Reducing maternal mortality ratio in Nepal still a daunting challenge

Kathmandu, September 14

Considering the investment and efforts put in by the government in the field of maternal health, it is unlikely that the government will meet the target of reducing maternal mortality ratio to 70 per 100,000 live births by 2030 as outlined in the Sustainable Development Goals for Nepal, 2016-2030.

According to the National Demographic Health Survey 2016, the maternal mortality ratio for Nepal was 239 per 100,000 live births for the seven year period before the survey. The confidence interval for the 2016 maternal mortality ratio ranges from 134 to 345 deaths per 100,000 live births.

Achieving the SDGs target of a global MMR to fewer than 70 maternal deaths per 100,000 live births by 2030 needs continued investment in maternal health research, programmes and policy.  “There should be at least 90 per cent institutional deliveries to bring down the MMR. But currently there is only 53 per cent of institutional deliveries,” said Bhim Singh Tinkari, director, Family Welfare Division, Department of Health Services.

Safe abortion too plays a significant role in lowering the MMR. As per the division 58 per cent of illegal abortion is taking place in the country.

“We should make the programmes related to maternal health effective and inclusive if we are to meet the sustainable development goals. Safe abortion services should be made accessible. Travel allowances should be properly given to women to encourage institutional delivery. Use of family planning methods should be increased. Awareness about antenatal health check-up and institutional delivery should be increased,” he said.

Meeting the 2030 targets is a big challenge as there are no parturition centres in many areas in the country. “If we are to reduce the MMR then we must increase the number of parturition centres in  remote areas,” added Tinkari. The health centres should also be equipped with skilled manpower and equipment, said Aruna Uprety, a public health specialist.

“Proper coordination between the three tiers of government should be ensured to meet the target. We are working on a roadmap for safe motherhood. This roadmap will explain the necessary programmes and policies required for safe motherhood,” added Tinkari.

“A pregnant woman must get examined at least four times to avoid the risk of maternal and child death. Women in rural areas still do not visit health centres for antenatal and postnatal check-ups,” said Uprety.

Expansion of 24-hour emergency obstetric care services in public health facilities is a must. High blood pressure, nutritional status, untimely arrival at health centres for delivery are also some of the causes for maternal mortality, according to Chhatra Amatya, former director of Department of Management at Department of Health Services.

The majority of maternal deaths are preventable. Many maternal deaths are caused by postpartum haemorrhage, infections, unsafe abortion and other delivery-related complications. “An integrated approach should be taken to overcome all such problems to meet the 2030 targets,” said Amatya.

“There should be preparedness and proper referral system to help women get quality health care,” added Amatya.