Maternal and Newborn Health
Despite a 10-year insurgency, persistent political upheaval, and some of the world's most challenging terrain for the delivery of healthcare, Nepal has reduced its maternal mortality ratio substantially since the early 1990s. It is one of the few countries to achieve Millennium Development Goal 5. There have also been reductions to infant deaths but advances in neonatal health are less encouraging. Numerous systemic challenges remain including addressing inequalities, increasing the role of community to improve accountability, working more effectively across sectors and, most importantly, maintaining political and financial commitment to safer motherhood.
Complications during pregnancy and childbirth continue to be a leading cause of death and disability among women and newborns in Nepal. Almost all of these deaths occur in low-resource settings and most could be prevented. As part of the Sustainable Development Goals, all countries have been called on to commit to ending the unequal spread of maternal mortality and to reach the poorest, most underserved populations. Interventions and actions must be scaled up to save lives.
We work to support this by:
- Designing and supporting the implementation of Safe Motherhood programmes to improve access to and quality of care
- Promoting preventive care by raising awareness in women and their families of danger signs and of the need to seek care from a skilled birth attendant at the right time
- Supporting the training of health staff on clinical practice, on how to provide reliable long-term contraceptives for women, and how to advise on the prevention of unwanted pregnancies
- Advocating for the provision and scaling up of quality maternal health services through evidence generation, advocacy for resource allocation and support implementation
- Improving access to data and evidence in usable formats so that planners and civil society can hold decision-makers to account.
We rolled out a demand-side financing programme, known locally as Aama Surakchya programme, which gives women free access to delivery services at all public health facilities and a transport subsidy. Between 2006 and 2014 the percentage of deliveries delivered by a skilled birth attendant increased from 18% to 56%.
We have strengthened district hospitals’ ability to provide 24/7 Comprehensive Emergency Obstetric and Newborn Care, and we have trained skilled birth attendants, family planning providers and medical abortion providers at strategically located Birthing Centres. Between 2010 and 2015 the number of districts with at least one health facility providing CEONC functions 24/7 increased from 52% to 92%. Population based C-section rate increased from 3% in 2006 to 8.6% in 2014.
We have worked to improve access to services for women living in remote areas where families often live several days’ travel from their closest health facility. We are working with the Government of Nepal to pilot a package of interventions that improve access to and the use of maternal and neonatal health services in a remote, mountainous district in Eastern Nepal.
Key results and achievements
- Maternal mortality has dropped from 901 to 258 per 100,000 live births between 1990 and 2015. Neonatal mortality has dropped from 53 to 22 per 1,000 live births between 1990 and 2015.
- We have supported Nepal’s consistent policy focus on maternal and newborn health and sustained financial commitment by the government and donors, including substantial increases in funding for MNH. Our experiences in Nepal provide important lessons for other countries struggling to address high levels of maternal and neonatal mortality and morbidity, especially within a context of difficult terrain and high poverty rates.
Between 2006 & 2014 babies delivered by a skilled birth attendant increased from 18% to 56%
Between 2010 & 2015 the number of districts with at least 1 health facility providing CEONC functions 24/7 increased from 52% to 92%