Saving Mothers' Lives With Calcium: An Innovative Program in Nepal to Prevent Pre-Eclampsia

A pregnant woman receives a free supply of calcium at a health facility participating in Nepal's program to prevent pre-eclampsia/eclampsia, the leading cause of maternal deaths in the country.

By Dipendra Rai and Yeshoda Aryal

Dailekh, Nepal—While attending her prenatal care visits, Sunita learned about a new program offered by the Government of Nepal that gives pregnant women calcium supplements for free. The 25-year-old mother of three knew the value of calcium: it reduces the risk of a potentially fatal pregnancy-related condition. But, at $10, it was too costly.

Through the new calcium supplementation program, Sunita can now get the calcium that will help reduce her risk of pre-eclampsia, which if left untreated can lead to eclampsia—the leading cause of maternal death in Nepal. Sunita visited the local health clinic in her home district of Dailekh. There, she was examined for symptoms of pre-eclampsia, including high blood pressure and elevated levels of protein in urine, and counseled on calcium use. Before leaving, she received two bottles of calcium and an informational brochure.

Sunita is one of nearly 5,000 pregnant women in Dailekh who have participated in the calcium supplementation program. This intervention is being implemented by the Family Health Division of the Nepal Ministry of Health and Population (MoHP), with support from the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego.

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Sunita is one of the thousands of women in Dailekh district to benefit from calcium during her most recent pregnancy. Photo by Dipendra Rai.

Calcium is an important part of prenatal care in developing countries such as Nepal, as it is proven to reduce the risk of pre-eclampsia by 50 percent. If undiagnosed, women with pre-eclampsia/eclampsia can have seizures and other medical conditions that put themselves and their babies at a high risk of death.

This innovative calcium intervention could mean 50 percent fewer mothers and babies who need emergency care, which is especially critical in places where women cannot easily reach a hospital. In the remote villages of Nepal, accessing health care can mean a several-hour walk through mountainous terrain.

Because pre-eclampsia/eclampsia can develop rapidly and it can be difficult to predict who might be at risk, the MoPH and MCHIP started the program in Dailekh. Together, they launched the pilot in August 2012, after training 268 health workers and 789 female community health volunteers. Now in Dailekh, a pregnant woman who comes for even one prenatal care checkup receives a supply of calcium tablets for the duration of her pregnancy.

Since participating in the program, Sunita has encouraged other women to receive prenatal care and take calcium. Upon meeting an MCHIP staff member, Sunita said, “I already finished one bottle and started the second bottle, and I am feeling better. I have recovered from the weakness which I was experiencing."

This program is yet another example of a successful collaboration between Jhpiego and the Government of Nepal. Almost a decade ago, Jhpiego worked in partnership with the MoPH to help reduce the number of women dying from postpartum hemorrhage (PPH), which was the leading cause of maternal death at the time. The innovative PPH program trained community health workers to educate pregnant women and their families on the use and benefits of misoprostol, as well as how to properly distribute this lifesaving medication to women who could not reach a health facility to give birth. The program was so successful in preventing PPH at home births that the MoPH has since expanded the intervention from 31 to 75 districts.

Ultimately, the calcium supplementation program seeks to demonstrate that women are interested in receiving calcium and taking it throughout their pregnancy. Thus far, the free supplementation has proven to be so popular that the number of women who have received calcium has exceeded expectations. Based on these findings, the government will consider providing it for free for all pregnant women in Nepal, as they already do with iron/folic acid tablets.

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