Seven months pregnant and working in the fields
Women in Nepal do the lion's share of agricultural work, and it's common for them to continue working in the fields throughout pregnancy. But this can seriously affect their health, and that of their unborn child.
In the Himalayan nation of Nepal, in the village of Pawati, Januka Rasaeli plants vegetables on her farm. After an hour, she treks back home to chop wood. Before long, she is herding goats on a hillside, under the hot sun.
"From the moment I wake up at 06:00 until I go to sleep at 22:00, I'm doing work the whole time," she says. "I work about seven or eight hours a day in the fields."
It is common here for women to do backbreaking work in the fields, but Januka is seven months pregnant. Despite her expanding belly, there is no let up.
"Up until the day the baby is born, I'll be working all the time," she says.
In recent years, Nepal has made a big push to improve the health of pregnant women. The government has built new birthing centres. It has covered the cost of delivering babies in clinics. It has given out medication to prevent excessive bleeding, which can be fatal.
These efforts are working. The country has seen a dramatic drop in the number of women dying during childbirth.
"The challenge still is, can we even lower it further?" asks Arzu Rana Deuba, a member of parliament and campaigner on women's health issues. She says a big remaining problem is that so many women work so hard late into their pregnancies.
In places like the US, where women have regular access to prenatal care, doctors recommend exercise during pregnancy. But experts say in regions where pregnant women have no medical supervision and may not eat enough, it is better to avoid strenuous activity, as it can cause serious complications.
Deuba says pregnant women work hard in Nepal because they have to support their families, and it is part of the culture.
"That's the concept women in Nepal are mostly socialised in, that you have to make your presence felt, and your worth is the labour you contribute," Deuba says. "They are taught to think of themselves as responsible for this kind of work. They have the lowest status inside the family, so they need to do the hardest labour."
When Januka is not working in the fields, she crouches in her smoky kitchen and blows air into a wood-fired stove. She dices and grinds vegetables while breathing in swirling ashes. She says she wishes she could take a break from the hard work, at least once in a while.
"My back hurts, my stomach hurts," Januka says. "While planting corn and rice a month ago, my legs got swollen and cramped. My body is in constant pain."
Health experts say women like Januka should take a break. In extreme cases, hard work in late pregnancy can cause the uterus to slide out of its normal position, a condition known as uterine prolapse, which can leave the mother infertile. Long hours of strenuous manual labour can reduce sustenance to the baby, resulting in low birth weight and impaired foetal development, especially if the mother's diet is poor. Extreme exertion can also deprive the uterus of blood and trigger premature birth.
These problems happen in other developing countries where women are expected to do the bulk of agricultural work. However, the situation is heightened in Nepal as many men have left the country looking for work abroad, leaving women alone to take care of the farms.
"What you have to reinforce is that the health of the mother has a direct impact on the health of that baby," says Carolyn Miles, president of the international aid group Save the Children.
Miles says even if husbands and mothers-in-law are not worried about the mother's health, they are often extremely concerned about the baby's health. So organisations like Save the Children are meeting families and appealing to their concern for the baby's welfare - to give pregnant women much-needed rest.
"Now what we're seeing is mothers-in-law step forward and say, 'I'm going to actually go take care of the garden for the next month,' or, 'I'm going to make sure my daughter-in-law gets the right food and enough food,' which is a big shift," Miles says.
Husbands are also changing their behaviour.
When Januka was pregnant with her first child, her husband, Madhav, was working away from home. But this time he came back to the village to help her through her second pregnancy.
Madhav says he returned to protect the health of his wife and unborn child. "When my wife is working in the fields and she says she has a stomach-ache, I get scared," he says. "I was worried during my wife's first pregnancy, and now I'm scared again how it will go."
And so he helps with the chores, at least a little. On one day, Madhav shovelled earth in a rain-soaked field, while Januka planted seedlings in the holes. In the past, Januka says, she had to do all the digging herself.
"During my previous pregnancy, I worked a lot harder," she explains. "This is nothing in comparison."
In a place like Pawati, hard work in late pregnancy is far from the only thing that threatens the well-being of mothers and unborn children.
Two months after I met her, Januka went into labour.
She had planned to deliver her baby at a hospital in the nearest town, a couple of hours away, but Januka's labour came early. There was no time to get to the hospital.
She gave birth at home. The delivery was complicated, for reasons most likely unrelated to her hard work in the fields. The baby became tangled in its umbilical cord. There were no birth attendants on hand, and the ambulance took too long to arrive.
The baby died.
Januka says she wants to try again to have another baby. Her husband may look for work abroad in a few months. For now, he is still helping in the fields at home.