Associate Professor, School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal. Correspondence:
Consultant, Mother and Infant Research Activities (MIRA), Kathmandu, Nepal.
Sex Reprod Health Matters. 2021;29(2):1907026. doi: 10.1080/26410397.2021.1907026.
Nepal made impressive progress in reducing maternal mortality until 2015. Since then, progress has stagnated, coinciding with Nepal's transition to a federation with significant devolution in health management. In this context, we conducted key informant interviews (KII) to solicit perspectives on policies responsible for the reduction in maternal mortality, reasons for the stagnation in maternal mortality, and interventions needed for a faster decline in maternal mortality. We conducted 36 KIIs and analysed transcripts using standard framework analysis methods. The key informants identified three policies as the most important for maternal mortality reduction in Nepal: the Safe Motherhood Policy, Skilled Birth Attendant Policy, and Safe Abortion Policy. They opined that policies were adequate, but implementation was weak and ineffective, and strategies needed to be tailored to the local context. A range of health system factors, including poor quality of care, were identified by key informants as underlying the stagnation in Nepal's maternal mortality ratio, as well as a few demand-side aspects. According to key informants, to reduce maternal deaths further Nepal needs to ensure that the current family planning, birth preparedness, financial incentives, free delivery services, abortion care, and community post-partum care programmes reach marginalised and vulnerable communities. Facilities offering comprehensive emergency obstetric care need to be accessible, and in hill and mountain areas, access could be supported by establishing maternity waiting homes. Social accountability can be strengthened through social audits, role models, and empowerment of health and management committees.
尼泊尔在降低孕产妇死亡率方面取得了令人瞩目的进展，直到 2015 年。此后，进展停滞不前，恰逢尼泊尔向联邦制过渡，卫生管理权力大幅下放。在此背景下，我们进行了关键知情人访谈（KII），以征求对降低孕产妇死亡率的政策、孕产妇死亡率停滞不前的原因以及加快降低孕产妇死亡率所需干预措施的看法。我们进行了 36 次 KII，并使用标准框架分析方法对转录本进行了分析。关键知情人确定了尼泊尔降低孕产妇死亡率的三项最重要政策：《安全孕产政策》《熟练接生员政策》和《安全堕胎政策》。他们认为政策是充分的，但实施不力，需要根据当地情况制定策略。一系列卫生系统因素，包括护理质量差，被关键知情人认为是导致尼泊尔孕产妇死亡率停滞不前的根本原因，还有一些需求方面的因素。关键知情人表示，为了进一步降低孕产妇死亡人数，尼泊尔需要确保当前的计划生育、生育准备、经济激励、免费分娩服务、堕胎护理和社区产后护理计划覆盖边缘化和脆弱社区。需要使提供全面产科急诊服务的设施能够获得，并在丘陵和山区，可以通过建立产妇等候之家来支持获得这些设施。可以通过社会审计、树立榜样和增强卫生和管理委员会的能力来加强社会问责制。
