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 six in the morning until I go to sleep at ten at night, 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, her chores will not let up.
"Up until the day the baby is born, I’ll be working all the time," she says.
Saving women’s lives
In recent years, Nepal has made a big push to improve the health of pregnant women. The government has built new birthing centers. 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 women’s health advocate in Nepal. 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 calories, strenuous activity can cause serious complications.
Deuba says pregnant women work so 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 socialized in, that you have to make your presence felt, and your worth is the labor you contribute," Deuba says. "They are taught to think of themselves as responsible for this kind of work. Because they have the lowest status inside the family, so they need to do the hardest labor."
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."
A focus on the baby
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. But it is often difficult to convince women to slow down in a society that values them for their productivity.
"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 organizations like Save the Children are meeting with 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.
And behaviors are shifting for husbands, as well.
When Januka was pregnant with her first child, her husband, Madhav, was 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 stomachache, 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 shoveled mud 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."
Hazards of childbirth in the village
In a place like Pawati, hard work in late pregnancy is far from the only thing that threatens the wellbeing of mothers and unborn children.
Two months after I met her, Januka went into labor.
She had planned to deliver her baby at a hospital in the nearest town, a couple of hours away, but Januka’s labor came early. There was no time to get to the hospital.
Januka gave birth at home. The delivery was complicated, for reasons 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.
Sushama Pandey contributed to this report. Produced with support from the International Center for Journalists (ICFJ).