Free bus rides driving safer births for Nepali women

The Aama Surakshya, or ‘protection for mothers,’ program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk. (AFP)
Updated 17 July 2018
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Free bus rides driving safer births for Nepali women

  • The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal
  • A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey

RAMECHHAP, Nepal: As a teenager Meera Nepali was terrified as she went into labor with her first child at home in a remote village, miles from a hospital with nobody but her mother-in-law to help.
“I was a scared, but that was the norm. We didn’t have doctors close by,” Nepali said of her three-day labor in Khadadevi village in Nepal’s hilly Ramechhap district.
This year however, she delivered her second child in a rural health center thanks to a small cash incentive that is getting pregnant women to hospital by paying their bus fares.
The Aama Surakshya, or “protection for mothers,” program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk.
The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal, where the risk of dying in childbirth is higher than anywhere else in South Asia except Afghanistan.
A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey, as well as the paucity of clinics in many parts of the country.
“We found that one of the main reasons rural women did not go to a hospital during childbirth was because they did not have hard cash to pay for transportation,” said Suresh Tiwari, one of the original architects of the scheme.
The program was started in 2005 with British aid money but has since been taken over by the Nepal government.
Today, it covers not just transport but medical costs for mothers and babies and includes a cash bonus for attending antenatal check-ups.
2017 marked a milestone for the program: more Nepali women opted for hospital births over home deliveries for the first time on record, official figures show.
“The free service and transport incentive have been very effective in bringing women to health centers and hospitals where they can be saved in the case of complications,” said Tara Nath Pokharel, head of the government’s Family Health Division, which now runs the program.
Nepali, one of the beneficiaries, paid nothing for her three-day stay at a clinic in Ramechhap district, east of Katmandu, in January.
She was discharged with 1,000 rupees ($9) for transport plus a 400 rupee bonus for attending four antenatal appointments.
“I returned home in an ambulance. We hardly had to spend anything. I am really grateful for this facility,” Nepali said, cradling her young son in her arms.
The scheme is also saving lives outside the maternity wards, in part by tackling cultural obstacles.
Deeply patriarchal attitudes and traditional preferences for home births also see hospital visits dismissed as an unnecessary expense for poor families.
Sita Khatri went into labor weeks before her due date and, unable to walk the three hours to the nearest health center, gave birth to a healthy boy at home.
But the 27-year-old suffered a retained placenta, a painful and potential fatal complication of childbirth, and had to plead with her husband to take her to hospital.
“He said we don’t have money. I insisted, saying there are government facilities, we won’t have to spend too much,” Khatri said.
“It is better to go the hospital than to die at home.”
Eventually Khatri’s husband relented, and she was treated for free at a nearby clinic. The couple were also given 1,000 rupees to pay for transport.
But some women cannot be reached by road and must be carried, while others encounter poorly equipped facilities once they arrive, said Niliza Shakya, a doctor at a health center in Ramechhap.
“Some women still don’t have the decision-making power to say they want to go to a hospital, and health posts like ours are not equipped enough,” said Shakya.
Nepal managed to reduce maternal mortality by 71 percent between 1990 and 2015 — just missing out on an ambitious Millennium Development Goal to reduce the rate by three-quarters.
But it has a long way to go in improving the overall quality of its health care, said Binjwala Shrestha, a charity worker from the Safe Motherhood Network Federation of Nepal.
“Reaching the hospital alone is not enough,” she said.


Meet the woman who reunites Syrian pets with their refugee owners

Updated 58 min 44 sec ago
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Meet the woman who reunites Syrian pets with their refugee owners

  • The woman has helped transport 400 cats and 15 dogs into Europe
  • The foundation was featured in a Netflix documentary called Dogs

A Syrian refugee in the Netherlands has revealed how she is helping reunite stranded pets in war-torn Syria with their owners abroad, London daily The Metro said Sunday.

Animals Syria is a non-profit foundation that helps save the lives of pets in Syria and reunites them with their owners overseas, and is run by Rawaa Kilani and her friend Irma.

Kilani said before she fled Syria in 2016, she found an injured cat, that she named Lucy, and nursed back to health.

After fleeing to the Netherlands, she was approached by a woman named Irma, who had an unusual request which inevitably led to the creation of the foundation, Animals Syria.

Irma said she wanted to adopt a paralyzed animal, and asked Kilani to let her take Lucy.

Since then, Kilani and Irma have enabled the transportation of 400 cats and 15 dogs to Europe, and another 44 dogs to the US. Animals Syria also rescued some birds, foxes, a monkey and even a donkey.

Kilani said people who are fleeing Syria are usually unable to take their pets with them, because most of them are escaping the war on boats. So, they entrust their loved ones with their pets or leave them at foster homes.

After the owners settle in their new asylums, Animals Syria helps reunite owners with their pets by organizing the medical procedures and documents required for the transportation. Kilani says the process of vaccinating, micro-chipping and preparing the paperwork might sometimes require up to four months.

Most of the work of the foundation is done by Kilani and Bashir, who is based in Syria. Two volunteers help Syria Animals by feeding strays in Syria and two of her friends provide foster homes while the trips are arranged.

The foundation even starred in a Netflix documentary, Dogs, showing how they helped a dog, Zeus, reunite with his owner in Germany.

Kilani’s foundation focuses on disabled animals now, as they have lower chances of surviving in Syria.

When they just started, most of the expenses were covered by Kilani and Irma. Now, the foundation relies on donations, which are usually small and insufficient.

Animals Syria have a Facebook page, where they post stories of rescued animals and offer links for donations.