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 Inequality in institutional delivery of the recent birth among married women in Nepal: a trend analysis

2020 ◽  
Author(s):  
Ramesh Adhikari ◽  
Aakriti Wagle
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Rural Women ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Binary Logistic Regression ◽  
Bivariate Analysis ◽  
Demographic And Health Surveys ◽  
Chi Square ◽  
Safe Delivery

Abstract Background The huge discrepancy in health statistics between developed and developing countries occur in the area of maternal mortality, with developing countries contributing most of the figures. Nepal has higher maternal mortality ratio than its South Asian neighbors. This study assesses the trend of institutional delivery of recent birth and compared the inequalities with associated factors that affect institutional delivery in Nepal.Methods The data for this study was obtained from three sequential Nepal Demographic and Health Surveys [NDHS] of 2006, 2011, and 2016. The information was collected from mothers having a child within last five years preceding the survey years. The total number of such mothers was 4066, 4148, and 3998 respectively in the survey of 2006, 2011, and 2016.The association between institutional delivery and the explanatory variables was assessed via bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression).Results The utilization of health service during delivery stepped up from 21% in 2006 to 62% in 2016.Although the proportion of delivery in health facility increased among poorest over the period of 10 years, the disparity between richest and poorest still persisted from 2006 to 2016 and the association was highly significant in all the surveys. Although, government of Nepal has launched the maternity incentive scheme through safe delivery incentive program in 2005, poor women are still deprived from utilizing the service. Poorest and poorer women were 78 percent (aOR=0.22, 95% CI 0.17-0.27) and 71 Percent (aOR=0.23, 95%CI 0.23-0.35) respectively less likely to have institutional delivery than the richest women after controlling the other socio-demographic and culture factors. Furthermore, this study found that education, place of residence, women’s autonomy, religion, number of ANC visits, exposure to newspaper and TV were significant predicators for place of delivery. Conclusion Although there has been three-fold increment in utilization of health services during delivery over the period of 10 years, the discrepancy between rich and poor, educated and uneducated and urban and rural area is highly evident. Overall, our study highlights the necessity of interventions to promote institutional delivery with greater focus on poor, uneducated, and rural women.

scholarly journals Towards safe motherhood to - are we moving in the right direction?: experience from an urban health facility in South India

2019 ◽  
Vol 8 (7) ◽  
pp. 2851
Author(s):  
Ramya Thangavelu ◽  
Lalitha Natarajan
Keyword(s):  
Maternal Mortality ◽  
Universal Access ◽  
Maternal Mortality Ratio ◽  
Safe Motherhood ◽  
Quality Health Care ◽  
College Hospital ◽  
Mortality Ratio ◽  
Classical Triad ◽  
Maternal Suicide ◽  
The Right

Background: This study was designed to evaluate the institutional Maternal Mortality Ratio (iMMR) in our institution, a tertiary private medical college hospital and to suggest recommendations and possible interventions to reduce it.Methods: This retrospective descriptive study was conducted by reviewing the hospital records over a period of ten years from January 2009-December 2018. The case records were reviewed for maternal demographic characteristics and complications.Results: The total number of deaths during the study period was 21, giving an iMMR of 85.268 per 100000 live births. Most of the maternal deaths (>80%) occurred postpartum. Obstetric causes contributed to 57% of the deaths with hypertension and hemorrhage topping the list. Other causes were sepsis and non obstetric causes including one case of maternal suicide. 52.38% of the women died more than 48 hours after admission to the hospital, while 28.57% succumbed in less than six hours. Secondary complications noted were ICU admission, extended intubation, massive transfusion, operative intervention and multi organ dysfunction.Conclusions: The classical triad of Hypertension, Hemorrhage and Sepsis continues to be the major determinant of maternal mortality and are potentially preventable by promoting universal access to quality health care, strengthening of health services and ensuring accountability.

scholarly journals Association of Antenatal Care Visit with Utilization of Institutional Delivery Care Services in Afghanistan: Intersections Between Education, Wealth, and Household Decision-Making Autonomy

2021 ◽  
Author(s):  
Mostafizur Rahman ◽  
Priom Saha ◽  
Jalal Uddin
Keyword(s):  
Decision Making ◽  
Social Status ◽  
Institutional Delivery ◽  
Skilled Birth Attendant ◽  
Safe Motherhood ◽  
Care Utilization ◽  
Delivery Care ◽  
Household Decision ◽  
Care Services ◽  
Statistical Interactions

Abstract Background: The importance of antenatal visits in safe motherhood and childbirth is well documented. However, less is known how social determinants of health interact with antenatal care (ANC) visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the association of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.Methods: We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,581 women of reproductive age (15-49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results: Regression analyses adjusted for socioeconomic and demographic covariates suggest that women who had 4 or more ANC visits were 5.7 times (95% CI= 4.78, 7.11, P<0.001) more likely to use delivery care at a health facility and 6.5 times (95% CI= 5.23, 8.03; P<0.001) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions between ANC, education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion: Our findings suggest that the association of ANC visit with institutional delivery care services is stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

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 Inequality in institutional delivery of the recent birth among married women in Nepal: a trend analysis

2020 ◽  
Author(s):  
Ramesh Adhikari ◽  
Aakriti Wagle
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Rural Women ◽  
Institutional Delivery ◽  
Maternal Mortality Ratio ◽  
Binary Logistic Regression ◽  
Bivariate Analysis ◽  
Demographic And Health Surveys ◽  
Chi Square ◽  
Safe Delivery

Abstract Background The huge discrepancy in health statistics between developed and developing countries occur in the area of maternal mortality, with developing countries contributing most of the figures. Nepal has higher maternal mortality ratio than its South Asian neighbors.This study assesses the trend of institutional delivery of recent birth and compared the inequalities with associated factors that affect institutional delivery in Nepal.Methods The data for this study was obtained from three sequential Nepal Demographic and Health Surveys [NDHS] of 2006, 2011, and 2016. The information was collected from mothers having a child within last five years preceding the survey years.The total number of such mothers was 4066, 4148, and 3998 respectively in the survey of 2006, 2011, and 2016.The association between institutional delivery and the explanatory variables was assessed via bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression).Results The utilization of health service during delivery stepped up from 21% in 2006 to 62% in 2016.Although the proportion of delivery in health facility increased among poorest over the period of 10 years, the disparity between richest and poorest still persisted from 2006 to 2016 and the association was highly significant in all the surveys. Although, government of Nepal has launched the maternity incentive scheme through safe delivery incentive program in 2005, poor women are still deprived from utilizing the service. Poorest and poorer women were 78 percent (aOR = 0.22, 95% CI 0.17–0.27) and 71 Percent (aOR = 0.23, 95%CI 0.23–0.35) respectively less likely to have institutional delivery than the richest women after controlling the other socio-demographic and culture factors. Furthermore, this study found that education, place of residence, women’s autonomy, religion, number of ANC visits, exposure to newspaper and TV were significant predicators for place of delivery.Conclusion Although there has been three-fold increment in utilization of health services during delivery over the period of 10 years, the discrepancy between rich and poor, educated and uneducated and urban and rural area is highly evident. Overall, our study highlights the necessity of interventions to promote institutional delivery with greater focus on poor, uneducated, and rural women.

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.

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