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Maternal health in Nepal

A holistic and coordinated approach to maternal health in Nepal has drastically improved the lives of mothers and children.

Identity and cultural diversity, Social justice and human rights

A female health worker checks another woman's blood pressure.

Devi Gurung has a health check at a new clinic in Pokhara, Nepal Photo by Jim Holmes for DFAT

Mothers alive

The Nepal Government with the support of donors, including the Australian Government, has made significant progress in keeping children alive and preventing mothers dying in childbirth – despite a decade-long armed conflict, political instability, poverty, inequality and challenging terrain.

Holistic approach to health

Medical personnel provide care to a mother and child.Maternal deaths fell from 539 per 100,000 live births in 1991 to 170 in 2011. Similarly, the under-five mortality rate is 75 per 1000 live births for the poorest 20% and 36 per 1000 live births for the richest 20%. The under-five mortality rate declined from 118 to 54 per 1000 live births.

The government of Nepal has coordinated a country-wide strategy over two decades.  There has been a sustained investment in a system of health care with strong community-based services being delivered through trained female community health volunteers. Nepal has doubled health spending and concentrated on the poorest areas. Experienced health ministry officials have used data about the causes of maternal death and their knowledge of the barriers to accessing services in remote areas to formulate and advocate for change.

Birthing centres were built, staffed with trained birth attendants 24 hours a day and supplied with medicines. Safe blood supplies were made available for emergencies. Almost 50,000 female community health volunteers have visited women in their villages and educated them about preventative health, safer birthing practices, family planning, nutrition and hygiene.

A graph of improvements in five areas of maternal care: rate of births attended by a skilled birth attendant; rate of delivery at a birthing centre; at least one visit to antenatal care; at least four visits to antenatal care; and postnatal care within 48 hours of birth. The graph shows a trend of gradual improvement in all areas between 1991 and 2006, and then very sharp improvement between 2006 and 2011.Women are now more likely to deliver their babies with a skilled birth attendant (36 per cent in 2011 compared to 19 per cent in 2006) and to have babies immunised (96 per cent in 2011 compared to 82 per cent in 2010). Increased access to family planning means Nepali women now have an average of 2.6 children (down from 6 children in the 1980s).

The Aama Surakchhya Programme provides financial incentives to mothers who deliver at a health facility, with a free service and covering costs of travel. Women who attend four antenatal care visits are also paid.

Gender gap

Improving the lives of women generally depends on the cultural expectations of their role. 

Ganga Pun and her two daughters live in a single room in Pokhara, Nepal.Sociocultural norms and taboos continue to prevent women of different ethnic groups or living in remote areas from gaining an education, earning a living and seeking medical treatment. The cultural tradition of chaupaudi, which isolates menstruating women and mothers who have just given birth because they are 'impure', is still practised in the mid- and far-western regions, despite being banned by the Supreme Court in 2004. 

Education

A close up of a girl writing in her book in a classroom.Education is a key factor for poverty reduction and accessing available health services. Scholarships, school feeding and mother-tongue teaching have increased the number of girls and children from the disadvantaged Dalit and Janjaati groups attending school. An increase in the education level of mothers has led to a large increase in the number of expectant mothers seeking health care.

Water and sanitation

Improvements in access to water and sanitation support health and nutrition and reduce poverty.

A woman pumps water into a bucket outside her home.A woman points to hand-drawn pictures on a wall showing the impact of open defecation.Programs have increased access to safe drinking water to less than a 20-minute walk and increased access to basic sanitation so that many communities have been declared 'open defecation free'. This means women are freed to care for family and earn an income, and girls are more able to attend school. Improved knowledge of hygiene practices (hand washing with soap and water) has led to decreases in water borne-diseases.  

Economic participation

Two women use sewing machines to make clothes.Poverty is a factor associated with low access to health care. The Micro-enterprise Development Program facilitates entrepreneurship with training and access to finance. The program predominantly supports women, who have used grants to start small businesses making clothing and jewellery, weaving, farming and cooking snacks. They have lifted themselves out of poverty and gained self-confidence and respect in their communities.

Poverty has dropped from 42% of the population in 1996 to 25% in 2011. Women are now more likely to have paid work and have greater wage equality, but they still have low access to property ownership, financial credit and political power. 

Future challenges

Although Nepal has made strong progress, not all groups have benefitted equally, and the maternal mortality rate is still high in comparison to many developed countries.

Inequity based on wealth, setting (rural/urban), region, caste and ethnicity has contributed to great differences in maternal health and child mortality throughout Nepal. For instance, the percentage of deliveries assisted by skilled birth attendants is 10.7% for the poorest 20% of the population, and 81.5% for the richest 20%. Similarly, the under-five mortality rate is 75 per 1000 live births for the poorest 20% and 36 per 1000 for the richest 20%. The under-five mortality rate is three times higher for the Muslim minority than for the high-caste Newaris.

Slowing economic growth and political uncertainty will be a challenge to sustaining the investment in women and children's health and improving the reach to rural areas and all cultural groups.

Going further

Overseas Development Institute (UK), Nepal's Story: Understanding improvements in maternal health  
World Bank, Maternal and child health video
Australian Aid, Enterprising Women: Nepal's micro-entrepreneurs in their own words (nine short films)
 

Contributors' notes

Ozan said:

24 October 2014

This is a very good and interesting topic to research... I have been researching this at school and it has helped to both help me complete my project, and help me understand more about Maternal Health in Nepal. Check It Out!!

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A mother brings her child to be vaccinated for measles, mumps and rubella during one of her antenatal visits, Pokhara, Nepal
Photo by Jim Holmes for DFAT
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A mother brings her child to be vaccinated for measles, mumps and rubella during one of her antenatal visits, Pokhara, Nepal Photo by Jim Holmes for DFAT
Safer motherhood indicators in Nepal, 1991–2011
Overseas Development Institute (UK), Nepal's Story: Understanding improvements in maternal health
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Safer motherhood indicators in Nepal, 1991–2011 Overseas Development Institute (UK), Nepal's Story: Understanding improvements in maternal health
Ganga Pun and her two daughters live in a single room in Pokhara, Nepal.
Photo by Jim Holmes for DFAT
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Ganga Pun and her two daughters live in a single room in Pokhara, Nepal. Photo by Jim Holmes for DFAT
Students at Shree Dharmasthali Lower Secondary School, Pokhara, Nepal
Photo by Jim Holmes for DFAT
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Students at Shree Dharmasthali Lower Secondary School, Pokhara, Nepal Photo by Jim Holmes for DFAT
Jangali Ram draws water from a tubewell before carrying it back to her home, Bastipur, Nepal
Photo by Jim Holmes for DFAT
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Jangali Ram draws water from a tubewell before carrying it back to her home, Bastipur, Nepal Photo by Jim Holmes for DFAT
Aasu Ram explains her toilet mural highlighting the spread of disease in open defecation, Bastipur, Nepal
Photo by Jim Holmes for DFAT
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Aasu Ram explains her toilet mural highlighting the spread of disease in open defecation, Bastipur, Nepal Photo by Jim Holmes for DFAT
Nama Maya Gurung used finance and training from the Micro-enterprise Development Program to create a business employing and training women in needlework skills, Nepal
Photo by Jim Holmes for DFAT
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Nama Maya Gurung used finance and training from the Micro-enterprise Development Program to create a business employing and training women in needlework skills, Nepal Photo by Jim Holmes for DFAT
Devi Gurung has a health check at a new clinic in Pokhara, Nepal
Photo by Jim Holmes for DFAT
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Devi Gurung has a health check at a new clinic in Pokhara, Nepal Photo by Jim Holmes for DFAT