National population and housing census 2021: a report on maternal mortality

Abstract

Executive Summary: The Sustainable Development Goals include the target of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births, with no country having an MMR that exceeds twice the global average. Nepal has committed to reduce the MMR from 281 per 100,000 live births in 2006 to 116 by 2022, 99 by 2025, and 70 by 2030. This Nepal Maternal Mortality Study 2021 is the first ever joint undertaking of the Ministry of Health and Population (MoHP), the National Statistics Office (NSO), the Nepal Health Research Council, and health development partners for estimating the MMR and identifying the causes of maternal deaths – during pregnancy, delivery, and postpartum periods – in Nepal. By doing so, it intends to inform evidence-based policies and programs at the federal, provincial, and local levels. The MoHP, in collaboration with the NSO, made an arrangement through a Memorandum of Understanding, where the census enumerators, as a part of their regular work, collected data on live births and deaths of women of reproductive age (WRA) in the enumerated households for the last 12 months preceding the National Population and Housing Census 2021. In the first phase, those Census enumerators then completed the death notification forms to identify pregnancy-related deaths, and submitted them to the census supervisor and notified the deaths to the pre-identified and trained local level health workers. In the second phase of the study, the local level health workers visited the household of each of the deceased women, verified the information and identified the pregnancy related deaths. For each pregnancy-related death identified, a verbal autopsy was conducted by trained health workers using the verbal autopsy form. The MMR was found to be 151 per 100,000 live births in Nepal, with higher ratios in the Lumbini and Karnali provinces (207 and 172 per 100,000 live births respectively) and a lowest ratio in the Bagmati province (98 per 100,000 live births). Of the 12,976 deaths among women of reproductive age (15-49 years), 653 were pregnancy-related, comprising five percent of the total deaths in this age group. Of the 653 pregnancy-related deaths, 622 (95 percent) were classified as maternal deaths. The overall proportion of maternal deaths among the deaths of women of reproductive age was 4.8 percent. Only 611 maternal deaths were analysed further for causes and other attributes due to lack of sufficient information for 11 maternal deaths. The majority of the maternal deaths occurred in the postpartum period (61 percent), while thirty-three percent occurred during pregnancy and six percent during delivery. Nearly half of the deaths (47 percent) were reported in the Lumbini and Madhesh provinces. One in ten maternal deaths was among adolescent mothers. The majority of the deaths (57 percent) occurred in health facilities, whereas 26 percent occurred at home. Out of 412 women who died during delivery and post-partum period, fifty-three percent had attended all four antenatal care visits; while of the 173 women who died between 7-42 days of delivery 45 percent had attended all three postnatal care visits as per the protocol.