The Tragic Story of a Teenage Mother in Achham
In the remote village of Ward 4 in Turmakhand Rural Municipality, a young girl, just 12 years old at the time, was married to a 16-year-old boy who was still in grade 7. This early marriage had devastating consequences for both the girl and her unborn child. Two years later, she became pregnant, but due to her early marriage, she had already dropped out of school. As a result, she lacked the physical, mental, and social maturity needed for parenthood.
Her pregnancy brought with it an overwhelming burden of domestic chores and agricultural labor, all while her body was still developing. She suffered from chronic malnutrition and had limited access to basic healthcare, which severely impacted the health of her unborn child. When her expected delivery date passed without any signs of labor, she was referred to the District Hospital in Mangalsen for further evaluation.
Upon arrival, doctors found that the fetus was dangerously overdue and recommended an immediate Caesarean section. However, the young couple, under pressure from their families, decided to consult with their elders before proceeding with the surgery. They then left the hospital without formal discharge.
The teenager explained that her in-laws believed that surgery would permanently harm her body and make her unfit for physical work. They insisted on a natural delivery, and the couple could not withstand the intense domestic pressure. Once they returned home, they sought help from dhami-jhankri (faith healers) and made ritual offerings to local deities, thinking that divine anger might be the cause of the delayed labor.
After a week, the couple returned to the hospital, but it was too late. The delay resulted in an intra-uterine foetal death. The teenager was forced to deliver a stillborn baby, marking a tragic end to what could have been a hopeful journey into motherhood.
Persistent Challenges in Achham
This case highlights a broader crisis in Achham, a remote district in Sudurpaschim Province. Despite a slight decline in stillbirth numbers, health authorities say progress remains unsatisfactory. According to data from the District Health Office, Achham recorded 362 stillbirths between the fiscal years 2020-21 and 2025-26. Of these, 173 occurred during active labor or delivery, while 189 occurred in the womb prior to the onset of labor.
Annual figures show a fluctuating trend: 109 stillbirths in 2020-21; 86 in 2021-22; 59 in 2022-23; 36 in 2023-24; 39 in 2024-25; and 33 so far in the current fiscal year.
Public health workers attribute this stagnation to several factors, including child marriages, chronic maternal malnutrition, and deep-seated superstitious practices. These issues are compounded by repeated pregnancies and a lack of reproductive autonomy.
The Case of a Woman with Six Children
A similar tragedy unfolded with a 38-year-old woman from Ward 5 of Dhakari Rural Municipality, who arrived at the District Hospital to deliver her sixth child. She had previously given birth to five daughters and faced immense social pressure to produce a male heir. Her labor at home lasted 12 hours, and due to the lack of emergency obstetric care infrastructure at the local health facility, she was transferred to the District Hospital.
Despite medical intervention, the baby was stillborn. The psychological toll was immense when she discovered the infant was a boy. Her family and community subjected her to continuous humiliation, blaming her for failing to bear a son. After her husband abandoned her at the hospital, she received no postpartum care or nutritional support.
Societal Pressures and Family Planning
Societal pressures continue to disrupt family planning decisions. A 21-year-old woman from Ward 7 in Mangalsen Municipality had mutually agreed with her husband to delay their first pregnancy for two years to balance domestic work, agricultural labor, and her education. However, her in-laws pressured the couple to conceive immediately after the wedding.
Because she did not conceive within two years, her in-laws accused her of infertility and took her to faith healers. Eventually, the couple gave in to the pressure. During her pregnancy, her workload increased significantly, and she was forced to carry heavy bundles of fodder and firewood alone from the forest.
With her husband away working in India, her in-laws increased her physical workload during the third trimester. Chronic physical exhaustion and emotional distress severely compromised the pregnancy. By the eighth month, she noticed reduced fetal movement but was not allowed to seek medical care immediately. When she finally reached the hospital, the baby had already died in the womb.
Ongoing Challenges in Safe Motherhood
Budha Magar, an information officer and senior nursing inspector at Achham District Hospital, noted that while safe motherhood initiatives have contributed to a reduction in the maternal mortality rate, stillbirths remain a major challenge, especially among teenage mothers. Adolescent mothers are often physically underdeveloped and may not be able to care for themselves or their fetuses adequately during pregnancy.
She added that many women arrive at health facilities too late, after intra-uterine death has already occurred. Turmakhand, Dhakari, and Ramaroshan rural municipalities have the highest concentration of stillbirths. Deep-seated resistance to surgical interventions often deters families from consenting to Caesarean sections even during critical emergencies.
Furthermore, women who deliver stillborn infants regularly face institutional and domestic abuse. Postpartum care and nutrition are frequently withheld, and some family members openly abuse the mothers inside the hospital wards. Several husbands abandon their wives in the obstetric beds, leaving them to deal with the trauma of loss alone.
