Maternal Mortality in Nepal: Addressing the Issue

By Roman Shrestha
2012, Vol. 4 No. 10 | pg. 4/4 |

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 , 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 , 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 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, 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.


Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., & Haws, R. A. (2005). Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Pediatrics, 115(Supplement 2), 519-617. doi:10.1542/peds.2004-1441

Crane, B. B., & Smith, C. E. H. (2006). Access to safe abortion: An essential strategy for achieving the millennium development goals to improve maternal health, promote gender equality, and reduce . Retrieved May 4, 2012, from

DHS Survey. (2006). Nepal: 2006 demographic and health survey key findings. Maryland, USA: Measure DHS, ICF International.

ImNepal. (2012). About Nepal: Introduction. Retrieved May 3, 2012, from

Mills, S., Chowdhury, S., Miranda, E., Seshadri, S. R. & Axemo, P. (2009). Reducing maternal mortality: Strengthening the world bank responseSamuel mills, sadia chowdhury, esperanza miranda, shreelata rao seshadri, and pia axemo. Retrieved May 5, 2012, from

Ministry of Health. (1996/97). Annual report. Nepal: Department of Health Services, Ministry of Health.

Ministry of Health. (1998). Maternal Mortality and Morbidity Study. Nepal: Family Health Division, Department of Health Services, Ministry of Health.

Nepal Monitor. (2010). Suicide #1 cause of death for Nepali women: Study. Retrieved May 4, 2012, from

Prata, N., Passano, P., Sreenivas, A., & Gerdts, C. E. (2010). Maternal mortality in developing countries: Challenges in scaling-up priority interventions. Women's Health (London, England), 6(2), 311-327. doi:10.2217/whe.10.8

Puri, M., Malla, K., Aryal, D. R., Shrestha, M., Hulton, L. & Pradhan, A. S. (2008). Maternal and perinatal death review in Nepal. Retrieved May 3, 2012, from

Rosenfield, A., & Maine, D. (1985). Maternal mortality - A neglected tragedy. The Lancet, 326(8446) 83-85. Retrieved from

complexity. Canadian Studies in Population, 35(1), 1-26.

Thapa, S., Thapa, P. J., & Shrestha, N. (1994). Abortion in Nepal: Emerging insights. Advances in Population : Psychosocial Perspectives, 2, 253-270.

UN. (2010). MDG 5: Improve maternal health. Retrieved May 4, 2012, from

UNESCAP. (2010). Gender equality and empowerment: A statistical profile of selected issues in the Asia-Pacific Region. Retrieved May 6, 2012, from

Weston, L. 1986. Reducing Maternal Deaths in Developing Countries. World Bank: Population, Health and Nutrition Department.

World Bank. (2012). Nepal country overview 2012. Retrieved May 3, 2012, from

Suggested Reading from Inquiries Journal

During the 2008 Presidential Election, voters designated health insurance reform as a key issue for their future president to work on. With 46.3 million Americans uninsured in 2008, voters demanded change, and upon his election... MORE»
As the nation’s largest health insurance program, Medicaid plays a huge role in the current health care reform debate. The program serves over 50 million people and has total outlays equaling over $280 billion[i]. Medicaid is much more than simply a program for the poor. It may also serve those who qualify for Supplemental... MORE»
A country of approximately 37 million people, Kenya has struggled to build a health system that can effectively deliver quality health services to its population. Access to health care varies widely throughout the country and is determined on numerous factors, though in particular, major divides exist between rural and urban communities... MORE»
Nepal is a small developing country in South Asia, bordered by China to the north and India to the south, east and west. With a total land area of 56,827 square miles, the country is predominantly mountainous with more than 80% of the total area covered by hills and mountains. However, the southern belt of Nepal consists of flat alluvial plains called the Terai region, populated by almost half of the total population of the country.1 According to... MORE»
Submit to Inquiries Journal, Get a Decision in 10-Days

Inquiries Journal provides undergraduate and graduate students around the world a platform for the wide dissemination of academic work over a range of core disciplines.

Representing the work of students from hundreds of institutions around the globe, Inquiries Journal's large database of academic articles is completely free. Learn more | Blog | Submit

Follow SP

Latest in Health Science

2020, Vol. 12 No. 07
A global pandemic is often characterized by an abundance of information, the race for a vaccine, and a focus on preventing others from contracting the disease. However, the socio-cultural ramifications of such an event are oftentimes overlooked.... Read Article »
2019, Vol. 11 No. 11
This paper compiles and analyzes a series of published articles discussing some of the genetic and physiological principles of obsessive-compulsive disorder (OCD), as well as provides insight into potential future investigations for furthering understanding... Read Article »
2018, Vol. 10 No. 10
Medical Debt has largely been viewed as a financial burden. While studies have linked Medical Debt to decreased savings, reduced health access, foreclosure of homes, and loss of income, there has been little to no research exploring Medical Debt... Read Article »
2018, Vol. 10 No. 01
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a wide range of severity, encompassing mild to severe levels of social, communicative, cognitive, and behavioral functioning. This social functioning disorder affects every 1 in... Read Article »
2017, Vol. 13 No. 1
Published by Discussions
Causal inference methods were performed on The Cancer Genome Atlas (TCGA) clinical datasets. First, relevant patient data were collected and merged. Then, an algorithm was used to create a causal directed acyclic graph (DAG). Next, the Iterative... Read Article »
2012, Vol. 1 No. 1
Published by Clocks and Clouds
This paper examines explanations for the current HIV/AIDS epidemic in the Deep South United States. The first set of explanations is categorized as social determinants of health and includes social and economic factors that influence public health... Read Article »
2017, Vol. 9 No. 03
This article argues that performance enhancing drugs (PEDs) ought to be allowed across all elite sporting competitions for athletes over the age of 16 so long as consuming them does not pose a significant risk to their health. I begin with a brief... Read Article »

What are you looking for?


7 Big Differences Between College and Graduate School
How to Select a Graduate Research Advisor
How to Read for Grad School