Maternal health issues in Nepal

Rubina Acharya, RN
Currently Living at Thailand

Maternal health is the health status of women during pregnancy, childbirth, and the postpartum period, which incorporates the health care dimension of family planning, preconception, and prenatal and postnatal care to reduce maternal morbidity and mortality.

Maternal health is still a public health problem in developing countries, especially in low-resource settings rural and poor communities where women have been facing different consequences during pregnancy and delivery due to lack of maternal health knowledge as well as the socioeconomic conditions. Most of the causes are preventable.

Maternal mortality is the indicator of women’s status in a society. Maternal mortality rate of Nepal is 258 per 100,000 live births, which is higher than its South Asian neighbors. Although there has been a reduction in pregnancy related mortality in Nepal from 543 deaths/100,00 live births in 1996 to 259 deaths/100,00 in 2016, but still there is much more to achieve. Proper ANC care, Institutional delivery or being assisted by SBA at health institution and at home, and receiving proper PNC care are vital in preventing maternal and new birth deaths.

Sustainable development goal (SDG) has ambitious target of MMR to 70 per 100,000 live births and neonatal mortality to 12 per 1,000 live births, and to achieve coverage of 90% for four ANC visits, institutional delivery, SBA delivery, and three PNC check-ups by 2030 (National Planning Commission 2017).

Maternal mortality remains one of the biggest public health problems in Nepal. Major obstacles to improving maternal health in Nepal include lack of access to basic maternal       healthcare, challenging geographic terrain, poorly developed transportation and communication       systems, poverty, illiteracy, women’s low status in society, political unrest, a shortage of health care professionals, and underutilization of currently offered services.

In order to effect real improvements in maternal health, attention needs to be focused both on biomedical and social interventions. Improving health facilities, mother’s nutrition, women’s status in the society such as freedom of movement, educating female children, integrating Traditional Birth Attendants into local health services can play a vital role in the improvement of mothers’ health.

For improving maternal and neonatal health and reducing mortality and morbidity related to maternal and neonatal health, Nepal is implementing its safe motherhood program since 1997. This program includes strategies focused on birth preparedness, ANC check-ups, and institutional delivery that reduce the risks of complications during pregnancy and childbirth and address factors associated with mortality and morbidity. In 2005, Nepal introduced the Aama Program (Maternity Incentive Scheme) which aims to reduce financial barriers for women who seek institutional delivery. Under the current Aama program, Nepalese women who deliver in a health facility are given a cash incentive of Nepali Rupees (NRs) 3,000 (mountain districts), NRs 2,000 (hill districts), and NRs 1,000 (Terai districts), with an additional NRs 800 to those women who complete four ANC visits per national protocol. In addition to cash incentives, the Aama program also provides free delivery, essential newborn care, and care for sick neonates.

Even though remarkable accomplishments have been obtained on a national level, not all segments of society have benefitted equally from the improvements recorded. For instance, the percentage of deliveries assisted by skilled birth attendants is 10.7% for the poorest and 81.5% for the richest quintile. Similarly, under-five mortality rate is 75 for the poorest quintile and 36 per 1000 live births for the richest quintile. Persistent inequities and the quality gap are seen as the main contributors to Nepal’s slow and steady improvement in maternal health outcomes.

Access to and use of maternal health services are still disproportionately low among less educated women, women of the lowest wealth quintile, and women who are difficult to reach.

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