Safe Motherhood Program of Nepal: Everything You Need to Know

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The Safe Motherhood Programme in Nepal is a cornerstone of the country’s public health initiatives. It aims to reduce maternal and neonatal mortality. The program ensures safe pregnancy and childbirth for all women. This review explores its history, objectives, strategies, policies, key programs, progress from the 1990s to 2024, and authoritative sources.

1.    Introduction

Nepal has historically faced significant challenges in maternal and child health. These challenges are due to geographic barriers, poverty, limited healthcare infrastructure, and cultural practices. The Safe Motherhood Programme, initiated in the 1990s, was designed to address these issues. It promotes access to quality maternal healthcare services. The programme aims to reduce preventable maternal and neonatal deaths.

The program aligns with global goals. These include the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs). It particularly aligns with SDG 3: “Ensure healthy lives and promote well-being for all at all ages.”

2.    History

1. 1990s:
   • Nepal’s maternal mortality ratio (MMR) was alarmingly high at 539 deaths per 100,000 live births.
   • The government launched the Safe Motherhood Initiative in collaboration with international partners like UNICEF, WHO, and USAID.
   • Focus areas included increasing institutional deliveries, training skilled birth attendants, and promoting antenatal care (ANC).
2. 2000s:
   • The National Safe Motherhood Plan (2002–2017) was introduced, emphasizing equity and accessibility.
   • The Aama Surakshya Karyakram (Mother’s Safety Program) was launched in 2005. It provides free delivery services and transportation incentives for pregnant women.
3. 2010s:
   • Integration of Safe Motherhood into broader reproductive health frameworks.
   • Emphasis on community-based interventions and behavior change communication (BCC).
4. 2020s:
   • Alignment with SDGs and focus on reducing MMR to less than 70 per 100,000 live births by 2030.
   • Adoption of digital health technologies for monitoring and improving maternal health outcomes.

3.    Objectives

The primary objectives of the Safe Motherhood Programme include:

• Reducing maternal mortality and morbidity.
• Increasing the proportion of institutional deliveries.
• Ensuring universal access to skilled birth attendants.
• Promoting antenatal and postnatal care.
• Addressing socio-cultural barriers that hinder access to maternal healthcare.

4.    Strategies

The program employs a multi-pronged strategy to achieve its objectives:

1. Free Maternal Healthcare Services:
   • Free ANC, delivery, and postnatal care services in public health facilities.
   • Transportation incentives for women in remote areas.
2. Training Skilled Birth Attendants:
   • Training auxiliary nurse midwives (ANMs), nurses, and doctors in obstetric care.
3. Community Engagement:
   • Use of Female Community Health Volunteers (FCHVs) to educate communities about safe motherhood practices.
4. Infrastructure Development:
   • Establishment of birthing centers in rural areas.
   • Upgrading health facilities to provide comprehensive emergency obstetric care (CEmOC).
5. Policy and Advocacy:
   • Implementation of policies to combat gender inequality and early marriage.
   • Promotion of family planning services.
6. Monitoring and Evaluation:
   • Use of data systems like the District Health Information System (DHIS2) to track progress.

5.    Key Policies and Plans

1. National Safe Motherhood Plan (2002–2017):
   • A roadmap for reducing maternal mortality through improved service delivery and community mobilization.
2. Aama Program (2005):
   • Provides free delivery services and transportation subsidies to encourage institutional births.
3. National Health Policy (2014):
   • Prioritizes equitable access to healthcare, including maternal health services.
4. National Reproductive Health Strategy (2016–2021):
   • Integrates safe motherhood with broader reproductive health goals.
5. Health Sector Strategy (2015–2020):
   • Focuses on strengthening primary healthcare systems to support maternal health.

6.    Important Programs

1. Aama Surakshya Karyakram (Mother’s Safety Program):
   • Offers free maternity services and cash incentives for transportation.
   • Has significantly increased institutional deliveries.
2. Female Community Health Volunteer (FCHV) Program:
   • FCHVs play a critical role in educating women about safe pregnancy practices and encouraging facility-based deliveries.
3. Maternal and Perinatal Death Surveillance and Response (MPDSR):
   • A system to investigate and respond to maternal and neonatal deaths, ensuring accountability and learning.
4. Emergency Obstetric Care (EmOC) Services:
   • Includes basic and comprehensive EmOC services to manage complications during pregnancy and childbirth.
5. Digital Health Initiatives:
   • Use of mobile apps and telemedicine to improve access to maternal healthcare in remote areas.

7.    Progress from 1990 to 2024

Key Achievements

1. Reduction in Maternal Mortality Ratio (MMR):
   • From 539 deaths per 100,000 live births in 1990 to 186 deaths per 100,000 live births in 2020 (Source: WHO).
   • Target is to reduce MMR to <70 per 100,000 live births by 2030.
2. Increase in Institutional Deliveries:
   • Institutional deliveries rose from 18% in 2006 to 63% in 2020 (Source: DHS).
3. Skilled Birth Attendance:
   • The proportion of births attended by skilled health personnel increased from 19% in 2001 to 65% in 2020.
4. Antenatal Care Coverage:
   • At least four ANC visits increased from 29% in 2001 to 70% in 2020.
5. Equity Improvements:
   • Significant progress in reaching marginalized groups, including Dalits, Janajatis, and women in rural areas.

Challenges

1. Geographic Barriers:
   • Remote and mountainous regions still face difficulties accessing healthcare.
2. Cultural Practices:
   • Traditional beliefs sometimes discourage institutional deliveries.
3. Resource Constraints:
   • Limited funding and human resources hinder program implementation.
4. Data Gaps:
   • Incomplete or unreliable data in some districts affects monitoring.

Authoritative Links and Sources

For further reading and verification, here are some authoritative links and sources:

• Ministry of Health and Population (MoHP), Nepal: https://mohp.gov.np
• World Health Organization (WHO) – Nepal: https://www.who.int/nepal
• UNICEF Nepal: https://www.unicef.org/nepal
• Demographic and Health Survey (DHS) Nepal Reports: https://dhsprogram.com/countries/Nepal
• National Planning Commission (NPC), Nepal: http://www.npc.gov.np
• USAID Nepal – Maternal and Child Health Programs: https://www.usaid.gov/nepal

At The END,

The Safe Motherhood Programme in Nepal has made remarkable progress over the past three decades. It has significantly reduced maternal mortality and improved access to maternal healthcare services. However, challenges remain, particularly in reaching marginalized populations and addressing systemic barriers. Continued investment in infrastructure is crucial. Workforce training is also essential, along with innovative solutions like digital health. These efforts will help achieve the SDG targets by 2030.