Nepal Safer Motherhood Project - Working to improve the Utilisation of Quality Midwifery and Essential Obstetric Care Services in Nepal Visit the DFID Website HMGN logo

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Pregnancy and Childbirth in Nepal

 

Attitudes and practices relating to pregnancy and childbirth in Nepal are influenced by social, cultural and religious factors. These are often so strong that, at times, they can seem to be insurmountable barriers to reducing maternal mortality using rational methods.


In addressing this complex area, the Nepal Safer Motherhood Project (NSMP) has developed a strong understanding and appreciation of local beliefs and practices in order to reinforce positive aspects and help to transform others. Both project staff and partners make continual and concerted efforts to study local antenatal, childbirth and neonatal practices.

 

Some of the key issues include:

 

Marriage and Childbirth

Women in rural Nepal marry at an average age of 16, but often as young as 13. Newlyweds live with the husband's parents and about 25% of women give birth to their first child before they are 18. Family sizes tend to be large (the total fertility rate was 4.4 in 2001), since children are seen as divine blessings. There are also strong economic and social arguments in favour of larger families.

 

Women are expected to deliver children without drawing attention to themselves and to bear any obstetric difficulties without complaint. Over 90% of births take place at home, with traditional birth attendants (TBAs) present in only 25% of cases. Mothers-in-law normally support their daughters-in-law during delivery, while husbands have the final say in financial decisions about whether any further care is sought.

 

a young child Perceptions about Childbirth

In Nepal the blood and bodily secretions associated with childbirth are widely viewed as unclean and polluting. As a result, most people are reluctant to help women who require obstetric assistance. This helps to explain the protests made by men in the community and transport workers when asked to carry women in labour to hospitals.

 

The attitudes of women themselves towards pregnancy are largely shaped by 'laj' (shame and fear of loss of dignity and prestige). This becomes an important factor from the start of a girl's menstruation and has a powerful influence on most of her social interactions. It is partly for this reason that many women do not talk about any pregnancy-related problems until complications have set in.

 

Perceived Causes of Complications

Obstetric difficulties that arise, including those leading to maternal death, are generally attributed to fate, karma, witchcraft or bad spirits. Witches and spirits, such as 'bhut-pret', are thought to be the single greatest danger during pregnancy and, as a result, women tend to downplay their condition in order to avoid attracting such supernatural forces. For this reason, 'Guruwas' (traditional healers) are often called out during labour.

 

Mothers-in-law, traditional healers, TBAs and, possibly, health post staff are the most likely people to support a woman during an obstetric emergency. Husbands generally know little about childbirth, feel that it is not their business and leave decision-making to older women and traditional service providers.


Two women sitting outside a clinicNSMP's response

Clearly, such deeply engrained attitudes and practices cannot be changed overnight, even with the improved availability of essential obstetric care (EOC) services. Therefore, NSMP uses a variety of communication techniques, tailored to each local cultural context and implemented by local partners. These aim to improve levels of knowledge about danger signs, change attitudes in favour of women's decision-making and raise the status of women both within households and in society at large.

 

TBAs and mothers are encouraged to work as catalysts for change and to uphold good EOC practices.NSMP monitors the change in knowledge, attitudes and perceptions that result from such activities through Knowledge Surveys and the community-based Key Informant Monitoring Tool.

     
 

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