Postnatal care (PNC) provides care to mothers and newborns in the first six weeks after birth. PNC includes support for breastfeeding, identification and treatment of complications, immunizations, and counseling on nutrition, contraception and resumption of sexual activity. About 2/3 of maternal deaths occur during the postnatal period due to complications like postpartum hemorrhage, preeclampsia, and infections. National policies aim to increase PNC coverage through home visits, skilled birth attendants, and promotion of exclusive breastfeeding. However, utilization of PNC remains low in Nepal due to inadequate resources, transportation barriers, and low prioritization of postnatal care.

1. Jene Shrestha
MPH 1st sem
Pokhara University
1

2.  Postnatal care (PNC) is the care given to the
mother and her newborn baby immediately
after the birth and for the first six weeks of
life(42days)
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3.  Support mother and family
 Prevention, early diagnosis and treatment of
 complications
 Referral
 Counselling
 Support of breastfeeding
 Educate on nutrition, and supplementation
 Counselling contraception and the
resumption of sexual activity
 Immunization of infant
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4.  To increase the awareness of warning signal
and appropriate intervention at all level.
 About 2/3 of the maternal deaths occur
during the postnatal period
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6.  Postpartum haemorrhage
 Pre(eclampsia)
 Pueperal genital infection
 Thromboembolic disease
 Psychological Problem
 Postpartum depression
 HIV/AIDS
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7. • Provide postnatal care in first 24 hours for every
birth:
 Delay facility discharge for at least 24 hours.
 Visit women and babies with home births within
the first 24 hours.
• Provide every mother and baby a total of four
postnatal visits on:
 First day (24 hours)
 Day 3 (48–72 hours)
 Between days 7–14
 Six weeks
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8.  Offer home visits by midwives, other skilled
providers or well-trained and supervised
community health workers (CHWs).
 Use chlorhexidine after home deliveries in high
newborn mortality settings.
 Re-emphasize and support elements of quality
postnatal care for mother and newborn, including
identification of issues and referrals.
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9.  Timing of discharge from a health facility
 Number and timing of post natal care
 Home visits for Postnatal care
 Assessment of the baby
 Exclusive breastfeeding
 Cord care
 Other post natal care for the newborn
 Assessment of the mother
 Counselling
 Iron and folic acid supplementation
 Prophylactic antibiotics
 Psychological support
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10. 1/12/2019 10

11.  Three postnatal check-ups, the first within 24
hours of delivery, the second on the third day and
the third on the seventh day after delivery.
 The identification and management of
complications of mothers and newborns and
referrals to appropriate health facilities.
 The promotion of exclusive breastfeeding.
 Personal hygiene and nutrition education, and
postnatal vitamin A and iron supplementation for
mothers.
 The immunization of newborns.
 Postnatal family planning counseling and services.
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12. 1/12/2019 12
Source: NDHS 2016)

13.  Eighty-one percent of women who delivered in a
health facility received a postnatal check within 2
days after the delivery
 Sixty-four percent of urban women received a
postnatal checkup within 2 days after delivery, as
compared with 48% of rural women.
 Only 39% of women residing in Province 6 received
postnatal care, compared with 68% of women in
Province 4.
 Women in the highest wealth quintile were more
than twice as likely (81%) to receive postnatal care
within 2 days of delivery as women in the lowest
quintile (37%).
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14.  More than half (53%) of women who gave birth in
the 2 years before the survey received their first
postnatal care from a doctor, nurse, or auxiliary
nurse midwife.
 Place of First Postnatal Check Among women who
gave birth in the 2 years preceding the survey, 39%
reported that their first postnatal check was
provided in a government-sector facility and 10%
reported receiving care from the private sector
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15. 1/12/2019 15

16.  Second Long Term Health Plan (1997 – 2017)
 Safe Motherhood Policy (1998)
 National Safe Motherhood Program (2002–2017)
 National Safe Abortion Policy (2003)
 Maternal Incentive Scheme (2005)
 Safe Motherhood and Neonatal Health Long Term
Plan (2006–2017)
 National Policy on Skilled Birth Attendants (2006)
 National Free Delivery Policy (2009)
 Nepal Health Sector Programme Implementation
Plan II (2010 – 2015)
 Nepal Health Sector Support Strategy (2015-2020)
 Safe Motherhood Information Education
Communication (IEC) strategy (2003-2008)1/12/2019 16

17.  To increase the accessibility, availability and
utilization of maternal health care facilities;
 To strengthen the technical capability of maternal
care, particularly at the district level and with
specific emphasis on appropriate referral of high-
risk cases;
 To increase the availability and use of
contraceptives for child spacing and family
planning purposes;
 To raise public awareness about the importance or
the health care of women and in particular ,
maternal health care and safe motherhood;
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18.  MMR will be reduced to 250 per 100000
 CPR will be increased 58.2%
 Percentage of newborns weighing less than 2500
will be reduced to 12 %
 Skilled birth attendant increased to 95%
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19. Objectives
 To ensure that sufficient SBAs are trained and
deployed
 To strengthen referral services
 To strengthen SBA training institutions
 To strengthen supervision and support system
 To develop regulating, accrediting and re-licensing
systems.(15)
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20. Purpose:
 Sustained increase in utilization of quality
maternal health services
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21. Specific emphasis on
 neonatal health,
 recognition of the importance of skilled birth
attendance in reducing maternal and neonatal
mortalities,
 health sector reform initiatives,
 legalization of abortion,
 recognition of the significant levels of mother to
child transmission of HIV/AIDS and
 equity issues in safe motherhood services.
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22.  Emphasized in community-based services; FCHVs, mother’s
group etc
 Expanded in service SBA training
 Improved the coverage of CEOC and BEOC services
 Expansion of medical abortion services
 Piloted community based administration of misoprostol
 Expansion of blood donation service
Target
 to reduce MMR 134 per 100000 live birth and
 to increase births attended by SBA to 60% by 2015;
 to train maternal health care provider to fulfill the demand (5000
by 2012 and 7000 by 2015);
 to expand BEmOC/CEmOC facilities;
 to upgrade sub health post to health post with 24 hours normal
delivery facility throughout the week.(19)
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23.  To reduce MMR to 400 from 850 per 10000 live
birth by 2000
 Policy stated maternal and child health services are
priority program of government.
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24.  Reduction in the MMR from 539 to 134 per
100,000 by 2017
 Increase in % of deliveries by SBA to 60% by
2017
 Increase % of deliveries taking place in health
facility to 40% by 2017.
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25. 1/12/2019 25
National Health Policy 2014
 The policy put emphasis on producing skilled
HR for safe motherhood and provision of a
doctor and a nurse in every VDC & a midwife in
every ward.
Nepal Health Sector Strategy 2015 – 2020
 G1: Reduction in MMR below 125 per 10000 live
birth by 2020.

26. 1/12/2019 26

27.  Birth Preparedness Package and community level
maternal and newborn health:
 Distribution of Matrisurakshya chhaki to prevent post
partum haemorrhage
 birth preparedness and complication readiness
(preparedness of money, health facilities for the delivery,
transport and blood donors);
 self-care (food, rest, no smoking and alcohol) in
pregnancy and postpartum periods;
 antenatal care (ANC), institutional delivery and postnatal
care (PNC) (iron, tetanus toxoid, albendazole);
 essential newborn care; and
 identification of and timely care seeking for danger signs
in the pregnancy, delivery, postpartum and newborn
periods.
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28.  Trained Human resources: SBA trained human
resources
 Expansion and quality improvement of
service delivery sites : BEONC and CEONC
services
 Nyano Jhola Programme
 Aama and Newborn Programme: Incentives to
health workers for home delivery, decreased to Rs
200 to discourage home delivery
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29.  A special focus is on increasing access in
rural and remote places and to poor, Dalit
and other marginalized people with high
unmet needs and to postpartum and post-
abortion women, the wives of labour migrants
and adolescents.
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30.  Inadequate information on PNC care
 Inadequate trained human resources
 Limited health infrastructure
 Economic status of women
 Transportation
 Cultural and geographical factors
 Perceived low importance of care in the
postpartum period
 Poor coordination of family planning
services, ANC providers, maternity wards,
and postnatal care providers also
contributed to the high unmet need for PPFP
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31.  PNC related health education and awareness
campaigns
 Recruitment of trained staff and training
should be given to existing staff
 Women empowerment
 Involvement of men in maternal care
 Coordination among institution
 Emphasizing on family support
 Home visits by trained staff
 Focusing on Postnatal care during
formulation of policies
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32.  DoHS. Annual Report: Department of Health
Services 2073/74 (2015/2016). Kathmandu,
Nepal Department ofHealth Services, Ministry of
Health, Government of Nepal; 2017.
 NDHS. Maternal and Newborn Health Care; P
151- 193: 2016.
 World Health Organization. (n.d.). World Health
Organization South East Asia Regional Office.
Retrieved 2019, from
http://www.searo.who.int/entity/health_situation
_trends/data/chi/postnatal-care-for-mothers-
and-babies/en/
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33.  Harvard School public health. (2014).
Postnatal care in Nepal. Retrieved from
Maternal health task force.
 WHO. (2013). WHO recommendations on
Postnatal Care and newborn.
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