply a drug used to stop excessive bleeding after childbirth, a UN agency has delivered $1 million worth of contraceptives to prevent another shortage.
The 1.6 million cycles of oral contraceptive pills and 776,000 units of injectable contraceptives and syringes will prevent roughly 75 000 unintended pregnancies, 22 000 unsafe abortions and 80 maternal deaths, according to the UN Population Fund (UNFPA).
As it was last year at this time, Nepal is at the tail end of a lockdown designed to break a runaway number of Covid-19 cases. Between April and May 2021, daily cases went from 150 to more than 8,000—fuelled by outbreaks in neighbouring India. Intensive care unit beds were unavailable in most hospitals in the capital Kathmandu and some cities on the southern border with India, and patients attached to oxygen tanks were forced into hospital parking lots. Crematoriums had to be expanded to accommodate the dead.
More than 9 500 people have died, and 667 000 had been infected as of 18 July, according to official figures, which are widely considered to underestimate the true impact.
“This support is very timely as Nepal was on the verge of facing a shortage of the injectable contraceptives and oral pills,” said Dr Tara Nath Pokhrel, Director of the Family Welfare Division (FWD) of the MoH. “These supplies will greatly help the federal, provincial and local governments to address the increasing family planning needs during the COVID-19 pandemic,” he added in a UNFPA press release.
Last year’s urgent need was misoprostol, a drug used for medical abortion and to stop excessive bleeding of new mothers, also known as postpartum haemorrhage (PPH). The condition is the leading cause of death among women who give birth at home, a number that skyrocketed after the first case of Covid-19 was detected in January 2020. Deliveries in health facilities fell by more than 50% during the 2020 lockdown, according to The Lancet journal.
The shortage affected only the three-pill package of misoprostol used to prevent PPH, not medical abortion kits. It was December before UNFPA could deliver nearly 500 000 doses to the government, a one-year supply.
Maintaining a steady supply of misoprostol has been a challenge for the Government of Nepal since it took over the programme from a project sponsored by the US government in 2010. Initially, it was able to turn to international partners to source the drug outside of the country, but it soon absorbed the purchasing into its procurement system.
However, in 2014 the government’s corruption agency charged eight ministry of health employees with importing poor quality misoprostol into the country at inflated prices.
Eventually, they were acquitted, along with private-sector suppliers, but the high-profile case put a ‘chill’ on further buying by government officials, a former employee of the project told IPS. “If the person needed to justify (misoprostol procurement) maybe they were thinking, ‘this created lots of tension in the past, so let’s not go for procurement’.
Shortages resulted. Then in 2015, earthquakes rocked Nepal, killing nearly 9,000 people. That disaster was followed by a months-long blockade of road routes from India after Nepal’s politicians approved a controversial new Constitution. Supply chains became twisted and unreliable.
In 2017, following Nepal’s first elections under a federal governance system, some health responsibilities were transferred from central authorities to provincial or local officials, including the purchase and distribution of misoprostol. But local governments appeared unprepared.
“In general, local governments did not have sufficient time and resources to strengthen their procurement capacity on lifesaving maternal and neonatal health commodities,” a spokesperson for UNFPA noted in a statement. “It also depended on how much priority each local government had given to the health sector in general.”
Before Covid-19 hit, the misoprostol programme was in place in 56 of Nepal’s 77 districts, but in January 2020, a survey of 12 of the 56 districts found that none had the drug, says Surya Bhatta, executive director of One Heart Worldwide, an international NGO working in Nepal.
“I think misoprostol is one of the most discussed matters in our office,” he adds. “We talk about this a lot with local leaders, pregnant mothers, female community health volunteers during their monthly meetings, and with service providers in the health facilities. Even for the managers, in larger government forums, there is a lot of discussion happening, but the implementation side has a lot of holes to fill.”
During the 2020 lockdown, misoprostol shortages and PPH deaths of women who gave birth at home generated many headlines. This year there have been no reports of misoprostol shortages, Dr Punya Poudel of the FWD told IPS. However, maternal deaths remained above average for the second year running. From mid-March 2020 to mid-June 2021, there were 258 maternal deaths, compared to 51 in the same period pre-Covid, according to preliminary statistics.
Nepal’s maternal mortality rate of 239 per 100,000 births is equivalent to roughly 1,200 deaths annually.
In the agency’s press release, UNFPA Representative to Nepal Lubna Baqi urged the government and partners to make reproductive health a priority.
“Nepal has continued to struggle with shortages in supplies due to competing priorities and demands, but it is time for the government and development partners to turn their attention to preventing unwanted pregnancies and unsafe abortions by investing in family planning and comprehensive sexuality education.”