After all its efforts failed to reduce ongoing maternal as well as child mortality rates, the Family Welfare Division under the Department of Health Services is preparing a guideline to increase the number of antenatal and postnatal care visits.

The guideline is expected to be enforced from next year, as it awaits endorsement from the Health Secretary and budget planning from the Ministry of Health and Population.

Officials at the division hope that the decision will help bring down maternal as well as child death rates.

"A lot of pregnant women encounter severe complications in their third trimester, some even resulting in deaths," Dr Punya Poudel, chief of Safe Motherhood Unit at the division, told the Post. "Frequent follow-up by trained health workers could prevent complications and deaths of both the mother and her newborn."

Nepal has committed to reducing and limiting maternal mortality to 125 per 100,000 births by 2020. But the target seems impossible to meet, as the number of deaths has not declined. The latest study carried out in 2016 put the maternal mortality rate at 229 per 100,000 births.
Previously, Nepal had reduced the maternal mortality rate from 539 in 1996 to 239 in 2016—for which the country had received the Millennium Development Goal award.

The Ministry of Health and Population has been asking pregnant women to receive at least four antenatal care visits at four months, six months, eight months and nine months.

To encourage pregnant women to make antenatal care visits, the Ministry of Health and Population provides them Rs 800 as an allowance for every visit.

However, the number of women visiting health facilities during pregnancy for routine follow-up is very low while the practice of postnatal care visit is almost non-existent.

According to the new guideline, pregnant women will now have to carry out five antenatal care visits during their nine-month pregnancy, said Paudel. Likewise, all new mothers will have to receive four postnatal care visits—one during the first 24 hours after delivery, second between three to seven days post-delivery, third on the second week and the last on the fourth week.

“Last hour complications are hard to predict. Therefore, these antenatal visits will help health workers rule out complications earlier in the pregnancy,” Poudel said. "Many women are dying due to postnatal complications too and that’s why we have made post-natal visits mandatory."
Of the total number of maternal deaths, 24 percent die during or after childbirth and 19 percent in the postnatal period, according to the data provided by the division.

As per the new guideline, trained nurses or health workers will provide the first three postnatal care visits at the new mother’s home.
The division has started hiring trained nurses for this purpose. Death of a new mother from excessive bleeding in the postnatal period is expected to be lessened with these mandatory postnatal care visits at home. Both mother and child will have to come to health facilities for the last postnatal care visit.