Case study

MDG 5 - Driving down maternal mortality in Nepal

Nepal is on track for MDG 5. Childbirth is no longer the leading cause of death among women of reproductive age.

Nepal: Women receiving maternal health care training. Picture: Ben Barber/USAID

Nepal: Women receiving maternal health care training. Picture: Ben Barber/USAID

Due to the high rate of pregnancies and limited access to maternal care, the poorest women in Nepal have been at great risk for death during childbirth. Within the last decade however, the Government of Nepal and international donors have made great efforts to improve these outcomes. From 1996 to 2006, the rate of maternal mortality was reduced by half–from 539 to 281 women per 100,000 live births. Since then, Nepal has achieved a significant increase in the number of skilled birth attendants to deliver emergency obstetric care and it is expected that this achievement will continue to drive decline in maternal mortality. Furthermore, consistent investments in family planning have increased access to antenatal care and contraception.

Several initiatives greatly contributed to social awareness of the importance of reproductive health and maternity care. First, the inclusion of reproductive health rights in the interim constitution has given legitimacy to a range of progressive policies to safeguard women’s health. Maternal healthcare is also now more affordable and therefore more widely used. This increase in demand has catalysed expansion and improvements in health service provision overall.

Accompanying these changes are several new programmes that advocate for maternal and reproductive health. For example, the Safe Motherhood Program trains and equips skilled providers to manage pregnancy-related complications and to provide emergency obstetric care. The National Family Planning Program offers client-centered counseling and ensures access to quality contraceptives and reproductive health products. In addition, community-based agents of change known as Female Community Health Volunteers work to provide essential women’s health services to rural and remote areas.

With the success of these interventions, Nepal is on track to meet MDG 5. Childbirth is no longer the leading cause of death among women of reproductive age. This year, 58% of women are receiving antenatal care, a significant increase from 44% as recently as 2006. Deliveries performed in hospitals or maternal care facilities have increased from 18% in 2006 to 28% in 2011. Deliveries attended by a skilled birth attendant have nearly doubled in the past five years–from 19% (2006) to 36% (2011). Furthermore, the percentage of maternal deaths due to post-partum hemorrhage has decreased from 41% in 1998 to 24% in 2009, although, unfortunately, this condition still remains the leading cause of maternal deaths.

Dhana’s Story, Jiri, Dolahka, Nepal, December 2009

I’ve worked in many other places over the last 23 years as a government nurse before coming to Jiri Hospital in Dolakha District. Yesterday a lady came to our hospital. She had 2 live births in the past and this time was pregnant again with a huge abdomen. The week before, she had gone to Kathmandu’s Maternity Hospital, where they did an ultrasound that showed a twin pregnancy. She was on her way back to her home in Dolakha yesterday when she began to have abdominal pain. The family decided to bring her to our hospital in Jiri.

When she arrived, she was in some pain, but her vital signs were normal. The pain increased in the night and her water broke. The next morning, her labour continued and, sadly, the twins were stillborn. But the placenta wouldn’t come out. I was glad that I had taken the Skilled Birth Attendant course just 3 months before. While I was training in Damak, a lady came in with retained placenta. The senior nurse asked me if I wanted to handle the case. She talked me through the procedure–which was something I knew would be useful after I returned to Jiri. I didn’t have much experience, but I knew I should try. So on this occasion, I felt very grateful that I could use this new-found skill to help this woman when she needed it. By the next day she was ready to be discharged from the hospital.

Key facts

The Government of Nepal leads national health planning and programmes.

More than 75% of the national heath budget focuses on maternal and child health, especially in marginalized and vulnerable populations.

Remarkable progress toward MGD 5 was made during a decade-long civil war, and despite subsequent political instability having not been fully resolved.

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Published 19 September 2011