Highlights
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In Nepal, 239 women lose their lives per 100,000 live births. Nepal’s maternal mortality rate (MMR) is the second-highest among the Asian countries. It has been reported that three infants die every hour and one maternal death takes place every eight hours1. Among the deaths, nearly two-thirds happen in the postpartum period, 28 percent during the antepartum period, and 10 percent during the intrapartum period (before birth). Most of these deaths can be prevented through institutional delivery under the supervision of trained health personnel2. Factors such as distance to the health facilities and birthing centers from rural communities, poverty, social norms encouraging home birth over institutional delivery, insufficient maternal newborn and child health (MNCH) services, lack of drugs and services, are some of the key factors that have resulted in low usage of health services leading to higher MMR and newborn mortality.
The availability of well-equipped health facilities and skilled health workers would improve the health conditions of mothers and newborns. The Ministry of Health and Population (MoHP) aims to address demand and supply barriers for maternal health services through various schemes and incentives. For example, the government through Aama Program3 provides financial incentives to encourage women to have four ANC visits and institutional delivery, regardless of their socioeconomic status. Likewise, MoHP has started expanding maternal, newborn and child health services coverage by establishing new childbirth sites/birthing centers in existing health institutions. The government has envisioned setting up basic emergency obstetric and newborn care centers (BEONC) within 2 hours walking distance from the home of mothers4. So far only 46% of health posts have been listed as the birthing center5. Most remain under resourced and inaccessible to women living in remote areas. There is the issue of the quality of the services of the birthing center because of lack of enough space for services. Majority of health facilities do not have adequate infrastructure as per the standard and offer no privacy to service seekers in lack of space6. The issues at health facilities include limited space, poor lighting, lack of heating system, irregular water supply, and absence of placenta pit for disposal of the placenta in a proper way. Hence several studies have recommended improving infrastructure to enhance the quality of birthing services and increase utilization of services