Safe Motherhood in Nepal

In July 2007, the results of the 2006 Nepal Demographic and Health Survey were published, with results suggesting a halving of the maternal mortality ratio, from 539 maternal deaths per 100,000 live births to 281 per 100,000, in just ten years. To further understand the facts behind these figures, the DfID/ Options Support to the Safe Motherhood Programme (SSMP) commissioned a study to examine the trends in maternal mortality, use of maternity services and socio-demographic changes in Nepal during the last ten years. The study concluded that there is strong evidence of a significant decline in maternal mortality in Nepal, as a result of a wide range of improvements, including reduction of fertility rates (from 4.6 children per woman in 1996 to 3.1 in 2006) due to increasing met need for contraception (from 29% in 1996 to 48% in 2006), increasing rates of antenatal check-ups and increased levels of education among women. Despite this promising progress there is still much to do in the area of improving maternal care, most significantly increasing the number of births attended by a skilled birth attendant and increasing access to emergency obstetric care when complications occur.

This report contains the findings of "Need Assessment of the Availability of Emergency Obstetric Services in Eight Districts".

Abstract: Evidence gathered from 1997 to 2006 indicates progress in reducing maternal mortality in Nepal, but public health services are still constrained by resource and staff shortages, especially in rural areas. The five-year Support to the Safe Motherhood Programme builds on the experience of the Nepal Safer Motherhood Project (1997-2004). It is working with the Government of Nepal to build capacity to institute a minimum package of essential maternity services, linking evidence-based policy development with health system strengthening. It has supported long-term planning, working towards skilled attendance at every birth, safe blood supplies, staff training, building management capacity, improving monitoring systems and use of process indicators, promoting dialogue between women and providers on quality of care, and increasing equity and access at district level. An incentives scheme finances transport costs to a health facility for all pregnant women and incentives to health workers attending deliveries, with free services and subsidies to facilities in the poorest 25 districts. Despite bureaucracy, frequent transfer of key government staff and political instability, there has been progress in policy development, and public health sector expenditure has increased. For the future, a human resources strategy with career paths that encourage skilled staff to stay in the government service is key.

Reaching Consensus on SBA: Increasing Access to SBA Attendants in Nepal – July 2005