In the slanted golden light of late afternoon, Lalu Nepali beat rice with a long wooden mallet. The wood extended a foot above her head, and she dropped it onto her pile of grains, separating rice from the hulls with a rhythmic thud, thud, thud. A white scarf was wrapped tightly around her midsection as if to hold in her nearly bursting belly. She grunted at the exertion with each strike. Thud, grunt, thud, grunt. Nine months pregnant, she was due any day.
Nepal is viewed as one of the success stories in the global effort to improve women's chances in pregnancy and delivery. The United Nations created the Millennium Development Goals to measure improvements in various aspects of life in developing countries, and the fifth goal is to reduce by 75 percent the rate of women dying around pregnancy and delivery by 2015. Almost nowhere has this been accomplished, as changing birth outcomes has proven more challenging than anticipated.