The causes of maternal and perinatal deaths will be investigated in nine more districts from this fiscal year, thanks to the United Nations Population Fund, which has agreed to fund the extension of the programme.

Officials hope that the investigation of the actual cause of maternal and perinatal deaths will help reduce the ongoing deaths of mothers and babies.

“Health workers will investigate if a particular death could have been prevented, or if human error was responsible for the deaths,” said Nisha Joshi, a public health officer at the Family Welfare Division under the Department of Health Services. “We requested the UNFPA for help,  which it agreed to. Measures will be taken to prevent the deaths.”

Maternal and perinatal death surveillance is a key intervention for improving maternal, perinatal, and neonatal survival. Experts say such surveillance helps identify the causes of death.

The World Health Organisation said that maternal and perinatal death surveillance and response (MPDSR) is an essential quality improvement intervention, which permits the identification, notification, quantification and determination of causes and avoidability of maternal and neonatal deaths and stillbirths with the goal of orienting the measures necessary for their prevention.

According to the UN health body, systematic analyses of overall mortality trends, as well as events and contributing factors leading to individual deaths, can identify barriers in health systems and inspire local solutions to prevent such deaths in the future.

“The primary goal of MPDSR is reducing future preventable maternal mortality through a continuous action and surveillance cycle followed by the interpretation of the aggregated information on the findings, which is used for recommended actions to prevent future deaths,” says the WHO.

Nepal has committed to reducing maternal and neonatal deaths, but the MPDSR programme has not been implemented nationwide.

So far, the programme has been implemented in 54 districts. Officials say maternal and perinatal deaths are monitored only in the districts that have implemented the MPDSR programme.

In the fiscal year 2024-025, 190 maternal deaths were reported from 54 districts.

With the programme now set to be launched in nine additional districts, the number of districts with maternal and perinatal death surveillance services will reach 63.

“We will impart master trainer training to four health officials of each district,” said Joshi. “Those trained will share their knowledge with other health workers serving in the respective districts.”

Earlier, division officials had told the Post that they would not propose expanding the maternal and perinatal death surveillance programme in the new fiscal year’s budget, citing budget ceilings.

The government has allocated Rs95.81 billion for the health sector for the upcoming fiscal year—Rs9.57 billion more than the allocation for the current fiscal year and around Rs13 billion over the ceiling set during budget preparation.

Despite the increase in budget size, funds were not allocated for this programme, due to which officials had to request the UN agency.

Maternal health experts say that without the MPDSR programme, ongoing maternal and perinatal deaths cannot be effectively prevented.

Excessive bleeding after childbirth, pre-eclampsia and eclampsia (pregnancy-related high blood pressure disorders) have been identified as some of the major causes of maternal deaths in Nepal. Likewise, prematurity (neonates born at less than 37 weeks' gestation), birth asphyxia (a condition in which a baby does not receive enough oxygen before, during, or directly after birth), and sepsis (organ dysfunction caused by a dysregulated host response to infection) are considered major reasons for neonatal deaths.

Maternal and child health experts say unless the causes of deaths of mothers and babies are determined, it is impossible to reduce the mortality rates. This makes maternal and perinatal death surveillance extremely important, according to them.

Nepal has reduced maternal deaths by over 70 percent since 2000, according to a report by the World Health Organisation.

The UN health body, in its report, stated that currently 142 Nepali women die from maternity-related complications per 100,000 live births.

A previous study carried out by the National Statistics Office in 2021 had shown 151 maternal deaths per 100,000 live births. Similarly, neonatal mortality now stands at 16.6 per 1,000 live births, and the stillbirth rate has decreased to 13.5 per 1,000 births.

The Nepal Demographic and Health Survey-2022, carried out by the Ministry of Health and Population, showed that 21 neonates die per 1,000 live births.

The health target under the UN’s Sustainable Development Goals is to reduce the maternal mortality rate to 75 for every 100,000 births by 2030.

The SDGs, which follow on from the Millennium Development Goals (MDGs), aim to end poverty and hunger and all forms of inequality in the world by 2030, and Nepal has committed to meeting the goals.