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Increasing Access Barriers
The increasing access component of the Nepal Safer Motherhood
Project (NSMP) aims to improve the social context for,
and access to, midwifery and obstetric services by addressing
six major barriers to care in Nepal:
- Lack of knowledge on danger signs during pregnancy
and the medical services available to help.
- Traditional attitudes towards childbirth that may
discount danger signs and discourage care seeking. Contributing
factors include the low status of women in families and
the concept of Laj (shame)
when discussing women's health.
- Poor physical access to health centres caused by inadequate
transport services and the poor condition of many roads,
trails and bridges. There is also a shortage of patient
carriers, such as 'Dokos' (baskets) and 'Dolas' (hammocks)
in villages.
- Financial barriers created by the need to raise large
sums of money quickly to meet the costs of emergency
obstetric care (EmOC).
- Inadequate referral practices caused by the low level
of skills among community health workers that, in turn,
lead to delays in correctly identifying problems and
making timely referrals.
- Inadequate institutional support, including funding
and other resources, for the promotion of safe motherhood
at district level.
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 NSMP responds to
these barriers through:
- Multi-sectoral approaches involving
a range of partners and district-level safe motherhood
forums. NSMP believes
that safe motherhood is not just a health issue, but a major
social concern. Therefore, it is vital to involve a wide range
of government and civil society organisations in promoting relevant
activities, including awareness raising among the general public.
- Behaviour change
communication (BCC).
At the heart of all of these activities lie specialist communications
techniques that use a wide variety of methods and media
- Changing
the social context. Through its BCC work,
NSMP seeks to enhance the
standing of women within families and communities and to
advocate for their greater involvement in local decision-making.
- Supporting practical needs. The project and its partners support
the establishment of emergency
obstetric funds and transport schemes that
enable practical access to health services. NSMP also
creates partnerships and links with other, Nepal-based, organisations
that support improvements to infrastructure.
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