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Birth and the Establishment of a Professional Organization in Nepalby Laxmi Tamang© 2011 Midwifery Today, Inc. All rights reserved. [Editor’s note: This is an excerpt of an article which appears in Midwifery Today Issue 99, Autumn 2011. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today Issue 99.]
Maternity Care and Birth in NepalHigh maternal and neonatal death rates are the indicators of an inadequate health care system, with poor quality of care and limited access to services. Around 40% of neonatal deaths are due to preventable causes like infection and birth asphyxia. Similarly, around 69% of maternal deaths are due to avoidable causes such as haemorrhage, eclampsia, abortion, obstructed labour, puerperal sepsis and anaemia (Suvedi et al. 2009). Many of those deaths are the direct consequence of underutilized maternal health services and could be easily prevented by a health worker with the right skills, the right equipment and the right support. Evidence has shown that up to 90% of maternal deaths can be prevented when midwives and others with midwifery skills, i.e., skilled birth attendants (SBAs) are authorized and supported by the health care system to practice their full set of competencies (World Bank 2003; WHO 2005; UNFPA 2006).  In Nepal, the uptake of maternal health services is very poor. More than 80% of deliveries occur at home in the absence of SBAs. Relatives assist the majority of childbirths, and women often birth on their own. Only 29% of Nepalese women make the recommended four antenatal visits, and only 18% of women give birth in a health facility (MoHP 2007). Reducing Child and Maternal MortalityThe Nepalese government is striving to achieve the fourth and fifth of the United Nations’ Millennium Development Goals—reducing child mortality and reducing maternal mortality. The government hopes to lower the mortality rates to 15 neonatal deaths per 1000 and 134 maternal deaths per 100,000 by 2015 (GoN 2009). In order to attain these goals by 2015, 60% of births will need to be attended by SBAs, 40% will need to occur at a health facility, and around 3000 additional SBAs will be needed by 2012 (GoN2006a). Laxmi Tamang is a nurse with a public health background who has worked in a number of settings since 1995. She is a founding member of the first and only free-standing birthing centre in Nepal led by nurse-midwives and a founding member of MIDSON. She is passionate about improving sexual and reproductive health services and strengthening midwifery education and service in Nepal. As an Australian Leadership Award scholar, Laxmi is currently doing her doctoral study at the University of Sydney, researching how gender-based power relations affect the uptake of sexual and reproductive health services among young Nepalese people. Learn more about MIDSON at www.midson.org. References:
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Like many resource-poor countries, Nepal has one of the highest rates of maternal and neonatal deaths in the world. According to the 2006 Nepal Demographic Health Survey, 281 women per 100,000 live births die of complications during childbirth, and 33 newborns die per 1000 live births; two-thirds of neonatal deaths occur in the first week of life (MoHP Nepal et al. 2007). This means that a newborn baby dies every twenty minutes, and every four hours a woman dies of childbirth-related causes. Most of these deaths occur in rural areas.
