Academic journal article Bulletin of the World Health Organization

Reaching Nepal's Mothers in Time: Women's Chances of Survival during Pregnancy and Childbirth Have Greatly Improved in Nepal

Academic journal article Bulletin of the World Health Organization

Reaching Nepal's Mothers in Time: Women's Chances of Survival during Pregnancy and Childbirth Have Greatly Improved in Nepal

Article excerpt

Standing at a community health post and looking around the valley, Laxmi Tamang, a nurse and public health expert from the Midwifery Society of Nepal, points to the other side of the mountain.

"See that, all the way over there? That's all the same district. If a woman is in labour, how on earth will she get here?"

The Midwifery Society of Nepal is running an outreach health camp in Nuwakot, 75 km from Nepal's capital of Kathmandu, after much of the district's infrastructure was damaged by the April 25 earthquake last year.

But for expectant mothers living in remote parts of the district--where there are few if any roads--accessing this midwifery care, especially in emergencies, is difficult--if not impossible.

Nepal, a landlocked country in south Asia and home to some of the world's tallest peaks, is considered to be a success story when it comes to improving the survival of its mothers in pregnancy and childbirth.

Between 1990 and 2015, the country reduced its maternal mortality ratio by 71% from 901 deaths per 100 000 live births to 258--just four percentage points short of millennium development goal (MDG) 5: to reduce the maternal mortality ratio by three quarters during that time period.

For this achievement, Nepal, which has been recovering from a decade-long civil war between 1996 and 2006, was selected out of 49 least-developed countries by the United Nations in 2010 to receive an award for its leadership, commitment and progress towards the achievement of MDG 5.

Experts attribute Nepal's success in improving maternal health to several factors, including free delivery services, transport incentives, access to safe delivery services and the use of the oral drug misoprostol for preventing postpartum haemorrhage during home deliveries or on the way to a health facility.

A study published in July 2014 in this journal on the success factors for women's and children's health shows that half the reduction in child mortality in low- and middle-income countries since 1990 resulted from health sector investments while the rest could be attributed to investments made in sectors outside health, such as education and road infrastructure.

Over the past decade, more women in Nepal are giving birth in a health facility than at home--another factor that has reduced the risk of postpartum haemorrhage, (loss of blood following the birth), which is the leading cause of maternal deaths worldwide.

In 2006, homebirths accounted for about 81% of births in Nepal. In 2011 that figure dropped to 63%, according to the Nepal Demographic and Health Survey reports for 2006 and 2011 respectively.

"Twenty-five years ago in the hilly regions of Nepal women had to deliver at home and maternal mortality was very high," says Dr Kiran Regmi, chief specialist at the health ministry.

"Now, caesarean sections are available, even in remote areas. There are birthing centres and health posts across the country, where safe delivery is assisted by skilled birth attendants," says Regmi, a former director of the health ministry's family health division.

In 2005, Nepal's government started providing stipends to help cover the transport costs for women to reach accredited birthing facilities and four years later added free delivery services to expectant mothers under its Safe Motherhood Programme.

The programme extended these benefits in 2011 by giving women US$5 if they came to a health facility for four antenatal check-ups during their pregnancy.

"In the past, most women faced a huge economic barrier," says Dr Meera Upadhyay, an obstetrics and gynaecology chief consultant at Paropakar Maternity and Women's Hospital in Kathmandu.

"We found out that women do come to the hospital to give birth when delivery services are free of charge," she says, adding: "The policy has emphasized the availability of services for everyone: for the poor, the uneducated and for people living in remote areas. …

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