Safe Motherhood in Nepal

The Government of Nepal (GoN) has a long history of commitment to improving maternal and neonatal health outcomes, most recently evidenced by the high priority given to the National Safe Motherhood Programme within the Nepal Health Sector Programme- Implementation Plan (NHSP-IP 2004-2009). Despite important gains over the past 15 years, the maternal and neonatal morbidity and mortality rates remain high (539 maternal deaths per 100,000 live births1 and neonatal mortality rate of 39/1000 live births1), largely due to the lack of skilled attendance at birth, as well as poor referral systems and lack of access to life-saving emergency obstetric care when complications occur.

There has been advancement in the understanding that the most
critical intervention to reduce maternal mortality is the care provided
by a skilled birth attendant working within a supportive environment
that provides an adequate system for referrals and emergency
obstetric care. Whether skilled attendants attend deliveries at home,
at primary health care level2, in health facilities or hospitals, they
require the support of an enabling environment that includes the
availability of adequate supplies, equipment, infrastructure and
efficient and effective systems of communication and referral to
provide quality obstetric and neonatal care. In the context of Nepal,
where the poorest families often live long distances from a facility
that can provide emergency obstetric care, it is important to
encourage women to deliver in facilities with skilled attendants with
access to Emergency Obstetric Care (EmOC). This will require 24
hours a day and 7 days a week, “women-friendly” services that are
culturally sensitive and affordable to all families, especially those in
poor and underserved areas. However, high financial cost has been
identified as a major barrier to women accessing skilled birth
attendance and health facilities for emergency obstetric care in
Nepal3, therefore in January 2005 the Government of Nepal
introduced the maternity cost sharing scheme to reduce the
economic barrier to access and utilisation of skilled birth attendance
in Nepal.