Safe Motherhood Programme
Reduction In Maternal Mortality

By Jhabindra Bhandari

MATERNAL mortality is still a leading cause of death among women of reproductive age between 15 and 49, in most developing countries. According to a joint statement issued by WHO, UNICEF, UNFPA and the World Bank, nearly 600,000 women die every year as a result of the complications of pregnancy and child birth. And this huge social tragedy, unfortunately, leaves many others with serious and life long health problems.

Unbelievable

Of central importance to note here is that South Asia is home to 22 per cent of the world’s population but accounts for 50 per cent of world’s maternal deaths. The magnitude of the problem in the region is unbelievable. This explicity pinpoints a social injustice—as most such deaths are avoidable. And, this reflects the lack of value placed on a woman’s life by society.

The first international conference on safe motherhood was held in Nairobi in 1987. This is regarded as a major landmark in the history of innovative efforts to reduce maternal mortality and morbidity and improve maternal health in poor developing countries—where the pressing needs are emerging significantly in the recent years.

Maternal mortality is one of the highest in Nepal. Family Health Survey in 1996 estimated Maternal Mortality Ratio (MMR) at 539 per 100,000 live births. This clearly indicates an urgent need of accelerated action to improve the present situation of maternal health. It is necessary to achieve significant improvement in the way maternal health care is presently provided.

The history of national attempts to reduce maternal mortality and morbidity is not so long. In 1993, the government initiated national safe motherhood programme, (NSMP) with the support from bilateral, multi-lateral agencies including national and international non-governmental organisations (I/NGOs). This further gained momentum with the formulation of National Safe Motherhood Plan of Action (NSMPA) for the period 1994-1997. The plan largely focussed on the need of inter-sectoral collaboration and multi-sectoral approach.

The new health policy (1991) and 20-year long. Second Long Term Health Plan (1997-2017) has also given high priority to the reduction of maternal mortality and morbidity among many other public health problems. According to annual report of Department of Health Services—1999/2000, the target of this long term plan is to reduce maternal mortality rate to 250 per hundred thousand births by the end of 2017.

Recognising that every pregnancy is at risk, the NSMP has been mainly adopting two major strategies. First, to provide twenty four hours essential obstetric services—either comprehen-sive or basic. Second, to ensure the presence of skilled attendants at deliveries, especially in home setting.

The annual review of the programme has identified some problems. For example: low coverage of antenatal, post-natal care and delivery services. Much more important is that there is lack of trained services providers—especially in the remote district hospitals and peripheral health facilities. Focus is now on capacity building of Maternal and Child Health Workers (MCHWs) at the sub health posts to provide basic maternity services.

In order to support the national safe motherhood programme, the role of external development partner has been crucial. It is encouraging to note that reproductive health programmes are operational in different districts of the country with the support from Department for International Development (DFID), UNICEF, UNFPA, GTZ and active participation of many other national and international NGOs in the country.

One of the important objectives of the NSMP is to strengthen essential obstetric care through improvement of facilities, provision of essential drugs and equipment, and to develop the capacity of service providers at district hospitals. On the other side, there is crucial need to establish functioning referral between peripheral health facilities and district hospitals.

In addition to this, education that empowers women to make decisions about their lives and health is key to reducing maternal mortality. So, community education and mobilisation are very important to increase access and utilise the EOC services at district hospitals and the peripheral health facilities. Sadly, these strategies have not reached the remote parts of the country effectively. After all, the purpose of community mobilisation is to ensure that appropriate health seeking behaviour becomes part of local social norms.

In order to overcome the social, economic and cultural barriers, empowering communities by providing access to information, education and communication is extremely important—in terms of raising community awareness on danger signs of pregnancy, importance of emergency funds and community support for local transport to reach the health facilities without any delay.

Other important issues related to maternal mortality are the early marriage and pregnancy, unwanted pregnancy and abortion. Millions of women around the world risk their lives due to unwanted pregnancy and abortion. Safe motherhood programmes should include promotion of family and community support for delayed marriage and child bearing, timely and planned pregnancies and education for all women.

Maternal mortality is increasingly being recognised as a violation of human rights to survive pregnancy and child birth. Interestingly, the governments of Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lankan share a strong commitment to human rights, including the rights of women and children. This commitment has been made explicit through ratification of the Convention on the Rights of Child (CRC) and Convention on the Elimination of All forms of Discrimination Against Women (CEDAW).

Until women are empowered and their human rights to quality services and information during and after pregnancy and child birth are fully realised, the impacts will be minimal. And also true that safe motherhood is vital social and economic investment as its impact on individuals, families and communities are potentially large.

Challenge

As women’s overall health influences their maternal health, making safe motherhood a reality in the years to come is a strong challenge of policy makers and planners of both national and international communities. Facing such a daunting challenge of reducing maternal mortality calls for strong political will and commitment. Inter-sectoral collaboration and multi-sectoral response are key to achieve the goal of safe motherhood programme.

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