Reducing Preventable Maternal Deaths in Nepal

Abstract

On March 24, 2023, the Nepal Government’s National Statistics Office (formerly the Central Bureau of Statistics) and the Ministry of Health and Population (MoHP), in collaboration with several external development partners, organized a study dissemination meeting, which was attended by the then Prime Minister. The primary purpose of the event was to disseminate findings from a study that aimed at assessing the current maternal mortality status in Nepal.1
Unlike previous maternal mortality data obtained from probability surveys (e.g., Nepal Demographic and Health Surveys2,3), the data for this particular study were collected through a census enumeration.1 First, during the 2021 census, each household head was asked whether any deaths had occurred in the household during the 12 months preceding the census day. For any female deaths reported in the 15-49 age group, the timing of death (whether during pregnancy, delivery, post-pregnancy, or post-abortion within 42 days of delivery) was recorded. These records were then shared with the MoHP maternal mortality study team stationed in communities in the country.
In the second phase, the MoHP team visited these households to verify the census information and conducted a verbal autopsy module/survey to gather additional details about the circumstances and causes of death. The respondent for the verbal autopsy was an immediate family member of the deceased woman who was closely familiar with the case. Since the 12-month period covered in the maternal death records mostly fell within 2021 (November 2020─November 2021), the maternal mortality data may be referred to the year 2021.
The retrospective nature of verbal autopsies may have introduced some recall biases and inaccuracies. Additionally, some underreporting may have occurred. No adjustments were made for potential underreporting of births or deaths in the report. Despite these limitations, the data represent information from every household that reported a maternal death. It must be acknowledged that a complete enumeration of all maternal deaths, supplemented by a verbal autopsy, is undoubtedly a major undertaking in terms of time, investment, and human and financial resources.
The study identified a total of 622 deaths, resulting in a national maternal mortality rate (MMR) of 151 per 100,000 live births for the period November 2020─November 2021. The MMR ranged from 98 in Bagmati Province to 207 in Lumbini Province, with Karnali Province having the highest MMR at 172. Lumbini Province’s MMR was more than twice that of Bagmati Province. The Terai region had an MMR of 147, compared to 159 in the Hill region and 133 in the Mountain region.
These data highlight the persistent disparities across provinces and ecological regions. The report also revealed that non-obstetric complications followed by obstetric hemorrhage were the leading causes of maternal deaths (31% and 25%, respectively). The majority (61%) of deaths occurred within 42 days following the delivery (postpartum period).
While more detailed analyses of the data are anticipated, the findings of the report underscore where Nepal currently stands and the challenges ahead. In this context, it should be noted that Nepal has set the target of achieving an MMR of 70 by 2030, as part of the Sustainable Development Goals.4 The recent mortality status report prompts critical reflection: how does the 2021 MMR compare to the trend over the years and the goal, which is only five years from now?