Approaches to address maternal health problems in Nepal

Maternal mortality is one of the key indicators of the status of reproductive health care service delivery and utilization, and also it also can be an indicator of women’s status in a society. The maternal mortality rate in Nepal is 539 per 100,000 live births, which is one of the highest in the world (According to Kathmandu University Medical Journal ,2006).

The reasons for such high rate of Maternal mortality in Nepal are:

1. Under utilization of the maternal health services (Poor accessibility, limited infrastructures and manpower)
2. Political instability (Lack of security, conflicts, strikes)
3. Limited health infrastructure (Especially in rural areas)
4. Lack of resources and shortage of trained health professional
5. Women’s position in society and women’s vulnerability (Low status of women in male dominated society)
6. Affordability (37.7% below poverty line)
7. Communication and transportation (In rural areas, to reach hospitals and health centers, people have to walk for hours)

Status of some programs and policies on maternal health:

Nepal’s Safe Motherhood Programme is coordinated by the Family Health Division of the Directorate of Health Services of MOH, within the context of the National Reproductive Health Programme. Under this programme a Safe Motherhood Committee has been established, in which most stakeholders participate and contribute, amongst others, to policy and strategy development.

Modern Birth centers are being established in rural areas by UNICEF

Health care delivery remains largely the responsibility of the Ministry of Health, although the non-governmental organisations (NGO’s) are increasingly providing health services, particularly in the urban areas of the country.

Safe motherhood Policy (1998) emphasized on:

1. increasing the accessibility, availability and utilization of maternal health care
2. strengthening technical capacity of service providers at all levels
3. strengthening referral services for maternity care, particularly at the district level
4. specific emphasis on appropriate referral
5. increasing the availability and use of contraceptives
6. raising public awareness about the importance of the health care of women and in particular maternal care
7. improving the legal and social status of women

Activities carried out for the improvement of maternal health:

1. Establishment of Safe Motherhood Sub-committee
2. Establishment of Reproductive Health Steering Committee
3. Establishment of Reproductive Health Coordinating Committee
4. Formulation of National Reproductive Health Strategy (1998)
5. Development of reproductive health (including maternal, and neonatal) clinical protocol for paramedics, nurses and medical officers
6. Formulation of long term Safe Motherhood Plan (2002-2017)
7. Development of Health Sector Strategy: An Agenda for Reform
8. Development of Health Sector Program: Implementation Plan, 2004-2009
9. Development of National Neonatal Strategy (2004)
10. National Policy on Safe Abortion Care

Approaches for improving maternal health:

1) Improving health service utilization

• Contact with health care providers during pregnancy, identification of pregnancy complications and timely referral to an appropriate institution is essential to prevent maternal death.
• Antenatal care (ANC) is an opportunity to inform women about the danger signs and symptoms for which help should be sought from health care provider.

2) Providing education and knowledge

• Best strategy to improve maternal health
• Educated women are more likely to realize the benefits of using maternal health services.

3) Involving men in maternal health matters

• Since men are the primary decision maker of most Nepalese families, men’s involvement in maternal health matter could promote a better relationship between men and women in household in women empowerment

4) Making services affordable

• Making services affordable for all poor people is essential to improve the maternal health.
• National policies development that ensure removal of financial barriers like fees for essential services and supplies should be implemented, so that women can easily have an access to skilled care.

5) More Budget Allocation in Health Sector

6) Improving communication and transportation system

• Improved transportation system can save women life when they need emergency obstetric services.

7) Expanding contraceptive options

• Increase and Ensure the availability of a wide range of family planning supplies
• Provide training, staffing, and supervisory support at clinics and hospitals
• Use mobile family planning clinics to reach clients in underserved areas

Posted in: Health education,Maternal and Child Health