Safe Motherhood in Nepal

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The National Maternal Mortality and Morbidity Study

Jointly funded by DfID and USAID, the field work for this major study of the causes and factors related to maternal and non-maternal deaths and disabilities in Nepal is now almost complete. In total, over 8,000 researchers and local health workers were trained to collect the mass of qualitative and quantitative data required in a sample of eight districts, including interviews and verbal autopsies. For those carrying out interviews with the families of women who died during the one-year observation period of the study, it can be harrowing work as families re-live their grief.

As data analysis proceeds, already some patterns are beginning to emerge, which will help direct future safe motherhood planning and programming. For the maternal (pregnancy related) deaths, two key factors noted are:

1.    The tragic “culture of silence” among Nepali women, especially in traditional rural areas, which means that women say nothing about their symptoms of pain or illness until it is too late - “She was such a good daughter-in-law, never complained about anything” is a common refrain.
2.    Fatal delays in the processes of decision-making and travelling to health facilities in an obstetric emergency. Often the first course of action is still to consult the traditional healer, and only when he has failed is hospital considered, then arranging transport takes time and decisions about who should go with the woman and what provisions to take.  

These factors are not new and not unknown, but the study findings seem to confirm that they remain critical, despite the efforts of many projects and the national programme. Among the non-maternal deaths of women of reproductive age, the researchers have been surprised at the number of suicides; which could be a reflection of many social issues, such as domestic violence, desperate poverty, lack of recognition of post natal depression or the shame of an unwanted pregnancy.

The full report is expected later this year, and will include an up to date and robust estimate of the maternal mortality ratio.