2014年-世界发展银行全球_Nepal___Maternal_and_Reproductive_Health_at_a_Glance_4页_1mb

Nepal: Maternal and Reproductive Health at a Glance Summary

Core Content

Nepal has made significant progress in achieving several Millennium Development Goals (MDGs), particularly in reducing extreme poverty and improving education. However, despite achieving MDG 5 (reducing maternal mortality by three-quarters between 1990 and 2015), challenges remain in ensuring equitable access to maternal health services and addressing nutritional deficiencies among pregnant and lactating women.

Main Points

• MDG Achievements:

  • Nepal achieved MDG 5, with the maternal mortality ratio (MMR) decreasing from 790 per 100,000 live births in 1990 to 190 in 2013.
  • The country is classified as "on track" for MDG 5, with an average annual decline of 6% in MMR.
  • The total fertility rate (TFR) dropped from 5.2 in 1990 to 2.4 in 2012, and contraceptive prevalence rate (CPR) increased to 49.7% in 2011.
  • Despite these improvements, 27% of women still have unmet needs for family planning.

• Maternal Health Services:

  • Skilled Birth Attendance (SBA): Only 36% of births are attended by skilled medical personnel.
  • Antenatal Care (ANC): 58.3% of women received ANC from skilled providers in 2011, but only 50% received the recommended four or more visits.
  • Postnatal Care: 44.5% of women received postnatal care within the first two days after delivery.
  • Delivery Location: Most births occur at home (64.7%), with only 35.3% taking place in institutions.
  • Barriers to Institutional Delivery: Belief that it is unnecessary (62.2%), distance (13.5%), cost (4.5%), and lack of customs (9.5%).

• Equity in Access:

  • Residence Disparities: Urban women are more likely to access ANC (87.9%) and SBA (72.7%) than rural women (54.9% and 32.3%, respectively).
  • Wealth Disparities: The richest quintile has 91.8% ANC coverage, while the poorest quintile has only 33.3%.
  • Skilled Birth Attendance by Wealth: The richest quintile has 81.5% SBA coverage, compared to 10.7% in the poorest quintile.

• Nutritional Deficiencies:

  • 18.2% of women aged 15–49 are undernourished (BMI < 18.5 kg/m²).
  • 35% of women are anemic, with 28.9% mildly anemic, 5.7% moderately anemic, and 0.3% severely anemic.
  • Only 40.3% of mothers receive a vitamin A dose in the first two months after the birth of their last child.

• Key Interventions:

  • Aama Safe Motherhood Program: Provides free delivery services and supply- and demand-side incentives to increase institutional deliveries.
  • Micro-planning Exercises: Aimed at improving the accessibility and quality of reproductive, maternal, newborn, and child health (RMNCH) services.
  • Financial Protection: Implemented to reduce the cost barrier for accessing health services.
  • Behavior Change Communication: Expands through peer educators in remote and poor areas, focusing on improving family planning uptake and male involvement.
  • Comprehensive Sexuality Education: Integrated into schools to address the needs of adolescents and youth.

Key Information

• Economic Context: Nepal is a landlocked country with a population of 27 million and a per capita income of $1,470 in 2012. The economy is primarily based on subsistence agriculture, but remittances contribute over 25% of GDP.
• Poverty Reduction: Poverty has decreased by 2.5 percentage points annually since 2004, with 25% of the population living below the poverty line in 2010–11.
• Demographic Trends: A large youth population (36% under 15) presents an opportunity for a demographic dividend.
• Education Progress: Nepal has eliminated gender disparities in primary and secondary education, with women holding one-third of parliamentary seats. However, adult literacy rates remain uneven, with 71% for males and 46.7% for females.

Conclusion

Nepal has made substantial progress in maternal and reproductive health, particularly in reducing maternal mortality and improving contraceptive use. Nevertheless, significant disparities in access to maternal health services persist, especially between urban and rural areas, and among different wealth quintiles. Nutritional deficiencies among women of reproductive age also remain a challenge. To further improve outcomes, Nepal must continue to implement targeted interventions, enhance the quality of health services, and ensure equitable access for all women.