Politics of Childbirth in Nepal

2021 ◽  
pp. 264-282
Author(s):  
Jeevan R Sharma ◽  
Radha Adhikari
Keyword(s):  
Maternal Mortality ◽  
Health Program ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Family Health ◽  
Women's Agency ◽  
Family Health Program ◽  
Oral Misoprostol ◽  
Mortality Ratio ◽  
Women’S Agency

Nepal has been hailed as a global success in reducing the maternal mortality ratio from around 540 women dying per 100,000 births in 1996 to about 240 in 2016. The chapter will critically analyse two interventions implemented around 2005. First, we will look at the USAID-funded Nepal Family Health Program, through which oral misoprostol (to control bleeding after delivery) was launched across Nepal. Second, we will look at Aama Surakshya Karyakram (or mother programme), which was implemented to promote institutional delivery. These two programmes, despite aiming to address high maternal mortality ratio in Nepal, adopted very different approaches, reflecting ideological struggles on women’s agency and the politics of childbirth. The chapter concludes that the costs of these changes (such as the lack of resources or the commercialization of healthcare) have been overlooked in the claims of Nepal’s ‘success’.

scholarly journals Strengthened family planning is critical to help accelerate the reduction of maternal mortality in Indonesia

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 904
Author(s):  
Budi Utomo ◽  
Nohan Arum Romadlona
Keyword(s):  
Family Planning ◽  
Maternal Mortality ◽  
Health Program ◽  
Program Effectiveness ◽  
Maternal Mortality Ratio ◽  
Emergency Obstetric Care ◽  
Government Support ◽  
Reproductive Health Services ◽  
Mortality Ratio ◽  
Core Program

The still stubbornly high maternal mortality ratio challenges Indonesia to improve health program strategies to achieve the Sustainable Development Goal 3.1 target of a maternal mortality ratio below 70 per 100,000 live births by 2030. Indonesia has already adopted maternal-neonatal health experts’ recommendation of four core program strategies to reduce maternal mortality: (1) family planning with related reproductive health services; (2) skilled care during pregnancy and childbirth; (3) timely emergency obstetric care; and (4) immediate postnatal care (WHO, 1996). These four core strategies would reduce maternal mortality through reduced high-risk births. To be effective, however, these four core program strategies require continued strong quality assurance and central and local government support to ensure program effectiveness yielded towards widely accessible, sustained, quality family planning and maternal and neonatal emergency services. This paper provides evidence for the importance of family planning to help health program strategies to accelerate maternal mortality reduction.

scholarly journals Safe Delivery Care: Policy, Practice and Gaps in Nepal

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Tulsi Ram Bhandari ◽  
Ganesh Dangal
Keyword(s):  
Maternal Mortality ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Skilled Birth Attendant ◽  
Safe Motherhood ◽  
Delivery Care ◽  
Care Policy ◽  
Safe Delivery ◽  
Policy Practice ◽  
Mortality Ratio

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.  Keywords: delivery practices; gaps; Nepal; place of delivery; safe delivery care policy.    

scholarly journals The Role of Social Norms in Institutional Delivery: Findings from A Survey in Makwanpur, Nepal

2020 ◽  
Author(s):  
Alicia M. Paul ◽  
Rajiv N. Rimal ◽  
Shraddha Nepal ◽  
Jeevan Lohani
Keyword(s):  
Social Norms ◽  
Maternal Mortality ◽  
Interpersonal Communication ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Skilled Birth Attendant ◽  
Descriptive Norms ◽  
Catchment Areas ◽  
Quasi Experimental ◽  
Mortality Ratio

Abstract Background: Nepal has a maternal mortality ratio of 186 per 100,000 live births, the second highest in South Asia. Institutional delivery, or giving birth in a medical facility with a skilled birth attendant, can prevent up to 16-33% of maternal deaths. Despite recent progress, Nepal’s institutional delivery rate is only 54%. As maternal mortality remains high and institutional delivery low, a transition from a biomedical to a psychosocial approach is needed, through which normative beliefs may be an entry point. The purpose of this study is to examine the relationship between descriptive norms and institutional delivery among mothers in Makwanpur, Nepal. Methods: This study uses baseline data from the Rejoice Architecture Project, a quasi-experimental study conducted in the Makwanpur District in Nepal in 2020. Female Community Health Volunteers (FCHVs) recruited 356 women from catchment areas of six health facilities across three Palikas (equivalent to municipalities) and administered oral surveys. Participants were eligible if they were 18 years or older, had a child younger than 2 years, and lived within the catchment area of a study site. Logistic regression was used to determine associations between descriptive norms and institutional delivery, controlling for antenatal care (ANC) visits, demographics, and interpersonal communication (IPC) with husband.Results: Approximately 30% of participants perceived most women in their community gave birth at home compared to medical institutions and nearly 65% gave birth in an institution during their last delivery. Logistic regressions showed an association between descriptive norms and institutional delivery after controlling for external factors such that on average, women who perceived institutional delivery to be most common had 3.18 greater odds of giving birth in an institution. Conclusions: Findings from this study support the notion that social norms relate to actual birthing behavior, specifically in the context of institutional delivery. These findings contribute to the growing body of literature relating to institutional delivery and offer insights for a potential norms-based approach for increasing rates of institutional delivery and reducing maternal mortality in developing countries.

scholarly journals Communication Norms in NGOs Advocating Reproductive Health: A Comparative Study of Malaysian and Nigerian NGOs

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Mumtaz Ali ◽  
Maya Khemlani David ◽  
Angela Rumina Leo
Keyword(s):  
Reproductive Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Family Health ◽  
Web Searches ◽  
The World ◽  
Health Initiatives ◽  
Mortality Ratio ◽  
The Right ◽  
Document Review

Reproductive health is an emerging issue in developing countries. The United Nations Population Fund (UNFPA) reports that every minute, a woman in the developing world dies from treatable complications of either pregnancy or childbirth. Nigeria is a country where the state of reproductive health of its population is dismal. In 2012, UNFPA pointed out that Nigeria has one of the worst maternal mortality statistics in the world with a maternal mortality ratio of 545 per 100,000 live births. Several NGOs around the world deliver services at various levels to advocate the right of mothers to have safe births as well as address the shortage of skilled midwives. In this context, Malaysia has done much to control its infant and maternal mortality rates, through its community reproductive health initiatives. This study then aims to determine the communication norms in two NGOs, one in Malaysian and the other in Nigeria. The analysis was of projects undertaken by two NGOs, the Federation of Reproductive Health Association of Malaysia (FRHAM) and the Association for Reproductive and Family Health (ARFH) of Nigeria. The communication norms and ways of getting the community involved in their projects were examined through progress reports, document review and web searches. Besides being interviewed, questionnaires were filled by the employees of the NGOs. The findings indicate that the Nigerian and Malaysian NGOs have different communication models and they can learn from each other’s best practices.

scholarly journals Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Mendez-Dominguez ◽  
Karen Santos-Zaldívar ◽  
Salvador Gomez-Carro ◽  
Sudip Datta-Banik ◽  
Genny Carrillo
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Maternal Mortality ◽  
Respiratory Distress ◽  
Pregnant Women ◽  
Distress Syndrome ◽  
Maternal Mortality Ratio ◽  
Maternal Deaths ◽  
Immune Impairment ◽  
Mortality Ratio

Abstract Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of < 19 or > 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria

2011 ◽  
Vol 31 (4) ◽  
pp. 315-319 ◽  
Author(s):  
B. A. Oye-Adeniran ◽  
K. A. Odeyemi ◽  
A. Gbadegesin ◽  
E. E. Ekanem ◽  
O. K. Osilaja ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Sisterhood Method ◽  
Lagos State ◽  
Mortality Ratio

scholarly journals Temporal evolution and spatial distribution of maternal death

2014 ◽  
Vol 48 (4) ◽  
pp. 662-670 ◽  
Author(s):  
Ioná Carreno ◽  
Ana Lúcia de Lourenzi Bonilha ◽  
Juvenal Soares Dias da Costa
Keyword(s):  
Spatial Distribution ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Temporal Evolution ◽  
Maternal Mortality Ratio ◽  
Rio Grande ◽  
The State ◽  
Rio Grande Do Sul ◽  
Maternal Risk ◽  
Mortality Ratio

OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution.METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008.RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding.CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death.

scholarly journals Human papillomavirus detection in cervical scrapes from women attended in the Family Health Program

2014 ◽  
Vol 22 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Everton Faccini Augusto ◽  
Larissa Silva dos Santos ◽  
Ledy do Horto dos Santos Oliveira
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
High Risk ◽  
Health Program ◽  
Vaccine Coverage ◽  
Family Health ◽  
Polymorphism Analysis ◽  
Genotype Distribution ◽  
Cross Sectional Survey ◽  
Family Health Program

OBJECTIVES: to survey the prevalence of human papillomavirus, associated risk factors and genotype distribution in women who were referred to cervical cancer screening when attended in a Family Health Program. METHOD: we conducted a cross-sectional survey, investigating 351 women. Polymerase chain reaction for DNA amplification and restriction fragment length polymorphism analysis were used to detect and typify the papillomavirus. RESULTS: virus infection was detected in 8.8% of the samples. Among the 21 different genotypes identified in this study, 14 were high risk for cervical cancer, and the type 16 was the most prevalent type. The infection was associated with women who had non-stable sexual partners. Low risk types were associated with younger women, while the high risk group was linked to altered cytology. CONCLUSION: in this sample attended a Family Health Program, we found a low rate of papillomavirus infection. Virus frequency was associated to sexual behavior. However, the broad range of genotypes detected deserves attention regarding the vaccine coverage, which includes only HPV prevalent types.

scholarly journals Construction and Validation of an Instrument to Evaluate Knowledge on Healthy Eating in Schoolchildren

Aquichan ◽  
2019 ◽  
Vol 19 (2) ◽  
Author(s):  
Celia Maria Ribeiro de Vasconcelos ◽  
Eliane Maria Ribeiro de Vasconcelos ◽  
Maria Gorete Lucena de Vasconcelos ◽  
Viviane Cristina Fonseca Jardim ◽  
Maria Cristina Falcão Raposo ◽  
...  
Keyword(s):  
Content Validity ◽  
School Health ◽  
Health Program ◽  
Family Health ◽  
P Value ◽  
Validity Index ◽  
Significance Level ◽  
Content Validity Index ◽  
Family Health Program ◽  
School Health Program

Objective: To validate the content and appearance of an instrument to evaluate knowledge on healthy feeding. Materials and Methods: Methodological study of validation of content, appeareance with 22 judges, and semantic validation with 12 schoolchildren from 4th and 5th grades in primary school education, ranging in age between nine and ten years. The Scale-Level Content Validity Index (S-CVI) ≥ 0.90 and the Item-Level Content Validity Index (I-CVI) ≥ 0.80 were considered approved in the validation. The Binomial test was used through the p value of the proportion (rejecting the H0 if p ≤ 0.80) to select items that should be revised or modified (items validated at significance level ≤ 0.05). Results: The instrument was validated with S-CVI = 0.93 and I-CVI ≥ 0.80 in the 12 items evaluated, with the mean proportion of “non-discordance” among judges = 0.93. The instrument with the suggested modifications was submitted to the target audience and completely approved by all the participating students. Conclusion: This instrument can be used during the health education activities of the School Health Program and the Family Health Program to promote healthy feeding with children between nine and ten years of age.

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