Safe Motherhood Program: Evolution and Impact in Nepal
Safe
motherhood program is one of the much talked and focused program for Nepal and
is a priority for the government of Nepal’s Health sector Strategy. Many
mothers died in past while giving birth to their children. Back in 1996, as
per the data of Nepal family health survey, 539 women died out of one lac
live births due to child bearing and many suffered other complications like
fistula, Prolapse. Women, in Nepal, were like birth machine back in the time even when the maternal mortality in Europe and America was decreasing rapidly. Total fertility rate of Nepal was very high. During 90s
decade women were likely to have more than four children in their lifetime. Unsafe
abortion was another dark side of maternal health. Before the legalisation
of safe abortion in 2002, many maternal deaths might have gone unnoticed and
underreported.
Women’s
health was in dire condition demanding immediate attention to it. If we compare today’s condition to the past
when our mothers were at high risk of maternal mortality and morbidity, we must
applaud the effort of our policy, our policy makers, program implementers and
health care professionals, advocacy and investment from governmental and non-governmental
agencies. Today we have total fertility rate of 2.1, many women will not have
the risk of morbidity and mortalities related to multi-parity, we have policy
to encourage institutional deliveries, we have health professionals skilled in
birth procedure, contraceptives are easily available, Abortion is legalized. We
have come very far from past perilous state of women’s health.
This
evolution was possible due to safe motherhood initiative, which was a result of
the first international Safe Motherhood Conference in Nairobi jointly sponsored
by WHO, UNFPA and the World Bank in February 1987.
This initiative consolidated
the attention and action of all the governmental and international sectors for
improving maternal health. When women’s health advocates like Allan Rosenfield,
Deborah Maine presented the fact that the maternal health is highly neglected
amid maternal and child health, maternal health got the momentum to move
forward.
In
the 1990s, a series of global conferences organised by the United Nations
identified maternal mortality and morbidity as an urgent public health
priority, and mobilised international commitment to address the problem.
International
Conference on Population and Development (ICPD) in Cairo in 1994 focused on the
reproductive health right that also specifically addresses the women’s health. In
1995, the Fourth World Conference on Women (FWCW) in Beijing gave substantial
attention to maternal mortality and reiterated the commitments made at the
ICPD. In September 2000, 189 countries at the UN Millennium General Assembly in
New York endorsed a series of Millennium Development Goals that aim to reduce
poverty worldwide. One of the Millennium Development Goals is the reduction of
maternal mortality by 75 percent between 1990 and 2015 and Nepal had the goal
of reducing maternal mortality to 134 per one-lac live births by 2015.
However, the current mortality rate is
229 per one lac live births according to maternal mortality, and morbidity
study 2008 of Nepal.
To
continue the commitment made in millennium development goals, one of the targets
in sustainable development goals is to reduce global maternal mortality ratio
to less than 70 per 100,000 live births by 2030.
National
safe motherhood program in Nepal was initiated in 1997 with the aim of
reduction of maternal mortality and morbidities. This has been able to address
the three delays, causing obstetric emergencies. The three delays are: i. delay
in seeking care, ii. Delay in reaching care, iii. Delay in receiving care.
To reduce the risks associated with pregnancy and
childbirth and address factors associated with mortality and morbidity three
major strategies have been adopted in Nepal:
- Promoting birth preparedness and complication readiness including awareness raising and improving the availability of funds, transport and blood supplies.
- Encouraging for institutional delivery.
- Expansion of 24-hour emergency obstetric care services (basic and comprehensive) at selected public health facilities in every district.
After
realizing newborn health is an integral part of maternal health, the National
safe motherhood plan (2002-2017) has been revised and the revised Safe
Motherhood and Neonatal Health Long Term Plan (SMNHLTP 2006-2017) guides our current actions and programs of safe motherhood.
Some of the vital interventions under National safe motherhood programs in Nepal are:
1. BirthPreparedness Package and MNH Activities at Community Level
2.
Uterine Prolapse
3.
Human Resource
4.
Emergency Referral Fund
5.
Safe Abortion Services
(Note: I will be covering these topics in the future posts.)
Investment
in maternal health not only reduced the maternal mortality and morbidity but
also improved the children’s health. It is in fact most cost effective approach
to improve health and well being of the population.
To
download National Safe Motherhood Plan (2002-2017): click here
To
download the revised Safe Motherhood and Neonatal Health Long Term Plan
(SMNHLTP 2006-2017): Click here
- Yagya B. Karki. Fertility Levels, Patterns, Trends in Nepal. Chapter 12. http://cbs.gov.np/image/data/Population/Monograph_vol_1_2(1-10,11-21)/Chapter%2012%20%20Fertility%20Levels,%20Patterns%20and%20Trends%20in%20Nepal.pdf
- Allan rosenfield, Deborah Maine. Maternal mortality- A neglected tragedy Where is the M in MCH. The Lancet. 1985. http://www.eldis.org/vfile/upload/1/document/0708/DOC18134.pdf
- DS Mallla, K Giri, C Karki, P Chaudhary. Achieving Millennium Development Goals 4 and 5 in Nepal. BJOG. 2011.
- MOHP. Annual Report 2069/70. Department of Health Services, Nepal
- Carla Abouzahr. Safe Motherhood: a brief history of the global movement 1947-2002. British Medical Bulletin, Vol. 67. 2003.
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