Birth in Nepal

In addition, 39 out of every 1,000 Nepalese babies die before their first birthday

Globally, the number of maternal deaths dropped from more than 500,000 a year in 1980 to 343,000 a year in 2008

Six countries accounted for more than half of all the maternal deaths in 2008: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo [GALLO/GETTY]

In the last 20 years, maternal deaths have been declining at a rate of about 1.4 per cent a year

A recent study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; better education of women; and the increasing availability of so-called skilled attendants to help women give birth

Afghanistan has the second highest maternal mortality rate in the world and poor health conditions and malnutrition make pregnancy and childbirth exceptionally dangerous for Afghan women [EPA]

A recent study shows that the maternal mortality ratio (MMR) of Nepal has decreased to 240 deaths per 100,000 live births

The study also reported that 41 per cent of maternal deaths occurred in health facilities, 40 per cent at home and 14 per cent in transit

In 1998, 21 per cent of maternal deaths occurred in health facilities, 67 per cent at home and 11 per cent in transit

Women are particularly vulnerable in rural areas where they have limited access to health care facilities

Bad roads and a lack of vehicles make the journey to the nearest hospital a perilous one

The vast majority of maternal deaths could be prevented if women had access to quality family planning services, skilled care during pregnancy, childbirth and the first month after delivery, or post-abortion care services, and where permissible, safe abortion services

Harsh conditions and some societal attitudes in the rural district of Acchram in Nepal contribute to the dire statistics

Women in Acchram - where it is a custom for women to do all the work - work up to 18 hours a day

When women menstruate, they must live separately in a small shed called a chaubadi

Locals believe that the woman may fall ill or that the family(***)s cattle will be taken by a tiger if this custom is not followed

Many men from the village work in India and those that have stayed behind sit around playing games. They are not expected to work

The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour

While these are the main causes of maternal death, unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible

Like many others, 31-year-old Basanti Sarki married when she was 14. She has five children and is about to give birth to her sixth child

Traditionally, girls in Accham have to work all day to help their mothers

While sons are allowed to play

The older generation in particular believes that sons are more valuable than daughters, ignoring the fact that without daughters the work would not get done

Despite the political instability of the past ten years of civil war, the Nepalese government is introducing measures to improve safety for mothers

The Nepalese government tries to raise awareness in rural communities and to increase access to medical services

There have been government initiatives to provide home visits for family planning, to give basic medical supplies and training to women in remote parts of the country, and to provide pregnant women with vitamin A

Nepal is now ranked 55 out of 181 countries with an annual change reduction of 3.7 per cent per year from 1980 to 2008 (ranked 44 in the world in 1990)