Lumbini Province is a fertile land for production. However, in recent years, due to the rapid development of settlements in the Terai and the rapid conversion of farmlands to barrenness in the hilly districts, production has declined. This has had a direct impact on the food security of the province. The number of malnourished children is increasing in most of the 12 districts of the province. The maternal mortality rate in Lumbini Province is also becoming alarming. Hunger, malnutrition and maternal mortality rates are pushing Lumbini to the list of problematic provinces in the country. However, the commitment letters of the parties that have been vying to make promises in the elections do not seem to prioritize productivity growth, malnutrition reduction and maternal mortality control.

The dreams of infrastructure development of the province and the use of technology are visible in the commitment letters. But the same old problems are taking root on the ground. The main impact of this is seen in the 'food security and nutrition crisis'. Due to lack of access to adequate food and healthy nutrition, 13 children have lost their lives in Lumbini Province in 2 years, including 7 in FY 2079/080 and 6 in FY 2080/081. More than 4,000 have been found to be severely malnourished. Women's health is even more at risk when looking at the maternal mortality rate. In Lumbini Province, 207 mothers die per 100,000.

The latest data in Lumbini Province has also shown a critical situation in nutrition improvement. In Lumbini, the provincial and federal governments have been spending nearly 30 million rupees every year to improve the condition of wasting, stunting and underweight among children. However, the number of malnourished children is increasing every year. While 7 people lost their lives in FY 2079/080, 6 people died in FY 2080/081. The last fiscal year's figures have not been made public yet. The number of children suffering from severe malnutrition in the fiscal year 2079/080 was 1,912, but in the fiscal year 2080/081, that number has increased to 2,555.

According to the annual report for the fiscal year 2080/081 released by the Lumbini Province Health Directorate on Falgun 9, 6 children from 4 out of 12 districts of Lumbini Province died in the fiscal year 2080/081. According to which 3 children died in Banke, 1 in Dang, and 1 each in Rupandehi and Pyuthan. In all 12 districts of Lumbini, 1,912 children were found to be severely malnourished in the fiscal year 2079/080, and in the fiscal year 2080/081, that number has increased to 2,555. This data is only for children who go for examination at government health institutions. The number of malnourished children is even higher outside government health institutions, said Kumar Thapa, focal person of the Medical Services and Disease Control Branch of the Health Directorate. ‘The number of malnourished children seems to be increasing every year in the Terai districts compared to the hill districts,’ he said. ‘This figure is only for those who come to health institutions for examination, the number of those who do not reach the health institutions may be even higher.’

According to government data, in the fiscal year 2080/081, severe malnutrition was seen in Lumbini with 689 children in Kapilvastu, 577 in Rupandehi, 437 in Banke, 278 in Bardiya, 224 in Nawalparasi West and 196 in Dang. In the hill districts, the highest number of children were seen in Rolpa with 54 children and the lowest number was seen in Rukum East with 9 children. Severe malnutrition has been observed in 42 people in Pyuthan, 22 in Palpa, 17 in Gulmi and 10 in Arghakhanchi. The data shows that the number of malnutrition patients is more in the Terai than in the hills. The government is operating malnutrition rehabilitation centers at Lumbini Provincial Hospital, Butwal, Rapti Institute of Health Sciences, Dang and Bheri Hospital, Banke for the treatment of malnourished children. The centers also provide beds, nutritious food and accommodation for the treatment of children. According to Nutrition Focal Person Thapa, Butwal and Dang have 10 beds and Banke has 17 beds.

The federal government provided Rs. 45 lakh to the Butwal center last fiscal year and the provincial government provided Rs. 15 lakh to the center. Similarly, the federal government has been providing budget only to the centers in Dang and Banke. In the last fiscal year, the budget was Rs. 50 lakh for Dang and Rs. 70 lakh for Banke. Bimala Poudel, in-charge of the center, said that on average, up to 190 people fall ill in a year in Banke, which has 17 beds. ‘The number of malnourished children in the district is high,’ she said, ‘but very few come to the center for treatment.’ She said that the number of people coming to the center for treatment is also low due to the lack of information that the center provides treatment for children and management of food and accommodation for mothers.

Six people are currently admitted to the center of the 10-bed Lumbini Provincial Hospital. According to Pratiksha Thapa, in-charge of the center, patients with low weight, malnutrition and stunting are admitted to the center and treated. The center should provide nutritious food according to the child’s condition and conduct regular tests. Both the malnourished child and mother are kept in the center for at least 45 days. "We feed the children who come to the center at least 9/10 times a day with nutritious food," she said. "That will help the child gain weight and improve their health in one and a half to two months. And then we will discharge them for follow-up." She also said that along with the child, the mother will also be given nutritious food and the child will be treated. Most of the children come to the center on the recommendation of local health institutions. Due to lack of information, poor families do not take their children to a health institution even if they are sick, keep them at home even when they are sick, and take them to a health institution in the last stage and only then bring them to the rehabilitation center, which is why the child dies, she said. Last year, 154 people received treatment at the rehabilitation center in Butwal. According to the 2078 census, the number of children under 1 year old in Lumbini Province is 76,449. The number of children between 1 and 5 years old is 439,841.

Malnutrition in children under 5 years of age is treated . Acting Director of the Health Directorate of Lumbini Province, Roshanlal Chaudhary, said that the number of children under 5 years of age is increasing in Lumbini Province. He said that the public figure of 6/7 deaths in a year should be understood as a serious problem of malnutrition . He claims that the child nutrition program in government schools is not effective, anemia is seen in girls, and the shortage of micronutrients is also causing malnutrition.  ‘The government has been continuously implementing programs by spending money to control malnutrition,’ he said, ‘However, the condition of malnourished children is becoming critical due to various problems, 6 children have lost their lives in a year. ’ He said that the problem is increasing despite the state spending money due to poverty, lack of nutritious food and lack of public awareness at the community level. He said that the school nurse program, community-level search for malnourished children, and awareness programs in underprivileged communities are being continuously conducted.

The lack of complete breastfeeding from birth to 6 months also causes malnutrition in children. Pediatrician Dr. Netra Rana of Lumbini Provincial Hospital, Butwal, said that there is a problem of complete breastfeeding up to 6 months after birth in Lumbini Province. 'Not breastfeeding until 6 months after birth is the main cause of stunting,' he said, 'it affects both the physical and mental growth of the child.' He said that there is a problem of complete breastfeeding in all districts of Lumbini.

According to national statistics, Nepal is ranked 12th in the Food Vulnerability Index. However, Lumbini Province is ranked first in the country's most vulnerable situation. The facts show that not only food, but also the nutrition crisis is becoming dire. All the facts of malnutrition, stunting, underweight and anemia show that the acute nutritional crisis is increasing in Lumbini. Karnali has the highest rate of stunting at 17.7 percent, while Lumbini is in second place with 16.2 percent.

While Lumbini has 25.1 percent stunting, Gandaki has the lowest rate of stunting at 19.7 percent. Karnali has the highest rate of stunting at 35.8 percent. Lumbini is also in second place in underweight. Lumbini has 23.3 percent underweight children, while Madhesh has the highest rate of 26.8 percent and Bagmati has the lowest rate of 10.5 percent. The data also shows that the situation of Madhesh and Lumbini in anemia is worrying. The situation of anemia in children under 5 years of age is even more serious. While 50.6 percent of children in Madhesh are anemic, 49 percent in Lumbini and the lowest is 21 percent in Koshi.

Declining production, rising cost of living and hunger

As investment in agriculture continues to decline in Lumbini Province, food production has declined, making the nutrition crisis even more dire. Although the provincial government claims to have been prioritizing agriculture, the latest data shows the exact opposite. According to Hari Prasad Pandit, spokesperson for the Ministry of Agriculture, Land Management and Cooperatives and senior agricultural economist at the Planning and Monitoring Division, the budget of the Ministry of Agriculture for the current fiscal year is only Rs 1.36 billion. Which was up to Rs 4 billion in the early years of the province's establishment. It has decreased to less than Rs 1.5 billion now. He said that a large part of it will go to the salaries and allowances of employees. ‘In the early years, a district used to receive up to 10-12 million,’ he said, ‘now it has hardly received even 1.5 million.’ He said that 90 million liabilities from the last fiscal year are still outstanding. He said that as the budget decreases every year, production has declined.

Although the production of fruits, vegetables and maize has increased, the production of wheat, oilseeds and pulses is decreasing. He said that the decline in production has naturally increased the nutritional crisis in the province. ‘Production has decreased due to the decrease in investment in agriculture as a whole. It is not possible to improve nutrition because of this,’ he said, ‘The special attention of the provincial government needs to be drawn to this.’ He said that the food crisis in the hilly districts including Palpa, Rolpa, Pyuthan and Arghakhanchi is even more dire than in the Terai districts.

Provincial Planning Commission member Bhuvan Chaudhary said that although all major parties have made election pledges to modernize the subsistence agriculture system, it has not been implemented in practice. ‘There are many things about agriculture in the pledges of all political parties, but none of them are implemented,’ he said, ‘Governments at all levels must work to end this trend.’ Lumbini Provincial Government Chief Minister Chetnarayan Acharya said that the government is serious about the growing crisis in nutritious food. He said that the provincial government has given priority in the second periodic plan to ensure access to nutritious food for all citizens. ‘The government is serious about the situation of nutritious food crisis seen in Lumbini Province,’ he said. For that, he said that the government has a strategy to promote such crops through organic production, saying that indigenous crops such as maize, wheat, barley, sorghum, millet, etc., which are associated with the identity of the province, have sufficient nutrition.

Maternal mortality rate: Highest in Lumbini

The maternal mortality rate of Lumbini province is also worrying. Looking at the provincial details, the highest maternal mortality rate is seen in Lumbini province. The lowest is in Gandaki province.

According to the latest report of the Department of Health Services, 207 mothers die in Lumbini province for every 100,000 live births. This rate is the highest in the country. Of the 12 districts of the province, the highest number of deaths is in Banke with 380 and the lowest in Rukum East with 111.

The main reasons behind the high maternal mortality rate in Lumbini are negligence in regular pregnancy check-ups, inability to reach women's health institutions in rural areas, the tradition of giving birth at home, poverty and lack of education. कर्णाली प्रदेशमा १७२, गण्डकीमा १६१, कोशीमा १५७, मधेश प्रदेशमा १४० र सुदूरपश्चिममा १३० को मातृमृत्यु दर छ । बाग्मतीमा ९८ रहेको छ । विशेषगरी शहरी पहुँचमा रहेका सुगम क्षेत्रका महिलाहरु समेत गर्भावस्थाको सुरक्षामा लापरबाही गर्दा मातृमृत्यु दर घट्न नसकेको लुम्बिनी प्रदेश स्वास्थ्य मन्त्रालयका वरिष्ठ स्वास्थ्य शिक्षा प्रशासक एवं प्रवक्ता नोदनारायण चौधरीले बताए । बाग्मती प्रदेशजस्तो तुलनात्मक रूपमा पहुँच र पूर्वाधार विकासमा अघि बढेको क्षेत्रमा समेत मातृमृत्यु उच्च हुनु आफैंमा स्वास्थ्य प्रणालीको कमजोरी देखाउने तथ्य हो ।

लुम्बिनी प्रदेशका ग्रामीण क्षेत्र, तराईका पिछडिएका समुदायमा मातृसुरक्षाको अवस्था दयनीय रहेको प्रतिवेदनले देखाएको छ । स्थानीय तहले सुरक्षित मातृत्व प्रवर्द्धन गर्ने प्रयासमा अझै सुधार गर्न सकेका छैनन् । मातृमृत्यु दर घटाउन समुदायमै आधारित सुरक्षित सुत्केरी सेवा, स्वास्थ्य चेतना अभिवृद्धि, महिलालाई लक्षित आयआर्जन कार्यक्रम र प्राथमिक स्वास्थ्य सेवाको पहुँचलाई सुधार गर्नुपर्ने आवश्यकता छ । ‘प्रदेशका सुगम जिल्ला मानिने कपिलवस्तु, बाँके, दाङ, रूपन्देहीका दक्षिणी बस्तीहरुमा मातृ मृत्युदर भयावह स्थितिमा छ,’ उनले भने, ‘आम सर्वसाधारणमा मातृसुरक्षा, सुरक्षित सुत्केरी सेवा, आपतकालीन स्वास्थ्य सेवा र नियमित स्वास्थ्य जाँचमा पहुँच बृद्धि गर्नु जरुरी छ ।’

लुम्बिनी प्रदेशमा सुरक्षित प्रसुती सेवाको लागि ४३५ वटा बर्थिङ सेन्टर रहेका छन् । जसले २४ सैं घण्टा प्रसुती सेवा उपलब्ध गराउने गरेका छन् । तर, पनि आव २०८०/०८१ मा ५७ जना आमाहरुको मृत्यु भएको छ । त्यो मध्ये सबै भन्दा धेरै कपिलबस्तुमा १४ जनाको मृत्यु भएको छ । रूपन्देहीमा ११, दाङ र बाँकेमा ९/९ जना, बर्दियामा ४, गुल्मीमा ३, पाल्पा र नवलपरासी पश्चिममा २/२, रुकुम पूर्व र अर्घाखाँचीमा ११ जना आमाले ज्यान गुमाएका छन् । प्यूठान र रोल्पामा मातृमृत्युदर शुन्य देखिएको निर्देशनालयका बरिष्ठ स्वास्थ्य शिक्षा अधिकृत भरतबहादुर कुँवरले बताए । नवजात शिशु तर्फ पछिल्लो तिन वर्षमा लुम्बिनी प्रदेशमा मात्र १ हजार ५ सय ७५ शिशुले ज्यान गुमाएका छन् । आव २०८०/०८१ मा मात्र ४ सय २२ जनाले ज्यान गुमाएको मन्त्रालयले जनाएको छ । लुम्बिनीका १२ जिल्ला मध्ये रूपन्देहीमा सबै भन्दा धेरै १९६ र पश्चिम नवलपरासीमा सबै भन्दा कम १ नवजात शिशुको मृत्यु भएको मन्त्रालयले जनाएको छ ।

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लुम्बिनी प्रदेशबाट आगामी निर्वाचनका लागि दुई पूर्व अर्थमन्त्रीसहित केन्द्रीय स्तरका नेता उमेदवार बनेका छन् । नेकपा एमालेबाट दुई पटकसम्म अर्थ मन्त्री बनेका उपाध्यक्ष विष्णु पौडेल रूपन्देही–२ बाट उमेदवार छन् । लुम्बिनीका पूर्व मुख्यमन्त्री एवं एमालेका महासचिवव शंकर पोखरेल दाङ–२ बाट उमेदवार छन् । त्यस्तै तत्कालिन नेकपा माओवादीबाट अर्थ मन्त्री बनेका वर्षमान पुन रोल्पाबाट उमेदवार बनेका छन् । कांग्रेसबाट लुम्बिनी प्रदेश सभापति अमरसिंह पुन बाँके–३ र राष्ट्रिय स्वतन्त्र पार्टीका महामन्त्री सुनिल लम्साल रूपन्देही–१ बाट उमेदवार छन् । उनीहरु चारै जनाले तयार गरेको स्थानीय स्तरको प्रतिबद्धता पत्रमा लुम्बिनी प्रदेशमा बढ्दो कुपोषणको रोकथामका नीति उल्लेख छैनन् । तर, केन्दीय घोषणा पत्रमा उल्लेख भएका नीतिहरु नै आफ्ना पनि प्रतिबद्धता भएको दावी गरेका छन् ।

पूर्व अर्थमन्त्री एवं एमालेका उपाध्यक्ष विष्णु पौडेलले एमालेले सधै नागरिकको स्वास्थ्य, रोजगार र आर्थिक सम्बृद्धिको सवालमा निर्णय लिने र नीति बनाउने काम गरिरहेको बताए । उनले देशको खाध्य संकट हटाउन र आयात घटाउने गरी घोषणा पत्रमा खाध्य आत्मनिर्भरता र निर्यातमुखी कृषि विकासको अवधारणा अघि सारेको बताए । एमालेको नीति प्रदेश र जिल्लातहसम्म नै कार्यान्वयन हुने उनको दावी छ । ‘हामी सरकारमा हुँदा या नहुँदा जहिले पनि नागरिकको स्वास्थ्य, रोजगारी र देशको सम्बृद्धिलाई पहिलो प्राथमिकतामा राख्ने गरेका छौं,’ उनले भने, ‘त्यसैले अहिले पनि खाध्य आर्त्मनिभरताका लागि रैथाने बालीहरुको प्रवर्धन एवं संरक्षण गर्दै अन्न, फलफूल भण्डारणका लागि शित भण्डार, परम्परागत कृषिबाट आधुनिक र व्यवसायीक कृषिमा रुपान्तरण गर्ने नीति लिएका छौं ।’ स्वास्थ्यमा गर्भवती महिलाका लागि भत्ता र जिवन विमा सुविधा, गरिब, बालबालिका, जेष्ठ नागरिकका लागि निशुल्क स्वास्थ्य सेवा जस्ता कार्यक्रमहरु पनि प्रतिबद्धता पत्रमा समावेश गरिएको उनले बताए ।