It includes about maternal mortality, its trends and its causes in Nepal. It also includes poor nutritional status of Nepalese women.

1. MATERNAL
MORTALITY
PREPARED BY:
Prabita Shrestha
B.Sc. Nursing 4th Year

2. Definition:
 Death of a woman while pregnant or within 42 days of termination of
pregnancy from any cause related to or aggravated by pregnancy or
its management but not from accidental or incidental causes.

3. Maternal mortality rate (MMR):
 MMR is the annual number of female deaths per 100,000 live births
from any cause related to or aggravated by pregnancy or its
management (excluding accidental or incidental causes).
 The MMR includes deaths during pregnancy, childbirth, or within 42
days of termination of pregnancy, irrespective of the duration and site
of the pregnancy, for a specified year.
 MMR: 258 deaths/100,000 live births (2015 est.) in Nepal.

5. Incidence and Trends of maternal mortality
Globally

7. Incidence and Trends of maternal mortality
Globally
 More than 1 woman dies every minute
 99% of these in developing countries

10. In South Asia
Incidence and Trends of maternal mortality

11. In Nepal
 1500 death occur in a year (2015)
 6 women die a day
 1 death in 4 hour
Incidence and Trends of maternal mortality

13. Family Tragedy
 Loss of active member of family
 95% of infants co-mothers who die are dead before 5th birthday
 Morbidity- for every maternal death, 15 develop severe disease or
disability
When do women die?
 16.6% within 24 weeks pregnancy
 11.4% after 24 weeks of pregnancy
 9.9% at the time of delivery
 62.1% after the birth of the baby
Incidence and Trends of maternal mortality

14. Where? Of what cause?
67.4% at home 47% PPH
11.4% on the way to get services 16% Obstructed labor
14.4% in the hospital 14% Eclampsia/ pre-eclampsia
4.5% in private clinics 12% Sepsis
2.3% at PHCC 5% APH
5% Abortion
1% Others (Ectopic pregnancy)

15. For every 100 women who get pregnant,
 40 will develop some complication during pregnancy, childbirth or
postpartum period.
 15 will develop life-threatening complication around birth
 5 will require surgical intervention
Incidence and Trends of maternal mortality

16. Reality
 Predicting who will develop complication is not possible.
Therefore,
 Early detection of complication
 Timely referral and
 Quality care is very essential
Our reality
 About 82% of babies are born at home
 Only 19% delivery assisted by SBA
Incidence and Trends of maternal mortality

17. Delay can kill: 3 delays
 1st delay: Delay in seeking care
 2nd delay: Delay in reaching care
 3rd delay: Delay in receiving care

19. Key findings of Maternal Health
o 44% of mothers received ANC from SBA
o 29% of pregnant women made 4 or more ANC visits
o 59% pregnant women took iron tablets and 20% take deworming tablets during
pregnancy
o 63% of pregnant women received TT2
o 18% of births took place in health facilities
o 19% of births were assisted by SBA
o 46% of pregnant women had no preparation for delivery of newborn
o 7% women experienced symptoms of uterine prolapse
o 33% women receive PNC for their last birth
o 36% women of reproductive age are anemic and 42.4% of pregnant women
have iron deficiency anemia.

21. Nutritional status of woman in Nepal
 Good nutrition is a critical part of health and development (WHO, 2012). It
leads to improved child and maternal health, builds stronger immune systems,
makes less susceptibility to non-communicable diseases and finally helps to
break the vicious cycle of poverty and hunger.
 Poor nutritional status is an alarming public health problem in Nepal.
Malnutrition, iron deficiency anemia and other micronutrient deficiency
disorders among the children, adolescents and women are some major
nutritional health problems prevailing in Nepal (WHO, 2008).

22. Reasons for poor nutritional status of
woman in Nepal

24. Reasons for poor nutritional status of
woman in Nepal
1. Food habits: Food habits are among the oldest and most deeply rooted aspects of any
culture. Family plays an important role in shaping the food habits and these habits are
passed from one generation to another.

25. Reasons for poor nutritional status of
woman in Nepal
2. Cooking practices: Draining away the rice water at the end of cooking, prolong boiling
in an open pan, peeling of vegetables, etc. influence the nutritive value of foods.

27. Reasons for poor nutritional status of
woman in Nepal
3. Customs, beliefs, traditional, attitude: It affects most vulnerable groups like infants,
toddlers, pregnant and lactating women. Papaya is avoided during pregnancy because
it is believed to cause abortion. In many places, valuable foods such as dais, other
leaves, rice and fruits are avoided by nursing mother. There is widespread belief that if
a pregnant woman eats more her baby will be big and there will be difficult in delivery.

29. 4. Food taboos and myths: Food taboos may be defined as quackery arising
from false or partial nutritional knowledge about beneficial effects of certain
food items resulting mostly in prohibition of eating those items.
 Many believe that pregnancy is a natural condition that does not need any
particular attention.
 Any special treatment of mothers tends to be for the protection of the unborn
child rather than for her own health and well-being.
 One widely held belief is that if a woman eats more during pregnancy she will
have a bigger baby which can cause problems during labour.
 Foods of animal sources are considered good for pregnant women.
Reasons for poor nutritional status of
woman in Nepal

30.  Social factors also influence the diet of pregnant women: women and girls usually
eat after male members and children have eaten and have less access to food from
animal sources and other special foods.
 Mothers who have recently delivered a baby are considered impure and are not
allowed to eat with other family members until the purification ceremony has been
held. In some communities, mothers’ food intake is limited during this period.
 Women in mid and far western hill regions practice a system in which the recently
delivered women are kept in the cowshed outside their homes in very unhygienic
conditions.
Reasons for poor nutritional status of
woman in Nepal

31.  In some cultures, it is believed that a connection between stomach
and womb exists and womb and stomach are rested together by not
giving food to the mothers.
 Ghee, meat, and milk are considered good for new mothers for
breast-feeding. However, for mothers in many families, the diet for
lactating mother is the usual family diet because they can’t afford
different foods.
 The diet for a lactating mother is further restricted when her baby is
ill.
Reasons for poor nutritional status of
woman in Nepal

32. 5. Lack of education: Most of the Nepalese woman are uneducated. So, they
don’t have adequate knowledge about nutrition and its requirement for
developing a healthy life.
Reasons for poor nutritional status of
woman in Nepal

33. 6. Poverty: Poverty is the most important determinant for poor nutrition in Nepal.
Due to poverty, women cannot fulfill their nutritional requirement which leads
to poor nutritional status.
Reasons for poor nutritional status of
woman in Nepal

34. 7. Food shortage: Due to seasonality in Nepal, there becomes the shortage of food
which directly hampers the nutritional status of women.
Reasons for poor nutritional status of
woman in Nepal

35. Ways the Health Assistant can help women
overcome barriers to good maternal nutrition:
1. Provide nutritional education
2. Raise awareness programme
3. Identification of Risk mothers
4. Nutritional intervention
5. Counseling

36. Reasons for High Maternal Deaths in Nepal
a. Health system reasons:
 Inadequate number of trained health workforce
 Inadequate blood transfusion facilities
 Inadequate quality maternal health services
 Inadequate physical health facilities for maternal health services

37. b. Very low percent of deliveries assisted by SBA
c. Three delays
d. Poor social and economic status of women
e. Too many traditional and cultural barriers for women
f. Poor nutrition and health status
g. Too early, too frequent and too many children
h. Too many unwanted pregnancies and no availability of equipped medical services
i. Inadequate transportation system
Reasons for High Maternal Deaths in Nepal

38. Causes of maternal mortality and
morbidity:
1. Obstetric causes
2. Psychological causes
3. Social causes
4. Common medical causes

39. Obstetric Causes of Maternal Death:

41. Obstetric Causes of Maternal Death:
1.Direct Obstetric Cause:
Short term
 • Sepsis
 • Hypertensive disorder
 • Hemorrhage
Long term
 • Vesico-vaginal or retro-vaginal fistula
 • Uterine prolapsed
 • Pelvic Inflammatory Diseases (PID)

43. Psychological Obstetric Problems:

44. Psychological Obstetric Problems:

45. Psychological Obstetric Problems:

46. Social Factors Responsible for Maternal
Mortality:
 Lack of access to material health services
 Lack of access to family services
 Low socio-economic status
 Heavy work-load
 Inadequate nutrition
 Some harmful traditional practices e.g. unsafe delivery
 Illiteracy
 High parity (number of children)
 Age at first pregnancy

47. Common Medical Causes of Maternal
Mortality and Morbidity:
• Severe anemia- cardiac failure
• Hemorrhage- shock, cardiac failure, infection
• Hypertensive disorder- eclampsia, CVA
• Puerperal sepsis- septicemia, shock
• Obstructed labor- fistula, uterine rupture
• Infection during pregnancy- pre-eclampsia, ectopic pregnancy, PID
• Hepatitis- Porto pulmonary hypertension (PPH), liver failure
• Unwanted pregnancy- unsafe abortion, infection, hemorrhage, infertility
• Unsafe delivery- infection, maternal tetanus
• Malaria- severe anemia, cerebral thrombosis

51. Bibliography
1. Department of Maternal, N. C. (2013). Maternal and Perinatal Health Profile.
Retrieved from
http://www.who.int/maternal_child_adolescent/epidemiology/profiles/maternal/npl.pdf
2. USAID. (2010). FOOD UTILIZATION PRACTICES, BELIEFS AND TABOOS IN
NEPAL AN OVERVIEW.
3. WHO. (2015). Trends in Maternal Mortalty: 1990 to 2015. Retrieved from
http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf
4. Park, K. (2005). Preventive medicine in obstetrics, paediatrics and geriatrics (18th
ed.). Jabalpur: M/s Banarsidas Bhanot.
5. Shrestha, S. C., & Shrestha, A. (2010). A Textbook of Primary Health Care and Family
Health (2nd ed.). Kathmandu, Nepal: Vidhyarthi Prakashan.