And you think you have it bad in the last trimester!
Consider women in rural Nepal: to get to their prenatal appointments, they might have to climb up the side of a mountain to get to a path that leads to the "local" village clinic. It could take one to two hours, depending on the amount of pain she's experiencing that particular day. She does all this while still on the hook for taking care of her kids, cleaning the house and stables, hauling water/firewood/cow dung, and making sure everyone is fed.
Why does she bother? Health officials have promised her a better chance of survival for her and her baby. And also? She's given a little over a dollar for the arduous trip. If she makes it to the clinic while in labor, she'll receive between $5 and $15—a real enticement for families in Nepal, which has one of the worst maternal mortality rates in the world.
Traditionally, and still commonly, rural Nepalese give birth at home surrounded by experienced women or traditional midwives, according to Allyn Gaestel and Allison Shelley, journalists working on a project about global maternity mortality and authors of a recent piece on birth in Nepal for The Atlantic.
But outcomes have been dismal. Poverty and lack of infrastructure have kept women in Nepal from accessing good nutrition and health care during pregnancy and birth, and so has the culture's deeply rooted gender inequality. Nepal ranks 156th out of 186 nations for Gender Inequality. Women's work there—particularly in the far western region of the country where women especially lack input—involves lots of heavy lifting. (Even if men were inclined to take on the physical labor in the last trimester, many are away in India working for low wages to send back home.) Fluid-heavy things like menstruating and giving birth are thought to be impure, so women are banished to the stables to live among the animals once a month and during big birthing events.
Children become better educated and grow up to have their own healthy birth outcomes.
Still, the fact that women will make the wilderness trek to get prenatal care, even if it is just for the money, is a bit of a success story for Nepal's women and for one of the United Nations' Millennium Development Goals, which called for a 75 percent reduction by 2015 in the number of women who die during pregnancy and birth. Central to the goal is providing better pregnancy and birth care for women, but also more family planning options and reducing the number of pregnancies in the first place. Reproductive rights, including abortion, were written into the constitution in 2007. Since 1996, the average number of children women have has been brought down from 4.6 to 2.6—a significant reduction. Health spending has also tripled in the last five years. And Nepal's payments for prenatal appointments are sort of working—though clinics in rural areas are not as busy as health officials had hoped.
A government study found the health clinics program was most successful in parts of the country where women were more empowered, had more say in family decisions and where there was better economic stability. In those areas, the better outcomes mean a greater likelihood that mom will survive childbirth, thereby reinforcing the family's economic stability. Children become better educated and grow up to have their own healthy birth outcomes.
Can the U.S. learn anything from this program? We far outspend other countries in terms of health care, but still rank 50th in terms of maternal mortality. In 2006, the U.S. reported 13.3 deaths per 100,000 live births, an two-fold increase from the previous 20 years. An Amnesty International report blamed discrimination, lack of health care access and barriers to family planning as among the leading contributors to the dismal numbers.
Do we need to look to the poorest nations for ideas on how to do it? If Nepal can improve its numbers and meet the 75 percent reduction in maternal deaths by 2015, surely the U.S. can, too.