Nepal Maternal Mortality Report 2021 : The Nepal Maternal Mortality Study (NMMS) following the National Population and Housing Census 2021 is a landmark, joint initiative undertaken by the Ministry of Health and Population and the National Statistics Office to estimate maternal mortality ratios (MMR) at the federal and provincial levels and set the ground for the MMR estimation at local levels. More importantly, this study identifies the causes and locations of maternal death in Nepal. This study is notable for its large population coverage, rigorous methodology, and stakeholder collaboration.
The study estimated the MMR of the country at 151 per 100,000 live births. This calculation was done using the Census data on live births and maternal deaths. The study also uncovered inequalities in MMR between different provinces in the country. For example, Lumbini and Karnali provinces had higher MMRs of 207 and 172, respectively, while Bagmati province had the lowest MMR at 98 per 100,000 live births. Similarly, the pregnancy-related mortality ratio was 158 per 100,000 live births.
The study has found that many maternal deaths in Nepal are due to preventable causes such as haemorrhage and hypertensive disorders during pregnancy. However, a significant number of deaths are also caused by nonobstetric complications, such as intentional self-harm.
The NMMS 2021 serves as an initiative to strengthen community-based maternal death surveillance and response in the country. For instance, in this study, local-level health workers were trained in screening for pregnancy-related deaths and conducting verbal autopsies (collecting information about the circumstances of death through interviews with family members and other sources) to determine the cause of death. This approach played a crucial role in identifying and responding to maternal deaths. Moreover, collecting this information and using it to identify trends and risk factors extends opportunities to develop locally tailored targeted interventions to address causes of maternal mortality across the three tiers of government. The study findings can be used at all levels of government and in communities to design targeted interventions to increase the coverage of quality maternal health services and prevent maternal deaths from preventable causes, paving the way for the country to achieve the Sustainable Development Goals.
This study sets a precedent for conducting nationwide censuses of maternal deaths in future censuses to estimate the MMR and identify the causes of death periodically. This will provide a strong evidence base to inform investment and interventions to improve maternal health in Nepal.
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