Nepal lagging in safe motherhood

Nepal made significant gains in maternal and neonatal healthcare in the last 25 years, but the gains have stalled and the country may not meet global targets.

The national maternal mortality rate (MMR) dropped from 536 per 100,000 live births in 1996 to 151 by 2021. This progress was driven by improvements in healthcare infrastructure, the work of female health volunteers, improvements in perinatal care and a significant increase in hospital deliveries.

The National Safe Motherhood Program, Ama Surakshya initiative and the Female Community Health Volunteers (FCHV) have contributed to progress in reducing MMR and increasing institutional deliveries.

But the World Health Organisation (WHO) 2025 report puts Nepal’s MMR at 142 per 100,000 live births, which means it has flatlined for the past four years.

The national MMR average hides regional disparities, with maternal deaths remaining high in Lumbini (207) and Karnali (172). Despite Lumbini having a relatively higher female literacy, the province has low institutional deliveries and poor hospital care. Similarly, there are wide disparities among ethnic communities and socio-economic groups.

“Societal norms, education for girls, and gender rights play a critical role in shaping maternal and women's health outcomes,” explains public health expert Aruna Uprety. “Comprehensive awareness about sexual and reproductive health is essential, especially in rural areas where there is still a significant knowledge gap.”

Indeed, there is a direct inverse correlation between female literacy and child marriage with MMR across Nepal. The cause of maternal deaths, perinatal care including post-partum haemorrhage need particular focus.

Under Nepal’s national Sustainable Development Goals (SDGs) the target is to reduce MMR to 116 by 2030, against a global target of 70 per 100,000 live births.

The National Planning Commission has also set its own target to improve maternal health outcomes, but they are inconsistent— while one section of its 16th National Plan sets a MMR goal of 100 by 2029, another section of the same document presents a more ambitious goal of 85.

Such inconsistency even in target-setting creates confusion and undermines planning efforts, in monitoring, and fulfilment of maternal health goals — especially when existing health statistics are unreliable to begin with.

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“Conflicting targets and the lack of clarity at the highest levels of national planning create uncertainty for maternal health professionals, making it difficult to align their efforts and strategies,” says Laxmi Tamang, South East Asia Board Member of the International Confederation of Midwives (ICM).

Meanwhile, issues with budget deployment, and a lack of coordination between local and international agencies have also affected maternal and child health outcomes, which has been further exacerbated by the USAID funding freeze. The aid agency had allocated $72 million to reduce MMR and enhance access to healthcare in Nepal for this year.

Laws targeted towards sexual and reproductive health have played a significant role in improving maternal health outcomes in Nepal. Legalisation in 2002 brought down the number of unsafe abortions. Better access to reproductive health also reduced conditions including uterine prolapse.

Currently, over half of the maternal deaths in Nepal occur at health facilities, 26% at home and 17% during patient transport or referrals.

“Legal remedies have definitely helped to reduce maternal mortality rates, but it is important that both men and women be informed about women’s health,” says Uprety.

However, Nepal’s maternal health sector is unlikely to see meaningful progress as long as critical shortages of skilled health providers persist and the retention of trained professionals remains weak. Strengthening legislation, scaling training, and improving rural infrastructure are critical to aligning Nepal with global standards and achieving SDG maternal health targets by 2030.

Says Tamang: “Maternal health must be recognised as a fundamental gender issue. Implementing existing policies, as well as forming a gender-responsive budget and increasing targeted investments in this sector are essential to ensuring equitable and effective healthcare for women.”

Midwives save lives

Along with doctors and nurses, midwives are crucial to Nepal’s maternal health workforce, and play an important role in improving Nepal’s maternal health and childcare outcomes.

However, those working in midwifery are hindered by the lack of professional recognition and systemic challenges in Nepal, leading to discontent among doctors and nurses in the maternal, reproductive and child care sectors, who fear they will be replaced by midwives.

There is a lack of clarity even within the medical community about the job description for doctors and nurses, versus that of midwives. While nurses are taught about multiple human body systems, midwives are specifically trained in sexual and reproductive health to assist in both home and institutional deliveries.

Obstetric nursing involves working alongside doctors to administer perinatal care. In contrast, midwives are exclusively trained to only handle pregnancies, deliveries, and postnatal care that are without complications.

The introduction of midwifery education in Nepal in 2016 marked a significant step toward improving maternal and newborn health outcomes. But there are currently only 91 professionally trained midwives across the country, which is significantly short of Nepal’s target of having 6,410 midwives by 2030.

Says Kiran Bajracharya, founder and former president of the Midwifery Society of Nepal (MIDSON), “A trained midwife is capable of reducing two-thirds of prevalent maternal deaths in Nepal.”

Even so, there have been some notable gains: the establishment of the Midwife-Led Antenatal Clinic (MLAC) at Paropakar Maternity and Women’s Hospital in Kathmandu in 2023 placed professional midwives at the centre of maternal health services for the first time in an institutional setting, marking a shift in antenatal care in Nepal.

The MLAC has provided personalised care, counselling, and emotional support to over 4,000 pregnant women so far. And unlike the obstetrician model of care, deliveries involving midwives at the MLAC allow husbands and partners to be present during childbirth.

“It is imperative that the government prioritise midwifery as a key step toward strengthening the maternal health system,” says Bajracharya. “There is an urgent need to create dedicated positions and deploy trained personnel to address existing workforce gaps.”