Nepal, while being a hotbed for adventure seekers, trekkers, tourists, and mountaineers, faces many economic struggles that heavily plague low-and-middle income countries. The vast majority of Nepal’s economy is based on remittances with 25 percent of its working population living outside of the country. Additionally, with an average population age of 23, Nepal has a dismal 50 percent unemployment rate. These systemic economic struggles, of course, disproportionately affect women and subsequently their children and families. Couple that with a stringent caste system and some Nepali women remain inherently stuck on the lowest rung of the class ladder and are subject to some of the basest forms of work available to them.
The Himalayan Climate Initiative (HCI), a youth-driven environmental NGO based in Kathmandu, is working with some of these women whose only other economically viable life option may be selling themselves sexually to the nearest customer, working in the illegal scrap waste trade, or going abroad to find work and then enduring whatever fate awaits them. HCI employs socially discriminated women waste workers at its PET Bottle Recollection Social Enterprise (Nagar Mitra) allowing them to create a livelihood beyond what might traditionally befall them.
When everyday Americans think about women dying during childbirth it is probable that their initial thoughts travel directly to Africa where it is quite well known that maternal mortality is rife. Chances are their thoughts never focus on the deaths and near deaths during childbirth that women experience right here in the United States. After all, the overwhelming consensus is that the United States has the best medical care, superior health workers and health system in the world despite some of its inherent challenges. This thinking renders maternal mortality in the US thoroughly inconceivable to many even while data reveal it should not be inconceivable at all. In fact, maternal mortality is on the rise in America having doubled over the past 25 years all while global maternal deaths are steadily declining. Globally, maternal mortality was effectively reduced by 44 percent according to the World Health Organization.
The United States, while not the overall leader in maternal mortality among all countries, it is the leader among all developed nations. The United States ranked number 33 out of 179 countries in Save the Children’s 2015 Mothers’ Index Ranking and 46th in the world due to the rate of women who die from pregnancy and childbirth complications. Compared to other developed countries, the United States’ ranking is abysmal, especially with Norway, Finland, and Iceland ranking in the top three overall. Even countries like Estonia and Belarus, whose GDPs are considerably lower than ours, far outrank America.
Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable – including obstructed and protracted labour and one of its side-effects, obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother’s pelvis is too small or the baby is too large.
In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.
South Africa has extremely high maternal mortality levels. This is true when compared with developed countries as well as other developing countries.
According to the World Health Organisation, for every 100,000 live births in the country in 2015, 138 women died due to pregnancy and childbirth complications. In Sweden, fewer than five women die for every 100,000 live births. In Brazil, the estimate is 44 women for every 100,000 live births.