Maternal health in Nepal goal way off, say experts

With only six years left to achieve its Millennium Development Goals (MDG), [see:] Nepal, like many other Asian countries, is lagging behind and must make further efforts, say local and international health experts.

A top priority is the maternal mortality ratio (MMR), which Nepal’s government hopes to reduce to 134 women per 100,000 live births from its current level of 281 per 100,000 live births, according to the government’s Demographic Health Survey 2006. [see:]

Put another way, this means one woman is dying every four hours (six women a day) due to pregnancy-related complications.

“It will be a big challenge for Nepal to really achieve the maternal health goal,” said reproductive health expert, Ava Darshan Shrestha, vice-president of the Safe Motherhood Network Federation (SMNF). [see:]

Skilled birth attendants are not present at nearly 81 percent of deliveries, something that is putting thousands of women at risk, according to SMNF.

There is a severe shortage of maternal health services, especially in the hills, where most of the maternal deaths occur.

“In rural areas, most women need to walk for hours. If they travel by bus it’s just as bad because the roads are so rough that women in labour end up in a serious condition even before reaching hospital,” said Sabitri Chettri, a female community health volunteer.

Weak administrative, technical and logistical capacity, inadequate investment and lack of skilled health personnel further hamper effective health services, according to UNICEF’s State of the World’s Children – 2009 report [see:]

Experts are concerned that failure to achieve the MMR goal will also adversely affect other MDGs.

Unless you reduce the MMR, it will be difficult to achieve other MDGs, including a reduction in child mortality [goal 4], as well as gender equality and empowerment [goal 3], Saramma Mathai, a maternal health expert with the UN Population Fund (UNFPA) in Bangkok, told IRIN. We know that unless a mother survives [childbirth], the risk of death of a newborn is much higher,” she said.

She said the maternal health goal was also linked to MDG 1, which relates to both poverty reduction and malnutrition.

“Without a mother, a child’s nutrition is going to suffer. And women contribute a lot to the economy, both in terms of working at home and contributing to the economy,” said Mathai.

Local health experts told IRIN the health of mothers and newborns was closely linked, and preventing deaths required implementing measures like antenatal care, skilled attendance at birth, access to emergency obstetric care, adequate nutrition, post-partum care, newborn care and education to improve health, infant feeding and care, and ensuring good hygiene behaviours.

“To be truly effective and sustainable, however, these interventions must take place within a development framework that strives to strengthen and integrate programmes with health systems, and an environment supportive of women’s rights,” said the State of the World’s Children 2009 report.

The Ministry of Health and Population, with the support of the UK Department for International Development (DFID), has started Ama Surakchhya Karyakram, a national programme offering free childbirth and travel costs to women who come and deliver at a maternal health facility.

The programme is available in all government hospitals and health centres.

“This programme is aimed at improving maternal health and newborn survival, and we are committed to its effective implementation,” said senior government official Girija Mani Pokhrel. “We need to remember that Nepal is the 14th poorest nation in the world,” Sushil Baral, DFID maternal health adviser in Kathmandu, told IRIN, adding that the programme was a “bold initiative”.


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