By Subina Shrestha
Nepal has some of the worst maternal death statistics in the world, with some six women dying in childbirth every day.
Despite the political instability of the past ten years of civil war, the Nepalese government is introducing measures to improve safety for mothers but so far little seems to be working.
Subina Shrestha, a Nepalese filmmaker who is herself five months pregnant, sets out to find out why so many mothers are dying in childbirth. In the following account she looks at the human stories behind these statistics.
Ten years of civil war in Nepal took over 15,000 lives. Within the same period, childbirth took the lives of over 22,000 women.
The war led to a revolution and there was an overhaul of the Nepali political system. The maternal deaths, however, hardly even featured in the newspapers.
When I realised that I was pregnant, I thought there would be no better time then now to look into this situation. And there was no better place than Accham.
Accham to me is one of the darkest corners of Nepal. I had been to the district ten years ago and had been shocked by the total lack of services. Ten years on, I believed myself to be a jaded journalist and a filmmaker. Accham proved me wrong once again.
Our destination, Sanfe Bagar, a dirt track flanked by shops of corrugated iron sheets, was as dusty as before. The mules had been replaced by motorcycles and people ran around scared every time young men drove spewing out dust and exhaust.
|Nepalese women have to stay in a chaupadi during menstruation
We did not have to go far to see that things had hardly changed.
Just around Sanfe, each house still had a chaupadi - an outhouse hardly big enough for two goats to crouch inside.
For five days every month during menstruation women have to live there.
I was shocked to hear a story about a woman who had to stand out in the rain all night with an umbrella because her family was too poor to build a chaupadi. She died of a snakebite.
And women are still dying. A few weeks before I reached Accham there was a story in the newspapers about a young woman who died in a chaupadi.
Toya Raj Giri, a health consultant from Unicef who accompanied us, explained that women light small fires in the hut to keep the cold away. With terrible ventilation, some get asphyxiated.
Within a day, I found myself getting angry. But I was preoccupied with finding a woman due to give birth that week. I heard there was a village where there were eight such women.
A five hour walk later we were told that all the babies were already born - a week premature. With multiple pregnancies and hard labour, women hardly ever make it to their due date.
By the time we found Basanti a few days later, I was convinced that I would fall into the category of village women who pop a baby out with considerable ease.
And women had been giving birth! There were children everywhere, running around with their big malnourished bellies and naked feet and flies stuck to their snotty noses and infected eyes. No woman in their late 20s had less then four children.
The narrow trails were full of defecation. None of the villages had toilets. Every monsoon, Accham suffers from diarrhoea and a few people die.
Stuck in the first floor of a house without improvised stairs, made of cement sacks on a cold rainy night, Toya started to vomit. I started to fear that the film would never be made.
The next day, when some men objected to us filming Basanti, I was certain that our time in Accham was up. I realised later that it was just envy, and that all the men wanted was attention and hopefully some money.
What struck me the most was the open mindedness and yet the helplessness of the women.
Accham has hardly any men – most men migrate to India for work. The handful that remain appear to do nothing but play cards and drink.
The women told me that many men bring "bad blood" from India - they return infected with HIV and infect their wives.
Lack of medical service
|Thirty-one year old Basanti got married when she was 14 and is expecting her sixth child
Laxmi, a nurse, told me that it is a nightmare; not only to change the attitudes of the people but also to get doctors and specialists to visit.
Women, including Basanti, wanted to get a permanent family planning operation done but the service was not available.
To Laxmi's knowledge, there has been one mini laprotomy camp, a permanent family planning procedure for women. Only one woman was operated on before the doctor packed up.
The government has sent many vasectomy camps, but with all the men in India it was a futile gesture.
Doctors occasionally visit to correct a prolapsed uterus in a woman. Malnourished and overworked, Laxmi believes that almost half the women in Accham have a prolapsed uterus. Nationwide, one in ten women suffer from uterine prolapse.
Laxmi had tales of women dying while giving birth. She talked about women who begged to be saved but their family refused to take them to a hospital, and of women whose vaginas were hacked by village "healers" after their baby died inside them.
No wonder Basanti was so keen to have us around. It meant that we would not let her die.
Tales of women suffering in Accham could make any sane person's blood boil. Even if women survive one childbirth, they might die in the next one.
If they have daughters, they are obliged to keep trying until they have several sons. Those who live through it all might have prolapsed uterus. When I think of the fate of 13-year-old Sunita, it breaks my heart.
Accham is like a black hole where women's dignity is destroyed. Even before the filming ended, all I wanted was to get out of there.