Nisdi Rural Municipality in Palpa District has recorded zero home deliveries in fiscal year 2024/25, with no home births reported so far in 2025/26, marking a full shift to institutional childbirth under a national safe motherhood push.

The rural municipality said the achievement is part of a national drive to ensure all deliveries take place in health facilities and to eliminate home births.

“This achievement has been made possible through the tireless efforts of health workers, elected representatives and community female health volunteers,” said Rem Bahadur Disha Magar, head of the rural municipality’s health section.

Officials said the situation marks a sharp change from earlier years. Before 2017, the rural municipality recorded 221 home births, while institutional deliveries were extremely low across former village units including Bankamalang, Sahalkot, Jhirubas, Mithyal, Galdha, Archale and Jyamire. Antenatal care coverage stood at 106 cases at the time.

Magar attributed the earlier trend to geographical remoteness and limited access to health facilities.

By 2023/24, home births had dropped to just one case, which officials said occurred when a woman travelled to the lowlands for agricultural work during the monsoon season.

Health officials also reported a decline in adverse maternal and neonatal outcomes. Between 2017 and 2021, one or two stillbirths were recorded annually, but none have been reported in recent years, according to the health section.

Public health inspector Arjun Rana said the municipality implemented a structured safe motherhood programme to eliminate home deliveries.

“Nisdi Rural Municipality has initiated an organised and effective safe motherhood and newborn programme and launched a campaign to bring home births to zero,” he said, adding that all wards are now covered by institutional delivery services.

Birthing centres were initially established at Bankamalang Health Post in Ward 1, Mithyal Health Post in Ward 4 and Archale Health Post in Ward 6. After local elections, additional centres were set up in Sahalkot, Jhirubas, Jyamire and Galdha health posts.

Chair of the rural municipality Mukta Bahadur Saru said the programme includes nutrition support and outreach services.

“The rural municipality has been providing eggs to pregnant women and nutrition allowances as part of safe motherhood promotion,” he said, adding that community health volunteers monitor high-risk cases in remote areas.

Vice-chair Tiran Kumari Shrestha said the rural municipality runs monthly mothers’ group meetings, provides transport support for referrals, and distributes iron, folic acid and calcium supplements.

Under the “Mother with Women Representatives” programme, women representatives accompany health workers during postnatal home visits, while the rural municipality provides Rs 2,000 in nutrition support.

Ward-level initiatives have also been introduced. In Ward 5, Galdha Health Post deposits Rs 8,000 directly into mothers’ bank accounts, according to Ward Chair Durga Bahadur Somai.

A rapid survey across all seven wards found 165 women had completed regular antenatal check-ups at health facilities. The rural municipality currently records 294 pregnant women and 244 children under one year of age.

Officials said Nisdi now has birthing centres in all wards, one laboratory-equipped health facility, and five community health units to serve remote settlements.

With home births reduced to zero, all wards and the municipality have been declared fully covered by institutional delivery services this year, in line with the Lumbini Province government’s Standard for Institutional Birth Service Local Level and District Declaration Criteria, 2023.

District and health officials jointly handed over a certificate recognising the achievement. On the occasion, the municipality also received certification for full immunisation coverage.

Nepal has seen a steady rise in institutional deliveries in recent years. According to the Nepal Multiple Indicator Survey 2024–25, the national rate rose to 90.5 percent in 2025 from about 80 percent in 2022.

The study carried out by the National Statistics Office in partnership with UNICEF, shows that four antenatal care visits have increased to 85 percent from 81 percent in three years.

Institutional delivery and delivery by skilled birth attendants or skilled health professionals is the country’s priority programme, which is credited with curbing maternal and child mortality rates.

The report shows that Gandaki province has the highest institutional delivery rate at 97.3 percent, followed by Lumbini province 96.3, Bagmati 94.1, Karnali 91.3, Sudurpaschim 90.6, Koshi 89.9, and Madhesh 83.2 percent, which is the lowest in the country.

Since the government announced free institutional delivery service in 2009 at all state-run health facilities, more than 2,800 birthing centres have opened across the country. The institutional delivery rate, which was around 18 percent then, has increased to around 80 percent by 2022.

Nepal 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 a Millennium Development Goals award.

The country reduced maternal deaths by over 70 percent since 2000, according to the World Health Organisation. The UN health body, in its latest 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, showed 151 maternal deaths per 100,000 live births.

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

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 country has to reduce the neonatal mortality rate to 12 to meet the Sustainable Development Goals.