Providing Quality Reproductive Health in Nepal

Some 90% of Nepal's population of 23.6 million live in rural areas and small villages. Half live on two dollars a day or less. The maternal mortality rate is 539 per 100,000 live births, the highest rate in South Asia. More than half of all births occur at home without the benefit of qualified birth attendants or doctors.

Providing appropriate, quality reproductive health services under such conditions is a major challenge. Although the contraceptive prevalence rate is close to 40%, sterilization still accounts for more than 60% of family planning methods. The unmet need for family planning is close to 30% and growing since more than one-fifth of the country's population is comprised of adolescents under the age of 21.

The project has three overall objectives:

• Increase understanding of the role of informed demand in efforts to improve the quality of reproductive and sexual health care provided in government, NGO and private sector facilities.
• Increase commitment and support at both national and international levels for disseminating lessons learned from project activities.
• Identify sources of funding for Phase II activities.

At the national level the project aims to: 1) assess existing knowledge regarding the quality of reproductive health care, especially the role of organized women's groups in influencing the quality of care provided; and 2) develop and disseminate a comprehensive national strategy for ensuring quality reproductive health information and services.

At the local level the project will: 1) facilitate participatory approaches in the provision of reproductive health; 2) enhance ability of service providers to provide appropriate, sensitive reproductive health care for women; and 3) better integrate reproductive health concerns and improve the quality of care delivered through community involvement in the formation of local health committees, savings/credit clubs, and micro-insurance schemes.

What's NEW

At the request of the Government of Nepal, the UN team led a participatory process with partners, including relevant ministries, donors, local communities and civil society groups to develop a National Quality of Care Strategy for Reproductive Health. Approved by the Ministry of Health, the strategy emphasizes reproductive rights and "demand" by the community for quality care to propose the way forward.

The policy builds on an assessment undertaken in the district of Saptari, near the border with India. It provided concrete inputs on how the national strategy can meet the reproductive health needs of local communities. Assessments carried out in Nepal found there is a need to expand contraceptive choice. Expanding choice can help Nepali women move away from using sterilization services at the end of their reproductive years. Findings also point to the need to delay the age at first marriage, prevent unwanted pregnancies as a birth spacing strategy, and confront gender inequity that is at the heart of these reproductive health problems. One useful entry point for addressing these issues is enabling female community health volunteers and development officers to educate and mobilize women’s groups for reproductive rights and improved quality of care.

Building on these findings, the National Quality of Care Strategy for Reproductive Health outlines concrete strategies and interventions that meet the rights of users and the needs of services to respond to those rights. The strategy will first be piloted in Saptari then upscaled in other districts in Nepal. This project will have a key role in ensuring that sexual and reproductive health care issues – especially the focus on working with communities – are embedded in national processes and policy dialogues.