Baglung Mums Struggle as Maternity Care Crumbles
Baglung, April 29 – In the distant municipalities of Nisikhola and Dhorpatan in Baglung, giving birth frequently turns into a dangerous game with women’s lives hanging in the balance. Even though there are national policies and pledges of financial assistance, the situation on the ground continues to be grim. Pregnant women either trek for hours to get to health centers or end up delivering their babies at home—often lacking proper medical care.
In Ward 5 of Nisikhola Rural Municipality, the community health unit in Niseldhor does not have even the fundamental facilities needed for maternal healthcare. There isn’t a dedicated birthing center. This facility is managed solely by Auxiliary Nurse Midwife (ANM) Yam Kumari Gharti and Office Assistant Prem Kumari Gharti. These two individuals manage around 10-12 patients each day using limited resources.
The closest maternity center requires a hike of three to four hours. Reaching the city hall in Nisi involves an arduous ten-hour trek on foot. "During my pregnancy, I had to secure a place to stay in Palpa for about a month prior to giving birth," stated Yam Kumari, adding that she managed to cover the cost, which is something few women from her area can do.
In stark contrast, Prem Kumari gave birth to all five of her children at home. She explained, “Nobody ever told us we should go to a hospital for delivery. Besides, I wasn’t able to leave my house, and there was nobody around who could assist me.” This experience is common among many local women. The region’s landscape is challenging, lacking adequate roads connecting Niseldhor to larger municipalities. During monsoon rains, rivers such as the Bhujikhola often overflow, making transportation difficult if not impossible. In wintertime, securing a transport vehicle might cost over Rs10,000—far beyond what most households can afford.
The problem is exacerbated by poverty and exclusion. It is believed that approximately 77 percent of the inhabitants in the Dhorpatan Valley, which includes Niseldhor, belong to the Dalit community. Many rely on temporary work such as raising livestock seasonally and growing potatoes for their livelihoods. Given their restricted earnings and minimal governmental assistance, access to secure maternal healthcare stays unattainable.
Dhorpatan Municipality has seen some advancements. They set up a maternity center close to the Dhorpatan Hunting Reserve. Nevertheless, this facility remains unreliable. As stated by ANM Sita Budhamager, "Four months back, the infant warmer stopped working, and we haven’t received any replacements since then." She added, “Currently, for each delivery, we have to burn around 8 to 10 bundles of wood just to maintain warmth for the babies.”
She described how the cold extends labor times and raises complication risks. "In emergencies, families attempt to rent a jeep and hurry to Burtibang, but this can be costly and isn’t always feasible."
Last month witnessed 334 individuals utilizing healthcare services provided by the Dhorpatan health facility. Throughout this financial year, merely 16 hospital births were recorded among approximately 35 anticipated prenatal consultations. Numerous mothers continue to deliver babies at their homes, often without professional assistance, relying instead on relatives or local midwives.
Without functional equipment and trained healthcare staff, the health post can provide only fundamental services such as prenatal examinations and small procedures. Pregnant women facing complications are directed to far-off hospitals—provided they reach these facilities promptly enough.
Hospitals still under construction
Both Dhorpatan and Nisikhola aimed to address these problems by building new hospitals. In Nisikhola, the foundation for a 10-bed medical center was laid in 2020, yet the project still isn’t finished. Likewise, in Dhorpatan, the development of a healthcare structure awarded in November 2023 has faced delays; only half of the intended progress has been achieved so far. Work ceased after the contractor received NRs87.6 million from an expected total payment of NRs175 million due to unpaid dues.
In the meantime, the Baglung District Hospital in Burtibang, which was announced way back in 2010, finally started operating in 2024—fourteen long years later. The facility continues to struggle with inadequate medical supplies and an insufficient number of skilled physicians. Nurse Parbati Aryal reports that the hospital attends to as many as 250 patients each day and handles approximately 20 births monthly, including cesarean sections. Nonetheless, numerous serious cases must be transferred to hospitals in Palpa or Butwal because vital surgical instruments are missing.
Home births still common
The Provincial Public Health Office reports that just 69% of deliveries take place in healthcare facilities within Baglung. This figure increases to 80% when accounting for individuals traveling to nearby urban centers such as Pokhara, Palpa, or Butwal. Nevertheless, in isolated areas including Nisikhola, Dhorpatan, and Badigad, the majority of births still happen at home.
Lack of geographical access and unawareness pose significant challenges," stated Laxmi Sharma, a public health official in Baglung. "Despite our routine efforts in conducting immunization and educational initiatives, we continue to observe births taking place at homes since the information has not yet permeated the farthest reaches of our region.
Sharma mentioned that she had only recently discovered the baby warmer in Dhorpatan was not working. "We provided it last year. Now we will look into whether it can be fixed or replaced," she stated.
The central government in Nepal now gives a transport subsidy of Rs2,000 for hospital deliveries. In addition, Nisikhola contributes another Rs2,000, whereas Galkot Municipality provides an extra Rs4,600. Local healthcare providers report that this increased financial aid from Galkot has significantly reduced the number of babies born at home.
Contrarily, in areas such as Dhorpatan, women continue to avoid seeking care at healthcare centers. "We directed a woman to Burtibang, yet she returned home," stated ANM Hiramati Gharti of Bhalkot Health Post. "Following childbirth, she started hemorrhaging. It was only then that we discovered this issue, so we immediately sent her to the hospital via ambulance. Fortunately, she made it through safely."
A community left to deal with it
Even with constrained resources, local populations have created their own answers. Since its establishment, a maternity waiting home in Boharagaun’s Nisikhola has accommodated more than 160 women. The local administration offers complimentary ambulance services and carries out routine health examinations for expectant mothers, senior citizens, and individuals with impairments.
However, these efforts fall short. As ANM Yam Kumari Gharti stated: "Despite our best efforts, we have neither the personnel nor the resources like basic stretchers, leaving us ill-equipped to handle emergency situations."
The women of Baglung—strong and capable—keep carrying the weight of a flawed system. Without completing the infrastructure, delivering vital supplies, and spreading awareness throughout every part of the district, giving birth at healthcare institutions will stay out of reach for numerous individuals.