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Increasing Skilled Birth Attendance to Reduce Maternal and Newborn Mortality

Woman in blue with wrapped baby.

With 80% of the Nepal’s population living in rural areas amid challenging topography, most women in Nepal still deliver at home and without the support and care of a skilled healthcare provider. When the ACCESS Program started, available data from the Nepal Demographic and Health Survey (NDHS 2001) found just 10.9% of women surveyed had delivered with a “health professional (doctor or nurse/midwife)” and just 9% in a health facility. Further, while remarkable reductions in child mortality rates have occurred in Nepal over the last decade, an estimated 32,000 children still die each year during their first month of life—with over two-thirds not surviving their first week.

From 2005-2007, the ACCESS Program worked in partnership with the Government of Nepal and development partners to increase skilled birth attendance and reduce maternal and newborn mortality.

Graph 1. Findings from the 2006 DHS on Skilled Birth Attendance - from left to right: ANC from SBA (second highest), Delivery at a health facility (lowest), Delivered with SBA (highest)

In support of national efforts to implement the National Policy on Skilled Birth Attendants (2006), ACCESS implemented several key activities to increase skilled birth attendance including:

  • A review of issues related to Increasing Skilled Attendance at the Community Level in Nepal—including recommendations for strengthening current systems to prepare and produce providers able to provide skilled attendance in communities
  • A study of existing models of skilled birth attendance to identify key characteristics as well as community perceptions of and needs for services with findings detailed in Utilization of Rural Maternity Delivery Services in Six Districts of Nepal: A Qualitative Study
  • Development of a national generic training package entitled Maternal and Newborn Care Learning Resource Package (MNC LRP) for Skilled Birth Attendants in English and Nepali in use for different cadres in both inservice and preservice systems
  • Development of resources to support the use of the MNC LRP in national training systems such as three inservice training curricula and training site quality improvement (QI) tools/standards

To aid other projects and governments to develop similar initiatives, ACCESS documented its efforts in several publications: Creating a MNC LRP in Nepal; Supporting the MNC LRP Use: Experiences in Nepal; and Strengthening Inservice Training Sites for SBAs Using Standards in Nepal.

In support of national efforts to reduce newborn mortality, ACCESS implemented several key activities including:

  • Development and testing of a package of community interventions (including exclusive breastfeeding, infection prevention and treatment and skin-to-skin care) aimed at identifying and managing low birth-weight (LBW) infants
  • Evaluation of the effect of this community model on identifying and managing LBWs for targeted care at the home level by families and community workers—detailed in Providing Care for LBW Infants: A Community Level Approach in Kanchanpur district, Nepal
  • Development of national guidelines managing LBW infants, based on community experiences
  • Promotion of Kangaroo Mother Care in selected healthcare facilities, described in the ACCESS publication Introducing Kangaroo Mother Care Services in Nepal

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