Maternal Mortality in Nepal: Addressing the Issue
Generalizability of Interventions
Maternal mortality (MM) presents a serious threat globally, with the vast majority the problem occurring in developing countries. Unintended pregnancies, socioeconomic variables, and inequalities in access to reproductive and general health care contribute to unacceptably high MM rates in these countries. In recent years, increasing attention has been given to this arena, especially in the context of the UN MDGs. Most of the developing countries like Nepal have similar issues such as lack of decision-making power, educational awareness, trained health personal, excessive physical labor and poor nutrition, which contribute to poor utilization of MHS, thus, increasing the risk of MM.
Several studies have demonstrated the applicability and effectiveness of simple, cost-effective interventions aimed at local level to encourage people to seek prenatal care, thus, decreasing risk during or after birth. For example, Srilanka and Honduras, a low-income country like Nepal, where MMR was well over 500 per 100,000 live births embarked on unique and rigorous community outreach programs and home-based service delivery system by skilled health workers, especially in underserved areas (Sharma, 2010). With the benefit of a newly increased public awareness and access to healthcare within communities, both countries were able to remarkably reduce MM. Our interventions in Nepal, which primarily implements similar approaches focused on population level, using the resources and personals available at community level, will be applicable to other countries, especially in developing countries.
Similarly, in a study by Prata et al. in Sub-Saharan Africa, it was concluded that FP and safe-abortion services saved the most number of lives, followed by PC. In developing countries, at least 200 million women are unable to use FP methods because of lack of access to information and services or the support of their husbands and communities (Prata et al., 2010). Our intervention, which also focuses on delivering educational awareness to women and their family members about the importance of use of family planning and MCH services, will be significantly useful in other countries, especially developing nations to increase overall utilization of these service and to reduce the risks of maternal mortality.
Limitation: Given the current international policy focus on intrapartum care, it is not surprising that more than twice as many interventions attempted to tackle tertiary prevention than primary and secondary i.e., the timeliness and quality of care received than decision to seek care and access to care. This is partly a reﬂection that simple and clinical interventions (e.g., hospital-based care, nutritional supplements) are easier to deliver and evaluate than programmatic or complex public health interventions (e.g., community knowledge/behavior or transport interventions). Interventions that address the ﬁrst or second delays are more likely to be complex-target on wider population, issues of cultural competency and outreach health personals, socio-economic hurdles, etc. This might serve as a discouraging factor for many health workers, especially policy makers and donors, to implement primary and secondary interventional approaches, like we proposed to reduce the risk of maternal mortality.
Maternal mortality is a serious public health problem in other developing countries. More than 80% of these deaths, which are caused by hemorrhage, sepsis, unsafe abortion, obstructed labor and hypertensive diseases of pregnancy, are preventable when there is access to adequate reproductive health services, equipment, supplies and skilled healthcare workers (Rosenfield, & Maine, 1985). These results suggest that there was a relatively lower utilization of prenatal care among women, especially, who are of poor socioeconomic status, older age groups, and rural areas of Nepal. In addition, women who lack knowledge of family planning and women who practice behavior related to unsafe reproductive health were directly linked to have poor use of prenatal care. These imply that providing information on prenatal care in simple terms or through pictures that enable them to understand easily are important. Interventional approaches and policies should be put in place to make reliable prenatal care easily accessible to disadvantaged group at free or low cost.
In a developing country such as Nepal, where rural and urban disparities in terms of health facilities and lifestyle are highly polarized, specific community-based programs are needed. Evidences have shown that collective effort of different governmental, and international organizations, education institutions, local NGOs, mothers group, mass media, etc. to implement community-based interventions have been successful to lower maternal deaths. This is possible due to the increased contraceptive prevalence rate, the decreased anemia among pregnant women because of free distribution of iron capsules, legalized safe abortion, financial incentive for women who deliver babies in health institutions, etc. Also, authorities need to emphasize not only in implementing of interventional programs but also on keeping track of their success rates and drawbacks. Also, special consideration must be given to sustain such programs in the future.
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