LMC journal Vol. 2.indd


78

Maternal Mortality: Sharing Experience from Banke District
Acharya S1 and Shanta A2

1College of Nursing, Lumbini Medical College, Palpa, Nepal, 2Plan International Nepal, Nepalgunj, Banke, Nepal

Corresponding author: Shusma Acharya, Lecturer, College of Nursing, Lumbini Medical College, Palpa, Nepal

ABSTRACT
Maternal mortality is a global burden, with more than 500,000 women during each year due to pregnancy 
and childbirth related complica  ons.1 Globally, 60-80% of maternal deaths are due to obstetric complica  ons, 
these are hemorrhage, sepsis (infec  on), obstructed labour and hypertensive disorder of pregnancy and 
complica  ons of unsafe abor  on.² OBJECTIVE: To iden  fy the causes of maternal mortality in Banke District. 
MATERIALS AND METHODS: The study was conducted in Banke district. Descrip  ve cross-sec  onal study 
was adopted, during a period of one year from July 2011 to June 2012 at Banke District in Western Region 
of Nepal. Non probability purposive sampling method was used for collec  ng the data. Both primary and 
secondary sources of data were taken for the study. RESULTS: The maximum number of maternal deaths 
was from Madheshi and Muslim community, most of them were illiterate. The main cause of maternal death 
was post partum hemorrhage. CONCLUSION: Nepal achieved an impressive reduc  on in maternal mortality 
between 2001 and 2006, but maternal deaths s  ll remains high. The trends of death from snake bite, suicide, 
epilepsy and physical assault are the new causes.

Keywords: infec  on, Maternal mortality, post partum hemorrhage.

Original Article L M Coll J 2013; 1(2): 78-79

INTRODUCTION 
Pregnancy and child birth is considered as a physiological 
process, but it is associated with certain risks to the life 
of both mother and newborn baby. At least 160 million 
women become pregnant every year around the world. 
Out of them 15% women develop serious complica  ons.

Reducing high maternal mortality is a priority agenda of 
the na  onal and interna  onal community, as evidenced 
by great interest in the Millennium Development 
Goal (MDG5).3 Nevertheless attaining Millennium 
Development Goal-5 s  ll remains a challenge to the 
world. Many countries are unlikely to a  ain many MDGs 
including that of maternal health, even though maternal 
health care has received par  cular a  en  on from the 
developing countries of African and Asian region.

Maternal mortality in Nepal has drastically came 
down to 229 per hundred thousand live births.4 In 
1998, government of Nepal formulated the na  onal 
reproduc  ve health strategy with safe motherhood 
program to address reproduc  ve health issues and 
developed na  onal maternity guidelines, standards 
of midwifery practice, safe motherhood clinical 
protocol and management guideline. Fi  een year safe 
motherhood plan of ac  on was developed in 2002. The 
long-term goal of the plan envisaged establishment of 
basic emergency obstetric care and comprehensive 
emergency obstetric care services in all district and 
skilled a  endance at birth including increased access to 
emergency fund and transporta  on.5 In spite of these 
en  re programs, the burden is s  ll high. 

Direct causes of maternal death accounts for 71%.
Majority of maternal deaths occurred at home i.e 67.4%, 
11.4% on the way and 21.2% in the health facility.5,6

METHODS
A cross sec  onal descrip  ve study was used to conduct 
the study. Non probability, purposive sampling method 
was used to collect the information. There were total 
22 mothers expired due to diff erent causes in diff erent 
Village Development Committee. In Banke total 34 
VDC namely Bajapur, Behari,Kachanpur, Manikapur, 
Shamshergunj, Sitapur, Radhapur, Bankatuwa, 
Basudevpur,Bhawanipur,Binouna, Fattepur,Ganapur, 
Hirminiya, Holiya, Udarapur,Paraspur,Puraini, Rajahina, 
Indrapur, Jaispur, Kamdi,Karkado, Katkuinjya, kohalpur, 
laxmanpur, Matehiya, Nepalgunj, Narainapurpur, Naubasta, 
Raniyapur, Saigaun and Sonpur. Data were collected through 
pre-tested interview schedule after taking of written 
permission of concerned authori  es (District Health Offi  ce, 
Banke).Data were tabulate through Excel spreadsheet and 
analyzed by using simple analysis methods.

RESULTS
During one year study period from July 2011 to June 
2012, there were total of 9705 deliveries during one 
year study period. 85.82% was hospital delivery. 14.18% 
was home delivery7. The number of female popula  on 
in reproduc  ve age group was 94793. There were 22 
maternal deaths on 34 Village Development Commi  ee. 
The percentage of maternal mortality was very low when 
we take total number of delivery in Banke i.e 0.226%.



79

The highest maternal deaths were reported from Mathehiya 
Village Development Commi  ee (VDC). This VDC is situated 
in the east across Rapti River and about 20 km from 
Nepalgunj city. There is one sub-health post and no birthing 
centre. Most of the  me health workers were not available 
due to remoteness. Among 22 maternal deaths 57% were 
form Madheshi and Muslim community.

Majority of 36.36% deaths occurred due to postpartum 
hemorrhage and 27% died due to infec  on. The causes 
of maternal deaths were changing in new context. Death 
from snake bite, suicide, epilepsy and physical assault 
were reported new trends of maternal deaths.

DISCUSSION
In Nepal, the social status of women varies among 
diff erent ethnic group. All the 22 maternal deaths in 
this study indicates that women today have access to 
health facility. Among 22 mothers, 57% were belonged 
madheshi and Muslim, 14% from Janja  , 10% Chhetri, 4% 
Dalit and remaining 14% from others and Newar 1%.  

In the study, 36.36% maternal death occurred due to 
postpartum hemorrhage, 27% due to infec  on, 4.54% 
due to prolonged labor and abor  on and rest due to 
indirect causes(not related to pregnancy). This fi ndings 
is consistent with fi ndings of maternal mortality and 
morbidity study 2009 which showed that maternal 
death due to hemorrhage 24%,  abor  on 7%, obstructed 
labor 6%, puerperal sepsis 5%.8  

Current study fi ndings is also consistent with study 
conducted in 1998, 47% maternal death was due to 
postpartum hemorrhage, 16% due to obstructed labour, 
12% due to sepsis.9  

The study indicated that majority of maternal death 
among 22 death was mainly in hospital i.e. 63.58%, 
22.72% maternal death was in home and 13.63% death 
was on the way to hospital. Similar study done by Family 
Health Division Nepal showed that Maternal death in 
health facility was 41%, at home 40%, way of health 
facility 7%, way from facility to facility 5%, transit from 

facility to home 2% and in pharmacy 1%.10 Similarly, 
another report by Shrestha et al showed 67% women die 
at home, 11.4% on the way to health services, 14.4% in 
the hospital, 4.5% in private clinics and 2.3% at Primary 
Health Care Centre.9 Another study was carried out on 
Nobel Medical college showed similar results.11

CONCLUSION
Nepal achieved an impressive reduc  on in maternal 
mortality between 2001 and 2006. Provision of safe 
motherhood  services even though maternal death 
remain high in this country. Quality and quick services 
would be helpful in avoiding maternal mortality in many 
situa  ons. Otherwise expending a huge amount of money 
for maternal health service will be not meaningful.

REFERENCES
1. WHO (2001). Managing Complication in Pregnancy 

and Childbirth.whq/ibdoc.who.int/hq/2000/WHO_
RHR_00.7.pdf.

2. WHO (2008). A Framework for Implementing the 
Reproduc  ve Health Strategy in the south-East Asia Region. 
WHO. Regional Offi  ce for South-East Asia. New Delhi.

3. Bhandari TR, Dangal G. Maternal Mortality: Paradigm Shi   
in Nepal. Nepal J Obstet Gynaecol 2012; 7(2): 3-8.

4. Ministry of Health and Popula  on (MoHP) [Nepal], New 
ERA, and ICF Interna  onal Inc.Nepal Demographic and 
Health Survey 2011. Kathmandu, Nepal: Ministry of 
Health and Popula  on, New ERA, and ICF Interna  onal, 
Calverton, Maryland; 2012.

5. S a fe  m o t h e r h o o d  i n  N e p a l  [ O n l i n e ] . [ c i te d  2 0 1 3 
november 30]. Available from from: URL:htpp://
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php?func  on=more_content&secid=74&con_id=44.

6. Family Health Division, (1998). Maternal Mortality and 
Morbidity Study. Kathmandu: 1998. 

7. DPHO [District Public Health Offi  ce] 2012. Annual Report 
2011/2012. Banke.

8. Ministry of Health and Popula  on (MoHP) [Nepal], New 
ERA, and ICF Interna  onal Inc. Nepal Demographic and 
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Health and Popula  on, New ERA, and ICF Interna  onal, 
Calverton, Maryland; 2007.

9. Family Health Division, USAID, DFID, SSMP, New ERA,Chrepa, 
(2009). Nepal Maternal Mortality and Morbidity Study. 
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10. Shrestha RD. Reproductive Health National and 
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11. Ghimire S. Maternal Mortality: Paradigm Shi   in Nepal. 
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S Acharya et al