Opening the lines to help pregnant women in Nepal
Prasansa is a 1st batch professional midwife of Nepal. She is one of the 14 professional midwives in the whole country. When COVID-19 shut things down in March, she and her midwife friends set up an emergency hotline number to keep women and girls connected during their pandemic pregnancies.
“All the health facilities were closed down by the lockdown except emergency,” she says. “There was no transportation at the time. The women were so scared that in case of emergency or in case of any queries, where they could go. They did not have any options at the time.”
Prasansha had just graduated as a midwife and along with two of her friends, they started an online and tele-midwifery service for women who were anxious and who could not go to help at facilities because of lockdown through the Young Midwives Committee.
“When this pandemic hit some of my friends who were pregnant contacted me,” she recalls. “They said they cannot go to health services because there was no transportation and they were scared.”
“They said they cannot go to health services because there was no transportation and they were scared.”
Prasansha started getting questions from several of her pregnant friends coping with the lockdown and lack of services.
At first they shared their own phone numbers online so that women could call for advice. She and her friends quickly got support from Dr Laxmi Tamang, President of Midwifery Association of Nepal (MIDSON) and the MIDSON, and they turned it into a national, toll free hotline to provide tele-health sessions.
“We wanted to make the government responsible for pregnant women,” she says. “Pregnant women could not wait, so we developed the support system they needed.”
“Pregnant women could not wait, so we developed the support system they needed.”
The hotline gave women a knowledgeable and helpful friend they could speak to about their concerns and all the questions that come during pregnancies.
“They were helped with transportation and how to get the right care in the hospital in coordination with different agencies and individuals” she says. “So far we have had 2,900 women who were counseled with information.”
The midwives provided advice, transport and referrals, but they also developed special remote services to help women cope with anxiety
“We enrolled women who were very anxious in sessions on gentle birth techniques,” she says. “We did several techniques that reduce women's anxiety like progressive muscle relaxation and self-hypnosis.”
“We enrolled women who were very anxious in sessions on gentle birth techniques. We did techniques that reduce women's anxiety like progressive muscle relaxation and self-hypnosis.”
Prasansha and her colleagues taught the women techniques that physically and mentally prepared women for childbirth.
She says the initial support from the Midwives Association and then from UNFPA from UN agencies helped them expand. Other agencies like Amakomaya and Beyond Beijing also supported it.
“UNFPA came along with us and actually motivated us to do more,” she says. UNFPA covers the cost of Midwives involved in the hotline and also the mobile/telephone costs.
Through connecting to health networks, the service was promoted on national radio and social media and through health centers across the country. UNFPA has recently developed animated video on Hotline service and is being disseminated through TVs and social media.
As the lockdown continued, Prasansha was able to visit some of the women she had counseled over the phone. She went to visit a young pregnant woman who was from rural Nepal but she was living in a vulnerable situation in the city.
“Whenever she called me she was always crying,” Prasansha says. “She could barely speak.”
Prasansha visited her and gave the young woman her first antenatal check up during the lockdown. With the help from the Midwives Associations and other helping hands, she gave some food, money and clothes for her and her baby.
Prasansha says it was the case of domestic violence which added an additional layer of urgency to the support. She was able to help the woman with transport and she delivered a healthy baby after she was taken to the maternity hospital.
Prasansha says she is glad that gender-based violence is included in midwifery training. She and her colleagues are specially equipped to provide service and counseling to gender-based violence survivors.
“One thing that I could give her was the psychosocial support she needed.”
“One thing that I could give her was the psychosocial support she needed,” she says.
Despite offering to connect the young woman with lawyers to talk about her options, she says the survivor always needs to decide.
“The young woman did not want to report her husband,” Prasansha says. If she would have wanted to proceed with legal procedures, we could have done the referral.”
Prasansha says it was always about pregnancy but the service was able to be an important part of the COVID-19 health network.
“We taught them about how COVID-19 spreads and how they can protect themselves from it.”
“We taught them about how COVID-19 spreads and how they can protect themselves from it.”
Prasansha and her friends realized that most of the pregnant women had limited knowledge about childbirth and pregnancy. The advice they were providing on a one on one basis could be scaled up to reach more women . She says, “by simply educating women and family about danger signs and birth preparedness complication readiness plans, we can definitely prevent delays in seeking and reaching health facilities. This will help reduce maternal and neonatal mortality and morbidity.
With support, they started a program called Childbirth Education for Young People in Nepal in association with the Midwifery Society of Nepal, the Rural Community Health Care Nepal, theNepal society of Obstetricians and Gynaecologist and Amakomaya. They enrolled young people below 25 years and provided education about pregnancy, the physiology of pregnancy, and care before, during, and after pregnancy.
“We empower them by talking about the danger signs that can happen during pregnancy and after childbirth,” she says. “We also talk about respectful maternity care and gentle birth methods and what special preparation they can do during the pregnancy to avoid complications and to manage the complications.”
They successfully completed the first batch and are also planning to enroll for the 2nd batch. Prasansha and her colleagues are an inspiring example of professional expertise and personal initiative in a pandemic.
“We can contribute to women from our own angle.”
“Instead of blaming the government or blaming other people or other organizations for not doing what they are supposed to do,” she says.“we can start contributing to the country. We can contribute to women from our own angle.”
Beyond the challenges of gender-based violence and teenage pregnancies, Prasansha says there were some heartbreaking times when they got calls from rural areas but their advice was not enough,
She remembers when she took the call, “The staff from the rural clinic contacted us and it was night time. It was raining and they were running out of medicine and supplies. The staff did their best and we could support them with advice with what they could do.”
They attempted to refer the pregnant woman to a health facility where there were doctors but on the way she died.
Prasansha says those moments of grief have been hard, but the work has been rewarding. She has personally advised over 800 women since the pandemic began.
“It makes me very happy especially when the women were happy with our services and I could help so many women,” she says. “We had organizations to support us, to motivate us and to inspire us to do more.”
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About the response
Following the declaration of the COVID-19 pandemic by WHO on 11 March 2020 and a nation-wide lockdown effective from 24 March 2020 by the Government of Nepal, UNFPA coordinated with the Family Welfare Division (FWD), Department of Health Services to activate the Reproductive Health Sub-cluster (RHSC) and implementation of Minimum Initial Service Package for RH (MISP) to ensure the continuation of sexual and reproductive health (SRH) services. UNFPA co-leads the RHSC with the FWD and engages a broad range of SRH national and international partners including MIDSON targeting different aspects of gaps in continuation of SRH services. To ensure coordination, UNFPA also facilitated activation of the RHSC at Provincial level. UNFPA contributed in development of the interim guideline on Reproductive Maternal, Neonatal, and Child Health (RMNCH) and supported roll out of the guideline by orienting SRH service providers in eight districts.
UNFPA carried out the rapid assessment of SRH services to assess the current status of health care delivery which provided evidence that informed preparedness and response plan to address RH needs and gaps. UNFPA provided PPEs, supported to establish helplines for SRH COVID-19, including toll free numbers for regular provision of counselling and information on safe motherhood, family planning and safe abortion services. Risk communication messages around COVID-19, specially focusing on pregnancy, new-born danger signs and breastfeeding were also disseminated throughout the country.