Long Read
27 February 2020

From unhygienic circumstances to safe deliveries in the hospital – the story of our Kapilvastu project

In the district Kapilvastu in Nepal there are several misconceptions that lead to preventable health issues – and avoidable deaths – of mothers and their babies. Programme manager Loan Liem* shares her story and the impact of her work: a change in knowledge and behaviour to improve the health of mothers and children.

Loan, what’s happening in this district?

Loan (in the middle) visiting the district

“I went to a remote rural village to speak with the women and hear their stories and needs. They told me that diarrhoea was ‘just a part of life’”. She points to her research prior to her visit, which showed that 2 out of 5 children and more than one third of the women has suffered diarrhoea in the past two weeks.

“The Nepalese government”, Loan continues, “had previously tried to work on better circumstances in this district, particularly focusing on the fact that many people defecate in the open. This means they do not have access to, or do not use a toilet indoors.  However, their attempts failed, because people were not interested to change their habits, and the Nepali government deemed the issue unresolvable.”

Pretty heavy! But what does that have to do with moms and their babies?

“Well, open defecation is strongly linked with unhygienic circumstances and behaviour in a broader sense. For example, unwashed cooking utensils can lead to diarrhoea, for moms and for their babies.”

“Diarrhoea can be especially dangerous for infants: it leads to dehydration and can ultimately mean a child does not survive. Additionally, it has a negative effect on many factors of life. Children miss school for instance, which leads to a lag in their development.”

“Diarrhoea is very preventable though. In the Netherlands we are used to having a toilet and clean drinking water from the tap. However, in Kapilvastu, open defecation is often practiced, even if they have a toilet at home. For instance, because a daughter in law does not want to use the same toilet as her father in law due to cultural norms.”

“For a safe pregnancy and delivery, other circumstances are also critical. Most moms in Kapilvastu don’t go for check-ups with a midwife or health worker, deliver their babies at home in unhygienic circumstances and without access to clean water. They don’t receive any health care after birth, and neither does the baby. This can lead to maternal and infant deaths.”

Why does this happen?

“A lot of it has to do a lack of knowledge on hygiene. Then there is the cultural structure: men are head of the households and decide for the women. Which means that they decide where money is spent on, meaning check-ups, ultrasounds, and a delivery at the hospital are not always prioritised. Sometimes the men even decide if and when the women are allowed to go outside. Next to that, home deliveries are seen as normal, more convenient, less costly and safe.”

So how do you turn things around?

“We provide information to the community and its leaders, and we organise women groups to discuss the issue. We also work husbands and the mother in laws, who are important decision makers at the household level regarding pregnancy.”

“Ultimately, we aim to empower women. So they can make their own informed decisions. Next to that we make sure that we have a supportive environment, where their needs are recognised and respected.”

What is the current situation in Kapilvastu?

“One year after the start of the programme, we have already seen incredible results”.
Loan sums up:

  • Women join group meetings. They discuss safe and hygienic practices and why health care during pregnancy is necessary;
  • We teach the women about warning signs during pregnancy. There has been an increase in planned delivery in a clinic or hospital: money is saved up in the household for the women to have the delivery at the hospital;
  • Increase in use of health care: women have more knowledge on a healthy pregnancy and visit a clinic for prenatal check-ups;
  • People are using toilets instead of defecating in the open, or are building toilets if they don’t have access;
  • Husbands and head of households are seeing and understanding the needs of women, they now organise family meetings to discuss how they can support the pregnant women;
  • Also at the community level, these issues are discussed, and the first measures towards better hygiene have been taken.

*Loan Liem is programme manager at Simavi, an organisation that works towards a healthy life for all.

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