Maternal, neonatal mortality “too high”

Each year more than 2,000 women die due to pregnancy-related complications in Nepal, according to government figures. Nearly 30,000 babies die even before reaching one month.

“We must face the fact that the maternal mortality rate (MMR) is too high,” Gillian Mellsop, the UN Children’s Fund (UNICEF) country representative in Nepal, said.

However, many of these deaths could be avoided if basic health and obstetric care services were more widely available.

According to government statistics, the MMR is 281 per 100,000 live births, though other figures suggest this is an underestimation.

The annual neonatal death rate (under 28 days) is 32 per 1,000 live births, one of the highest in the world, according to the government’s Demographic Health Survey. Many newborns die at home due to hypothermia, asphyxia, or complications resulting from low birth weight and infection.

“It’s a huge challenge to extend our health services to the most impoverished regions,” said senior government official and maternal health expert Sudha Sharma from Nepal’s Ministry of Health.

The government was trying to bring free maternal health care to all parts of the country, but the private sector should do more, she added. “The government cannot do this alone. There is a need for an active public-private partnership to deal with this most contentious humanitarian issue,” Sharma said.

Maternal and child health workers have also called on the government to ensure that reproductive health is a human rights issue, incorporated in the constitution.

Photo: David Swanson/IRIN
A mother smiles proudly at the camera with her newborn son

Doubt over government’s MMR figure

Some maternal health experts, who requested not to be named, told IRIN the government’s MMR data was highly problematic.

In 1996 the MMR was 539 per 100,000 live births, according to the government’s Demographic and Health Survey, and there is disagreement among experts about how the deaths have been reduced by over half when the percentage of deliveries by skilled birth attendants (SBA) is still very low.

At present only 19 percent of all deliveries are attended by an SBA and only 18 percent of mothers delivered their babies in the relative safety of institutions, according to UNICEF.

Government officials attributed the lower MMR figure to under-reporting of deaths in the villages or en route to hospital.

Most of the women die as a result of severe bleeding, sepsis, toxaemia, obstructed labour and the consequences of abortion, and many of the deaths occur in remote villages, and are due also to the lack of SBAs.

Harsh weather conditions, poor roads and difficult terrain pose huge challenges in delivering maternal health services in remote areas, especially in far and mid west regions, according to UNICEF.

Fewer than half of the country’s 28 million people have access to all-weather roads, making it difficult for up to 95 percent of mothers and newborns to reach modern healthcare facilities. It can take several days to reach such a facility, and this often turns into a death sentence for mother and child. The very poor are disinclined to spend money on transport, if available.

MDG goal in jeopardy

The lack of reliable data makes it difficult to determine Nepal’s progress towards achieving its Millennium Development Goal (MDG), by 2015, of an MMR of 134 deaths per 100,000 live births, said the experts.

“It’s doubtful whether we can do that [achieve the goal], given that there is still low political commitment,” said reproductive health expert, Ava Darshan Shrestha, vice-president of the Safe Motherhood Network Federation (SMNF)

Shrestha said awareness about safe motherhood practices was still low in the villages. The government should boost quality care and improve its health services, she said. “I’m doubtful [the goal can be achieved] - unless these things are in place soon,” she said.