According to the World Health Organisation, most obstetric complications during birth can be prevented or managed if women have access to a skilled birth attendant. In Nepal 41% of women give birth at home, with no one, or with just an untrained friend or relative present, posing a risk to life and long-term health of both the mother and baby. The barriers to accessing skilled birth attendants are multi-faceted, with service provision, trust in healthcare services and geographical disparities all contributing factors.
This exciting project, funded by the Burdett Trust for Nursing, will train 10 of our Auxiliary Nurse Midwives (ANMs) over 2 years to become Skilled Birth Attendants, reducing maternal mortality rates and building community trust in maternal healthcare services.
Spotlight on Women’s and Children’s Health
Historically in Nepal, women’s experiences and preferences have been overlooked in service design and development, particularly in remote areas where primary healthcare provision is low.
Nepal has made significant progress towards reducing the maternal mortality rate (MMR) nationally, but large disparities still exist geographically. A lack of advice, support in accessing and understanding the importance of ante-natal care and skilled birthing support is resulting in a maternal mortality rate of 320/100,000 in the Far West, compared to a national figure of 239/100,000.
This results in a lottery of birth, where a woman pregnant with a baby in a mountainous rural area faces more risk than those born in urban areas. PHASE works within these remote communities to ensure quality care can be provided in these contexts, so children born here have an equal chance at life.
Last year, health posts supported by PHASE Worldwide ensured the safe delivery of 636 babies. In areas where PHASE works, maternal mortality rates have reduced drastically, and with further training, our ANMs will be equipped to handle more complex cases and save even more lives.
Investing in Nurse Skills
PHASE’s model of development focuses on building the capacity and skills of health workers to ensure that service provision can be self-supported by the community and local government in the future.
Although highly skilled with at least 18 months training in child and maternal health, ANMs cannot be considered Skilled Birth Attendants under the WHO definition until they have received specific training in emergency obstetric care and practised a required number of deliveries.
ANMs will undertake 2 months of intensive training within a hospital, practising the required number of deliveries to become accredited. This training will equip them for a wide range of complications and scenarios during births which will inform their work in remote communities. This level of training is particularly important in contexts where PHASE works, where access to hospitals with emergency obstetric care is limited, resulting in the need for ANMs to deal with these complications themselves.
Completion of this project will mean that more than 50% of total PHASE ANMs at Community Health Posts in the Bajura, Humla and Sindhupalchok districts will be Skilled Birth Attendants. This training will also benefit government health workers, as PHASE ANMs work alongside these staff, mentoring and developing their skills and understanding, and influencing best practice.
Another factor affecting the uptake of clinical care during birth is cultural practice and tradition. Particularly in remote areas of Nepal, it has not been customary for women to give birth in a health facility, with many historically giving birth in cowsheds or out-buildings, greatly increasing the risk of infection.
Now that service provision is in place, PHASE is working to encourage women to give birth within supported health posts. This starts with effective antenatal care to increase awareness amongst women on the importance of having an assisted birth and the risks of giving birth at home. This education, alongside improved service provision and staff training, importantly gives women the means to make an informed choice about giving birth within a health facility.
We would like to thank the Burdett Trust for Nursing for their continued support of the training and development of our vital front-line healthcare staff. For more information on our primary healthcare work click here.