Nepal

South East Asia Region

Maternal and Perinatal Health Profile

Department of Maternal, Newborn, Child and Adolescent Health (MCA/WHO)

Demographics and Information System Health status indicators - Maternal and Perinatal mortality
Total population (2013) [1] 27,797,457 Maternal mortality ratio (2013) [3] 190
Total women aged 15-49 years (2013) [1] 7,549,746 Annual number of maternal deaths (2013) [3] 1,100
Annual number of births (2013) [1] 759,672 Perinatal moratlity rate (2011)[4] 37
Sex ratio at births (2005-10) [1] 1.05 Stillbirth rate (2009)[3] 23
Birth registration coverage [2] 42.3 Neonatal mortality rate per 1000 live births (2013) [5] 23
Total fertility rate (2013) [1] 2.3 Annual number of neonatal deaths (2013) [5] 12,974
Adolescent fertility rate [per 1000 woman] (2005-2010) [1] 95
Under five population (2013) [1] 2,911,107
Coverage of vital registration of deaths [2] -

Sources: [1] Population Division, Department of Economic and Social Affairs, United Nations, World Population Prospects: The 2012 Revision.
[2] WHO, World Health Statistics 2014 .
[3] WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality: 1990 to 2013.
[4] Demographic Health Survey.
[5] UNICEF/WHO/The World Bank/UN Pop Div. Levels and Trends in Child Mortality. Report 2014 .

Maternal nutrition Pregnancy involving risks

Prevalence of anaemia among pregnant women 47.6 Birth interval <24 months and birth order >3 4
Night blindness (adjusted) - Total age <18 and birth interval <24 months 0.5

Iron tablets taken during pregnancy (any tablets) 81.7

Source: Demographic Health Survey (2011)

Maternal mortality
One of the eight Millennium Development Goals (MDGs) that has made some progress, albeit slow, is MDG 5: Improve maternal
health. The two targets for assessing MDG 5 are reducing the maternal mortality ratio (MMR) by three quarters between 1990 and
2015, and achieving universal access to reproductive health by 2015.

Maternal mortality ratio (MMR): maternal mortality per 100 000 live births

% change in MMR between 1990-2013 -76 1000

Average annual % change in MMR 1990-2013 -6
Per 100 000 LB

800
Range of uncertainly on annual % change in MMR
-6.6 600No Data
790 Available
(lower estimate) MDG5
Range of uncertainly on annual % change in MMR 400 580 Target, 198
(upper estimate) -5.4 430
200
310 190
Progress towards improving maternal health On track
0
1990 1995 2000 2005 2010 2015
MDG 5 target by 2015 197.5

Note: Consultations with countries were carried out following the development of the MMR estimates. The purposes of the consultations were primarily:
to give countries the opportunity to review the country estimates, data sources and methods; to obtain additional primary data sources that may not
have been previously reported or used; and to build mutual understanding of the strengths and weaknesses of available data and ensure broad
ownership of the results.
Source: WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality: 1990 to 2013 .
 Nepal

Perinatal mortality
The perinatal mortality rate expressed per 1000 pregnancies of seven or more months' duration, is used as an indicator of the
quality of antenatal and perinatal care. Perinatal deaths include pregnancy losses of at least seven months’ gestation (stillbirths)
and deaths to live births within the first seven days of life (early neonatal deaths).

Perinatal mortality rate (PMR): Trend Perinatal mortality by background characteristics

50 80

Per 1000 births

45 45.0 60 52
44 40
37 38 32 37
40 40 29
No Data Available 37.0 No Data Available
23 19
35
Per 1000 births

20
30
27.4 0
25

Total

<15

Rural

lowest
39+

highest
Urban

No education

≥ Secondary
First pregnancy
22.7
22.2
20
15
10 9.7
Previous pregnancy Place of Mother's Wealth
5 interval in months residence education quintile
0
2006 2011

Stillbirth rate Early neonatal deaths rate PMR

Source: Demographic Health Survey Source: Demographic Health Survey (2011)

Note: information on stillbirths and deaths to infants within the first week of life are highly susceptible to omission and misreporting.

Perinatal mortality by region

40 40

39
No Data Available 38
38
Per 1000 births

37
37
37
36
36 36

35

34

33
Total Eastern Central Western Mid-western Far-western

Source: Demographic Health Survey (2011)

Maternal and perinatal country profile

 Nepal

Early and late neonatal deaths (proportion of death by timing)

A neonatal death is defined as a death during the first 28 days of life (0-27 days). Early neonatal death refers to a death
between 0-6 days after birth. Late neonatal death refer to a death between 7-27 days after birth.

No Data Available
Late neonatal
deaths
17% within 24 24-48
hours hours
36% 16%
Other
83%
48-
Day 6 72hours
3% Day 5 7%
4% Day 4 Day 3
7% 10%
Source: Demographic and Health Survey

Source: Demographic Health Survey (2011)

Trend of intervention coverage across continuum of care for maternal and perinatal health

100

80 No Data Available

60

40

20

0
% of women % of women % women who IPT during ANC visit Place of delivery - % of births delivered % of women who
currently using received ANC (at received ANC 4 times Any health facility by C-section had PNC within 2
modern least once) or more days
contraceptives

1996 2001 2006 2011

Source: Demographic Health Survey (2011)

Maternal and perinatal country profile

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Place of birth and type of provider

Place of Births - Where are babies born? Type of postnatal care provider
- who provides the postnatal care?

Private Others Health/

No Data Available
hospital 1.6% No Data Available
Communit
9.3% y-health
workers
5.6%

Public
hospital Qualified
26.0% doctor Nurse/mid No
Home 16.2% wife/auxill checkup
63.1% ary nurse 55.5%
22.7%

Source: Demographic Health Survey (2011) Source: Demographic Health Survey (2011)

Intervention coverage across continuum of care by geographical areas

100%

80%

No Data Available
60%

40%

20%

0%
Eastern Central Western Mid-western Far-western

% of births assisted by skilled birth attendant % of births received post-natal care within 48 h
% of births delivered by C-section % of births in health facilities

Source: Demographic Health Survey (2011)

Maternal and perinatal country profile

 Nepal

Equity across continuum of care

100 97.8
93.3

83.9 82.9
80 81.5
No Data Available 77.9 78.2
72.7 71.3 72.4
65.4
60
Percent

49.8 48.9
44.5
40 42.1 41.7
35.6 36 35.3
33.2 32.3 31.6

14.1
20 15.3

10.7 11.4 12.4

4.6
3.5
0 1
% of women % women who % births assisted by % of births by C- % births in health % of births
currently using received any ANC skilled personnel section facilities received postnatal
modern by skilled provider care
contraceptive
Poorest Richest Urban Rural Total
Note:
If more than one source of ANC was mentioned, only the provider with highest qualification is conserved in this tabulation.
Source: Demographic Health Survey (2011)

Utilization of services by wealth quintile

% of births in health facility % of births assisted by skilled personnel

100 100
90 Equity gap
90 Equity gap
% of births assisted by skilled

80 80
% of birth in health facility

70 No Data Available 70 No Data Available

60 60
personnel

50 50
40 40
30 30
20 20
10 10
0 0
Lowest Second Middle Fourth Highest Lowest Second Middle Fourth Highest
Wealth quintile Wealth quintile

Source: Demographic Health Survey (2011) Source: Demographic Health Survey (2011)

Maternal and perinatal country profile

 Nepal

% of births delivered by C-section % of mothers with postnatal checkup in <2 days of delivery

100 100
Equity gap Equity gap

% of birthts received post-natal care

% of births delivered by C-section

90 90
80 80
No
70 Data Available No70Data Available
60 60
50 50
40 40
30 30
20
20
10
10
0
0
Lowest Second Middle Fourth Highest
Lowest Second Middle Fourth Highest
Wealth quintile Wealth quintile
Source: Demographic Health Survey (2011) Source: Demographic Health Survey (2011)

Quality of care indicators Reasons for not seeking medical care

Contents of ANC can be an important indicator for Many barriers can prevent women from seeking medical
accessing the quality of ANC services that pregnant care in general when needed. Understanding these
women receive in order to be prepared for factors is critical to improve the accessibility and
complications and any danger signs associated with utilization of medical care during pregnancy and childbirth.
pregnancy and childbirth.

Signs of
pregnancy Getting
complicatio permission to go
ns for treatment
No Data 100 Available No Data Available
100
80 Any of the 80 Getting money for
specified
60 Height 60 treatment
problems
measured 40
40
20 20
0 Concern there
0
Distance to health
may not be a
facility
Blood Blood female provider
sample pressure
taken measured
Not wanting to go Having to take
alone transport
Urine
sample
Richest takenPoorest Total
Total

Source: Demographic Health Survey (2011) Source: Demographic Health Survey (2011)

Maternal and perinatal country profile

 Nepal

Workforce availability
1
Number of nurses/ midwives/ auxilliary nurse-midwives 7,740
Number of physicians, generalists 5,384
Number of obstetricians and gynaecologists 2,500

Source: UNFPA, State of the World's Midwifery 2014 report (http://www.unfpa.org/sites/default/files/pub-pdf/EN_SoWMy2014_complete.pdf) .

1
These figures do not necessarily reflect the number of practicing midwives or the ICM definition of a midwife.

Health system and policy indicators

Health system and policy indicators

Does the national policy/policy statement indicate the minimum ANC visits during the normal pregnancy? Yes

If yes, how many visits 4

Is there a national policy or policy statement on the right of every woman to have access to skilled care at
Yes
childbirth?
Is there a national policy on discharge of mother and the baby after normal cildbirth at facility? Yes

Is there a policy recommending postnatal follow up visit/review by a trained provider for mother and newborn? Yes

Maternal deaths review

Does national policy require all maternal deaths to be notified within 24h to a central authority? No
What year was the policy adopted? -
Does the national policy require all maternal deaths to be reviewed? No
If yes, what year was the policy adopted? -
Is there a facility maternal death review (audit) process in place? -
Is there a community maternal death review (audit) process in place? -
Is there a national panel (committee) to review maternal deaths in place? Yes
How often does the panel meet? Annually
Is there a subnational panel (committee) to review maternal deaths in place? Yes
Stillbirths
Is there a policy that requires all stillbirths (fresh or macerated) to be reviewed? No
What year was the policy adopted? -
Is there a facility stillbirth review (audit) process in place? No
Neonatal deaths
Is there a policy that requires all neonatal deaths (0-28 days) to be reviewed? No
What year was the policy adopted? -
Is there a facility neonatal deaths review (audit) process in place? Yes
Is there a community neonatal death review (audit) process in place? Yes
Essential drugs list for maternal and newborn health
Does national Essential Drugs List include the following drugs indicated for use during pregnancy, childbirth?
Magnesium Sulphate Yes
Oxytocin Yes
Source: WHO: Global maternal newborn, child and adolescent health policy indicator database (2014) based on key informant surveys in 2009-10, 2011
& 2013-14

Maternal and perinatal country profile