Abstract:Objective and the contextThis paper examines the beliefs and experiences of women and their families in remote mountain villages of Nepal about perinatal sickness and death and considers the implications of these beliefs for future healthcare provision.MethodsTwo mountain villages were chosen for this qualitative study to provide diversity of context within a highly disadvantaged region. Individual in-depth interviews were conducted with 42 women of childbearing age and their family members, 15 health service … Show more
“…Interviewing a woman who has experienced perinatal death is potentially a sensitive topic (from a Western perspective). However, not a single woman reported distress or seemed distressed, because perinatal deaths are considered such a natural occurrence to everyone; indeed, women rationalised such deaths as due to their Karma (past deeds), Bhagya (fate) or Lekhanta (destiny) [ 57 ]. Indeed, participants felt rather proud to have someone (the first author) coming to their doorstep to listen to how they went through these experiences.…”
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.
“…Interviewing a woman who has experienced perinatal death is potentially a sensitive topic (from a Western perspective). However, not a single woman reported distress or seemed distressed, because perinatal deaths are considered such a natural occurrence to everyone; indeed, women rationalised such deaths as due to their Karma (past deeds), Bhagya (fate) or Lekhanta (destiny) [ 57 ]. Indeed, participants felt rather proud to have someone (the first author) coming to their doorstep to listen to how they went through these experiences.…”
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.
“…They have been grateful for health services provided and expressed their wish for a permanent service. Although fatalism has been often addressed as a key factor for non-reporting of neonatal deaths and non-acceptance of changes, an approach including more active community participation through strengthening of health promotion could lead to positive results 9. There is surely readiness and hope from the side of the community.…”
Section: Discussionmentioning
confidence: 99%
“…Religio-cultural factors play a major role for the lack of improvements. Acceptance of neonatal death as it interpreted as karma , as fate due to previous bad deeds, is one of the major reasons that treatable conditions are neglected 9…”
Section: Discussionmentioning
confidence: 99%
“…According to the ‘Nepal Demographic and Health Survey 2016’,4 8 the overall figures regarding maternal health, the nutritional status of children and attendance at health centres are lowest in State 6, Karnali province. It is quite likely that there is under-reporting of stillbirth, neonatal death and child mortality 9. Studies in 2000 in Mugu district (neighbouring district of Dolpa) have reported an infant mortality as high as 201/1000 10…”
ObjectiveTo assess neonatal and under-five mortality and the health situation for children in Dolpa, a remote rural area of Nepal.Study designMixed methods: quantitative (retrospective cross sectional) and qualitative (semistructured interviews).RationaleProgress in reducing child and newborn mortality in Nepal has reached the remote areas to a limited extent. Furthermore, there may be substantial under-reporting and data may be unreliable.Setting and participantsThe population of Dolpa district is approximately 35 000. We visited 10 randomly selected villages (plus one settlement) with approximately 12 000 inhabitants.MethodologyRecords of the number of deliveries, neonatal and under-five deaths were collected. 100 children (10 different villages) were evaluated for common diseases present during the month prior to the investigation. 20 interviews were conducted about the cultural perceptions of neonatal death and morbidity; in each village at least one interview was undertaken.ResultsThe population of the 10 villages (plus one settlement) under investigation was 12 287. 300 deliveries have taken place during the last 12 months before the study. There were 30 children reported to have died; out of those 20 were in the neonatal period. This reflects an estimated neonatal mortality rate in Dolpa district of 67/1000 live births (95% CI 41-101/1000) and an estimated under-five mortality rate of 100/1000 (95% CI 70-140/1000). In the previous month, out of 100 children surveyed there had been 11 cases of acute lower respiratory infection (ALRI), 7 cases of diarrhoea, 3 cases of isolated malnutrition and 5 cases of malnutrition combined with ALRI or diarrhoea.Based on qualitative interviews traditional beliefs still play a major role, and are partly a hindrance to progress in health. There is also mistrust in the health services and misconceptions about ‘modern’ medicine and treatment facilities.ConclusionDespite progress in child morbidity and mortality in Nepal, some areas remain underserved by health services and neonatal mortality is far above the Nepalese average, which is 29/1000 live births. There is a substantial need to increase and train health staff. Health promotion should be encouraged but cultural perceptions have to be understood if positive behavioural change is to be achieved.
“…3 ), both to protect others from pollution but also as a sign of strength for the woman to give birth alone. Perinatal deaths during this period of isolation are matters of low concern, and often rationalised as Lekhanta (destiny) [ 61 , 88 ] The context created by the above beliefs and practices in these villages is therefore likely to be a social barrier to seeking healthcare and help maintain the high vulnerability of newborn babies to poor perinatal survival. Fig.…”
BackgroundWe aim to examine the gendered contexts of poor perinatal survival in the remote mountain villages of Nepal. The study setting comprised two remote mountain villages from a mid-western mountain district of Nepal that ranks lowest on the Human Development Index (0.304), and is reported as having the lowest child survival rates in the country.MethodsThe findings are taken from a larger study of perinatal survival in remote mountain villages of Nepal, conducted through a qualitative methodological approach within a framework of social constructionist and critical theoretical perspectives. Data were collected through in-depth interviews with 42 women and their families, plus a range of healthcare providers (nurses/auxiliary nurses, female health volunteers, support staff, Auxiliary Health Worker and a traditional healer) and other stakeholders from February to June, 2015. Data were analysed with a comprehensive coding process utilising the thematic analysis technique.ResultsThe social construction of gender is one of the key factors influencing poor perinatal survival in the villages in this study. The key emerging themes from the qualitative data are: (1) Gendered social construct and vulnerability for poor perinatal survival: child marriages, son preference and repeated child bearing; (2) Pregnancy and childbirth in intra-familial dynamics of relationships and power; and (3) Perception of birth as a polluted event: birth in Gotha (cowshed) and giving birth alone.ConclusionsMotherhood among women of a low social position is central to women and their babies experiencing vulnerabilities related to perinatal survival in the mountain villages. Gendered constructions along the continuum from pre-pregnancy to postnatal (girl settlement, a daughter-in-law, ritual pollution about mother and child) create challenges to ensuring perinatal survival in these villages. It is imperative that policies and programmes consider such a context to develop effective working strategies for sustained reduction of future perinatal deaths.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1776-3) contains supplementary material, which is available to authorized users.
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