Know the facts Over 20 years ago, international experts identified three kinds of delay, known as the ‘3Ds’, which are particularly applicable in Nepal: ■ Delay in deciding to seek care. ■ Delay in reaching a healthcare facility. ■ Delay in accessing adequate treatment at the facility. Women living in traditional Nepalese societies suffer social and religious discrimination. A woman is treated as ‘untouchable’ during her first menstruation. She is not allowed to see the sun, her husband or her brother due to a superstition that her male relatives would die. Women are not allowed to discuss pregnancy with anyone other than their husbands and mothers-in-law. For the first 11 days after giving birth, a woman is regarded as polluted and impure. Male relatives, including the husband, cannot go near her, so she is forced to live in isolation – often in a cowshed or makeshift hut. She sleeps with her newborn on a cold floor in unhygienic conditions, increasing her chances of septicaemia and risking the infant’s health. Male relatives don’t want to touch women who bleed after giving birth, while private and public vehicles alike may refuse to transport them. For Maili Chettri, it would have cost around US$ 250 to fly from Rukum to Nepalganj, catch a bus to the hospital and find accommodation – before considering the price of surgery and medicine. Such an expense is unthinkable to many Nepalese. In Maili’s region, the average agricultural wage is 54 rupees (75 US cents) a day, according to the World Bank. Nationwide, over 80 per cent of Nepalese subsist on less than US$ 2 a day. Out of an estimated 900,000 pregnancies in Nepal each year, the UN estimates that around 129,000 develop life-threatening complications and will require EmOC services. To access these services, women must travel to the district centre. However, of Nepal’s 75 districts, only 25 have comprehensive EmOC facilities, while there are just 17 basic EmOC facilities in other locations. Surgery and blood transfusion services are limited (see Box 4.2). As a result, 95 per cent of women who develop birth complications receive no emergency care, according to the United Nations Children’s Fund (UNICEF) in a report dated 2000. Dangerous motherhood practices significantly contribute to Nepal’s high infant mortality rate (IMR) of 64 per 1,000 live births. According to the government’s 2001 survey, around 50,000 children die each year before their first birthday. Of these, twothirds die within 28 days, which equates to over 30,000 neonatal deaths annually – one every 20 minutes. A WFP survey of 1,359 women across Nepal in 2005 found that 63 per cent of those in the terai and 45 per cent of those in the hills and mountains weighed less than the 45kg threshold. Poorly nourished mothers are not only more prone to bleeding and infection, their babies are born smaller and are more vulnerable to potentially deadly diarrhoea and pneumonia. A quarter of Nepal’s newborns are underweight, at less than 2.5kg. www.redcross.org/static/file_cont5917_lang0_2248.pdf