Maternal Health Status in Nepal

Nepal has achieved significant progress in Maternal health demonstrated by decreasing maternal mortality ratio in Nepal. Maternal mortality ratio is the impact indicator of the maternal health programmes. It was possible due to prioritization of safe motherhood and newborn healthprogram of Nepal along with other multiple socioeconomic and political advances.

To analyze the progress of the maternal health in Nepal, Lets look into the maternal health indicators.

(Impact indicator: It includes maternal mortality ratio, maternal mortality rate, lifetime risk of maternal death etc.)

Trends of Maternal mortality ratio and major development in the field of maternal health in Nepal

The decrement in MMR from 790 to 580 from 1990 to 1995 could be result of National Health Policy 1991 that had prioritized on preventive health services including Family planning, safe motherhood.

OUTCOME AND PROCESS INDICATOR

Nepal demographic and health survey 2011, instead of impact indicator, measured outcome and process indicator, which is relatively easy to enumerate than maternal mortality rate and ratios. Outcome and Process indicators are also important to evaluate the maternal health programmes as these will directly impact the progress in maternal health.

Indicator	Current data	Source
Antenatal care (% Of women attended at least four times during pregnancy by any provider)	50.1	NDHS, 2011
Skilled attendance at birth (% of births attended by skill health staff)	36	NDHS, 2011
Anti-Retroviral for women (HIV- positive pregnant women to reduce mother to child transmission)	20.1	NDHS, 2011
Postnatal care for mothers (% of mother who received care within two days)	45	NDHS, 2011

Maternal Health Services in Nepal: All the maternal health Policies, strategies and programmes are directed to make family planning service, antenatal care, delivery care, Postnatal care efficient so that mothers receive required services, get proper diagnosis and proper intervention when necessary. Activities in safe motherhood programme of Nepal focuses on making those essential care available, accessible to every woman and family. 

1. Antenatal Care

Antenatal care services include:

• At least four antenatal check‐ups: first at 4th month, second at 6th month, third at 8^th month and fourth at 9th month of pregnancy;
• Monitor blood pressure, weight and fetal heart rate;
• Provide information, education and communication (IEC) and behavior change communication (BCC) for danger signs and care during pregnancy and timely referral to the appropriate health facilities;
• Birth preparedness and complication readiness (BPCR) for both normal and obstetric emergencies (delivery by skilled birth attendants, money, transportation and blood);
• Early detection and management of complications;
• Provision of tetanus toxoid (TT) immunization, iron and deworming tablets to all pregnant women and malaria prophylaxis where necessary

Nepal had a target to achieve 80 percent of women completing at least four antenatal care visits during their last pregnancy by 2015.

2. Delivery care

Delivery care services include:

• Skilled birth attendants at deliveries (either home‐based or facility‐based); however, our programmes has focused on facility based deliveries
• Early detection of complicated cases and management or referral after providing obstetric first aid by health worker to appropriate health facility where 24 hours emergency obstetric services are available;
• Obstetric first aid at home and/or HP/SHP if complications occur, using Emergency Obstetric Care Kit (EmOC kit);
• Identification and management of complications during delivery and referral to appropriate health facility as and when needed;
• Registration of births and maternal and neonatal deaths.
• Nepal has committed in achieving 60 percent deliveries by SBA BY 2015 (2071/72). Institutional delivery as percentage of expected pregnancies has been increasing trend from 44 to 50 percent from 2068/69 to 2070/71 to achieve targeted 60% institutional delivery by 2015 (NHSP II, 2010-2015).

3. Postnatal care

Postnatal care services include:

• Three postnatal visits: First visit within 24 hours of delivery, second visit on the third day and third visit on seventh day after delivery;
• Identification and management of mother's and newborn in complications of postnatal period and referral to appropriate health facility as and when needed;
• Promotion of exclusive breastfeeding;
• Personal hygiene and nutrition education, post‐natal vitamin A and iron supplementation for the mother;
• Immunization of newborns; and
• Post‐natal family planning counseling and services

4. Emergency Obstetric Care:

The SMNH long term plan (2006‐2017) has envisaged that by 2017, CEONC services will be available in 60 districts, 80 percent of PHCCs will provide BENOC services and 70 percent of HPs will provide delivery services. All women who needed obstetric complication should receive EmOC services and there should be universal coverage of EmOC.

C/S as a proportion of all live births has been found increasing as compared to last two consecutive years. In FY 2070/71, C/S as a proportion of all live births has increased by 2 percent reaching 8 percent of all live births. At population level 5‐15% of C/S as a proportion of all live births is accepted as minimum and maximum standard by the WHO.

Still, there are many challenges affecting accessibility, availability, affordability and sustainability of maternal health programmes as some of the programmes are driven by external fund. However, the government should be alert enough for its sustainability or alternatives. Our progress is satisfactory, but still number of women die with preventable causes so universal coverage of maternal health services and prioritization of safe motherhood in the health sector should be continued.

Sources:

1. DOHS. Annual Report 2070/2071

2. Nepal’s Quest for health. Plan, Policies and their implications.

3. WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group. Maternal Mortality in 1990-2015:Nepal.