A qualitative study about the gendered experiences of motherhood and perinatal mortality in mountain villages of Nepal: implications for improving perinatal survival

Paudel, Mohan; Javanparast, Sara; Dasvarma, Gouranga; Newman, Lareen

doi:10.1186/s12884-018-1776-3

Cited by 13 publications

(52 citation statements)

References 57 publications

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“…Two points emerge from these findings: first, the importance of taking cultural determinants into consideration in formulation and implementation of any policy related to newborn and maternal health, and secondly, addressing well the quality of the health workforce and training to include community cultural issues. The importance of paying attention to a variety of cultural factors contributing to perinatal sickness and death is further discussed in two other papers: religio-cultural factors such as Karma, fate and destiny [ 57 ], and the gendered cultural context of motherhood [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices

Paudel

Javanparast

Newman

et al. 2018

J Health Popul Nutr

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BackgroundThis paper aims to examine the health care contexts shaping perinatal survival in remote mountain villages of Nepal. Health care is provided through health services to a primary health care level—comprising district hospital, village health facilities and community-based health services. The paper discusses the implications for future policies and practice to improve health access and outcomes related to perinatal health. The study was conducted in two remote mountain villages in one of the most remote and disadvantaged mountain districts of Nepal. The district is reported to rank as the country’s lowest on the Human Development Index and to have the worst child survival rates. The two villages provided a diversity of socio-cultural and health service contexts within a highly disadvantaged region.MethodsThe study findings are based on a qualitative study of 42 interviews with women and their families who had experienced perinatal deaths. These interviews were supplemented with 20 interviews with health service providers, female health volunteers, local stakeholders, traditional healers and other support staff. The data were analysed by employing an inductive thematic analysis technique.ResultsThree key themes emerged from the study related to health care delivery contexts: (1) Primary health care approach: low focus on engagement and empowerment; (2) Quality of care: poor acceptance, feeling unsafe and uncomfortable in health facilities; and (3) Health governance: failures in delivering health services during pregnancy and childbirth.ConclusionsThe continuing high perinatal mortality rates in the mountains of Nepal are not being addressed due to declining standards in the primary health care approach, health providers’ professional misbehaviour, local health governance failures, and the lack of cultural acceptance of formalised care by the local communities. In order to further accelerate perinatal survival in the region, policy makers and programme implementers need to immediately address these contextual factors at local health service delivery points.Electronic supplementary materialThe online version of this article (10.1186/s41043-018-0148-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices

Paudel

Javanparast

Newman

et al. 2018

J Health Popul Nutr

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“…Involving FCHVs in these wide ranges of interventions would aid in the integration of maternal, child and newborn services thus leading to the continuum of care and better outcomes in child survival [21,24]. It is however equally important to consider the work burden of FCHVs while task shifting and also capacitate FCHVs to deal with cultural and religious issues that surround during pregnancy and childbirth in Nepal as identified in other studies [25,26].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey

Bhattarai

Khanal

et al. 2020

BMC Health Serv Res

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Background: Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs. Methods: A national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ 2) followed by logistic regression. Results: Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers' group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technologywise, FCHVs who were using mobile were more likely to provide child health services. Conclusions: FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers' group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.

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“…Within the health system itself, besides viewing childbirth and perinatal survival as a medical emergency, to prevent persistent occurrence of perinatal deaths it should be acknowledged first as an agenda of health promotion, as enshrined in the Ottawa Charter for Health Promotion [ 45 ]. Genuine actions are needed in policy communities to reorient health services and the role of health service providers, and engage individuals and communities as true partners to prevent deaths which continue to occur due to socio-cultural factors [ 38 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach

Paudel

Javanparast

Dasvarma

et al. 2019

BMC Health Serv Res

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BackgroundNepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal’s perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal.MethodsSix key policy documents covering the period 2000–2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis.ResultsThe analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal.ConclusionsTo better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity.

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A qualitative study about the gendered experiences of motherhood and perinatal mortality in mountain villages of Nepal: implications for improving perinatal survival

Cited by 13 publications

References 57 publications

Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices

Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey

A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach

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