Nepalese Female Community Health volunteer Bhumishara Upadhaya (second left) counsels young mothers at Barlamgi in the Dailekh district, some 600 kilometres west of Kathmandu.
AFP/Kathmandu
On a wet and windy morning, Nepalese housewife Bhumisara Upadhyay is out visiting pregnant women, on a mission to slash newborn deaths in the Himalayan nation with a simple tube of gel.
Upadhyay is among thousands of volunteers at the front line of a campaign that has dramatically cut neonatal mortality in a country where nearly two-thirds of babies are born at home.
Health experts attribute Nepal's newborn mortality rate to infections contracted through the umbilical stump, which is traditionally coated with a mix of oil and turmeric after the cord is cut.
Instead, the volunteers persuade women to use a basic antiseptic gel which they distribute free of charge under an initiative launched three years ago with funding from the US development agency USAID.
Within a year of the launch, newborn deaths had declined by a dramatic 27% and organisers now plan to extend it nationwide over the next three years.
"When I had my own children 20-25 years ago, babies would just die overnight, no one understood why... it was like living in a graveyard," Upadhyay, 42, told AFP in her home village of Badalamji, perched on a ridge in the remote midwest.
"We used to say it was good to have lots of babies, because half would die before they learnt to talk."
Married before puberty to a man 22 years her senior, Upadhyay was just 17 when she gave birth to her first child after enduring eight days of labour.
Upadhyay's baby girl survived, but many others are not as lucky.
"People use dirty sickles to cut the cord and apply cowdung, turmeric, oil to the stump," said Rambha Sharma, matron of Kohalpur Teaching Hospital in midwestern Nepal, which pioneered the use of the antiseptic chlorhexidine gel on infants.
"Babies end up with life-threatening infections like neonatal tetanus thanks to these traditional practices," Sharma said.
A widely used disinfectant in developed countries, chlorhexidine is the main ingredient in the gel which is currently distributed for free across 47 of Nepal's 75 districts.
The gel, which only needs to be applied once to the stump, binds to the skin and dries in minutes.
"The key thing is to apply it soon after birth, so it stays on the skin for the first 24 hours and protects babies when they are most vulnerable to infection," Sharma said.
It sounds like a simple solution. But overturning traditional practices has been a major challenge.
Leela Khanal of US non-profit John Snow, Inc, which runs the programme, said many in Nepal's Muslim minority initially refused to use the gel, fearing it was a ploy to induce infertility among their young.
"It took us months to convince them that it would protect, not harm their children," Khanal said.
Every morning, thousands of housewives like Upadhyay walk for hours, braving rain, extreme temperatures and the threat of landslides to visit pregnant women scattered across Nepal's steep slopes.
The volunteers are community health workers, a network the government established in 1988 to promote family planning.
They teach pregnant women how to care for newborns, and hand out tubes of the gel so mothers can apply it themselves.