In a bid to examine the quality of services at health facilities offering cesarean delivery and those running special newborn units, the Family Welfare Division under the Department of Health Services is preparing to carry out a national-level assessment.

Officials said the planned assessment will help identify gaps in service delivery and reduce ongoing maternal and neonatal deaths.

“Assessment will be carried out in all hospitals of all seven provinces providing cesarean delivery services and hospitals running special newborn units,” said Nisha Joshi, senior public health officer at the division. “The move will help us to know the service gap and the improvements needed to reduce deaths.”

Caesarean section, also known as C-section, is a surgical delivery procedure performed during emergencies. The procedure is lifesaving when vaginal delivery poses a risk to the mother or baby due to obstructed labour, foetal distress or an abnormal position of the baby, doctors say.

According to the findings of the Nepal Demographic and Health Survey-2022 carried out by the Ministry of Health and Population, one in five women in Nepal give birth through caesarean section. The C-section delivery rate at private hospitals is several times higher than that at state-run hospitals.

Officials say scores of health facilities across the country provide C-section delivery services, which need to be assessed periodically to know the service quality and figure out the gaps.

“If gaps and shortcomings are addressed on time, previous avoidable mistakes can be prevented, and lives can be saved,” said Joshi.

Officials said that the division has requested various aid agencies and development partners for financial help to carry out assessment.

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

The UN health body, in its report released in April, stated that 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.

Earlier, in 2016, the country reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 births in 2016—for which the country even received the Millennium Development Goals award.

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

Officials said that they will also assess health facilities providing special newborn care units. Special newborn care units are general units designed to care for newborn children who fall ill shortly after birth. Doctors, nurses, and paramedics monitor ailing newborns admitted to the unit.

As many as 85 hospitals throughout the country have been running special newborn care units, which aim to prevent neonatal deaths from various causes—hypothermia, infection, low birth weight, premature birth, and abnormal birth asphyxia, among others.

Other programmes to lower child mortality include newborn care, kangaroo care, exclusive breastfeeding, infection prevention, chlorhexidine for umbilical cord care, and free neonatal care.

The WHO report shows 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 neonatal deaths to 12 for every 1,000 births.

The SDGs, a follow-up on 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.

Maternal and child health experts say that periodic assessment is necessary to know the service quality, and improve shortcomings to prevent ongoing deaths of mothers and newborns.

“If we have to achieve our goals to reduce maternal and neonatal deaths, we must identify the gaps, improve our service quality, and for that periodic assessment is a must,” said Dr Ganesh Dangal, a maternal and child health expert. “Along with this access to uninterrupted services in their own place and trained human resources must be ensured.”