Safe Delivery Care: Policy, Practice and Gaps in Nepal

Ganesh Dangal,Tulsi Ram Bhandari

doi:10.31729/jnma.2443

Abstract

Delivery care is regarded as safe when it is attended by a skilled birth attendant either at health facility or home. Childbirth practices differ from place to place and are determined by availability and accessibility of health services. After National Health Policy (1991), Nepal has focused on safe motherhood policies and programmes. Maternal mortality ratio decreased nearly fourfold between the years 1990 to 2011. The country is likely to achieve the Millennium Development Goal (MDG) 5. However, indicators of the MDG 5: skilled care at birth and institutional delivery rates are very far from the targets. From the initial findings of limited studies, safe delivery incentive programme has been successful for increasing the skilled care at birth and institutional delivery and reducing the maternal mortality twofold between the years 1990 to 2011. In spite of numerous efforts there is a wide difference in the utilization of skilled care at birth among the women by area of residence, ecological regions, wealth quintiles, education status, age and parity of women, caste ethnicity and so forth. This difference indicates that current policies and programmes are not enough for addressing the low utilization of safe delivery care throughout the country.

Highlights

There is unanimous consensus at international level on VJG FGsPKVKQP QH UCHG FGNKXGT[ 5CHG FGNKXGT[ KU TGICTFGF as that which is attended by skilled birth attendants either at health facilities or homes.[1,2]
The proportion of births attended by Skilled birth Attendants (SBAs) is more than 90% in WHO’s Europe, America and Western 2CEKsE TGIKQPU *QYGXGT #HTKEC 5QWVJ 'CUV #UKC CPF Eastern Mediterranean regions need to progress from the current despondent situation where Africa region has only 48% skilled birth attendance rate
We have found several studies on the contributing HCEVQTU QH FGNKXGT[ RTCEVKEGU KP 0GRCN 6JG OCKP sPFKPIU are lack of transportation, long distance to the health facility, unfriendly provider’s attitude, poor service delivery systems and physical infrastructure, women’s age above 35 years, high parities, low education status, low perceived attitude towards safer pregnancy and delivery care, rural residence, gender inequality, traditional socio-cultural practices and faiths towards delivery care, low decision making power and socioeconomic status of women, geographic constraints as important factors.[39,40,41]

Summary

Introduction

Childbirth practices differ in places, countries, cultures and are determined by availability and accessibility of the health services.[4,5] From early history, childbirth care was accepted as a humanitarian act and attended by midwives either at home or any convenient place to the woman. Women were given priority for care with culturally respected environment during the natal period.[6,7] It is a complicated process which is not under the control of the woman giving birth.[1,6]

Methods

Findings

Discussion

Conclusion