Abstract
BackgroundWe aim to examine the gendered contexts of poor perinatal survival in the remote mountain villages of Nepal. The study setting comprised two remote mountain villages from a mid-western mountain district of Nepal that ranks lowest on the Human Development Index (0.304), and is reported as having the lowest child survival rates in the country.MethodsThe findings are taken from a larger study of perinatal survival in remote mountain villages of Nepal, conducted through a qualitative methodological approach within a framework of social constructionist and critical theoretical perspectives. Data were collected through in-depth interviews with 42 women and their families, plus a range of healthcare providers (nurses/auxiliary nurses, female health volunteers, support staff, Auxiliary Health Worker and a traditional healer) and other stakeholders from February to June, 2015. Data were analysed with a comprehensive coding process utilising the thematic analysis technique.ResultsThe social construction of gender is one of the key factors influencing poor perinatal survival in the villages in this study. The key emerging themes from the qualitative data are: (1) Gendered social construct and vulnerability for poor perinatal survival: child marriages, son preference and repeated child bearing; (2) Pregnancy and childbirth in intra-familial dynamics of relationships and power; and (3) Perception of birth as a polluted event: birth in Gotha (cowshed) and giving birth alone.ConclusionsMotherhood among women of a low social position is central to women and their babies experiencing vulnerabilities related to perinatal survival in the mountain villages. Gendered constructions along the continuum from pre-pregnancy to postnatal (girl settlement, a daughter-in-law, ritual pollution about mother and child) create challenges to ensuring perinatal survival in these villages. It is imperative that policies and programmes consider such a context to develop effective working strategies for sustained reduction of future perinatal deaths.
Highlights
We aim to examine the gendered contexts of poor perinatal survival in the remote mountain villages of Nepal
Social constructionism and critical theoretical perspectives fit with the study’s socio-cultural approach and guided the choice of research method—policy review and qualitative interviews, analytical technique—the inductive thematic analysis, and discussion that revolves around gender, which is seen as a structural force underlying the ongoing poor perinatal survival rates in the mountain villages
Three key themes emerged regarding the influence of the gender-related cultural contexts of motherhood experiences that lead to poor perinatal survival in these villages
Summary
Perinatal deaths include pregnancy losses after 22 weeks’ gestation (stillbirths) and neonatal deaths within the first seven days (week) after birth [2]. An extended perinatal period that includes stillbirths plus neonatal deaths within the first 28 days (month) after birth, is in use, such as that reported in US and Australian studies [3, 4]. It is known that almost all perinatal deaths (98%) occur in developing countries; 75% in Sub Saharan Africa and South Asia [1, 9]. With current rates of reduction, it is estimated to take more than 100 years for women living in South Asia and Sub Saharan Africa to achieve a perinatal survival rate similar to that of women in developed countries [1]
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