;fdfGotof k|hgg :jf:Yo eGgfn] zf/Ll/s / dfgl;s

?kdf :j:y /xg'sf ;fy} ;fdflhs b[li6sf]0fn] ;d]t

;'v, ;'ljwf k|fKt cj:yf xf] . ctM
dflg;nfO{ s'g} /f]u gnfUg] jf la/fdL
gkg'{ dfq k|hgg\ :jf:Yo xf]Og . k|hgg\
:jf:Yo cGt/ut dflg;sf] k|hgg k|0ffnL / o;sf
sfdx? tyf k|s[ofut ;a} s'/fx? ;dfj]z x'G5g\ .

 ;'/lIft of}g hLjg ljtfpg ;Ifd x'g' .

;Gtfg hGdfpg ;dy{ x'g' .
slxn] / slt hgf 5f]/f 5f]/L hGdfpg] / ghGdfpg] eGg]
;DaGwdf cfkm' :jo+n] :jtGq ?kdf lg0f{o ug{ kfpg'
dlxnfn] d'n'ssf] k|rlnt sfg"gsf] ljkl/t gx'g] ul/ cfkm\gf]
dlxgfjf/L rs| / k|hgg\ k|ls|ofnfO{ lgoldt u/fpg kfpg'

 ue{ lg/f]ws ;fwg tyf pkfox?af/] k"0f{ hfgsf/L k|fKt ug]{ / cfkm\gf] nflu
k|efjsf/L tyf cfkm\gf] cfly{s cj:yfn] wfGg ;Sg] ;fwg cfkm}n] :jtGq ?kdf
5gf]6 ug]{ clwsf/ k|fKt x'g', dlxnfsf nflu uef{j:yfdf ;'/lIft lsl;daf6 ;'Ts]/L
x'g tyf :j:y lzz' hGdfpgsf nflu pko'Qm :jf:Yo ;]jf tyf ;'ljwfx? ;'ne ?kdf
pknAw x'g' .
dlxnfnfO{ cfkm\\gf] ;+k"0f{ hLjg rqmsf] x/]s cj:yfdf cfjZos kg]{
:jf:Yo ;]jf k|fKt ug]{ clwsf/
n}+lus ;dfgtf, dlxnf ;zlQms/0f tyf k|hgg\ :jf:Yodf k'?ifsf] ;xeflutf h:tf
ljifox? klg k|hgg\ :jf:Yo cGt{ ut g} kb{5g\ .

k|hgg :jf:Yo sfo{s|dsf] p2]Zo

JolQm tyf bDktLnfO{ k|hgg\ :jf:Yo ;DaGwL
hfgsf/L tyf u'0f:t/Lo ;]jfx? ;'ne ?kdf
k|bfg u/]/ pgLx?sf] ;dli6ut k|hgg\ :jf:Yo ;'wf/
ug]{ k|hgg\ :jf:Yo sfo{s|dsf] p2]Zo
/x]sf] 5 .

Plss[t k|hgg\ :jf:Yo ;]jfx?

kl/jf/ lgof]hg
;'/lIft dft[Tj
gjhft lzz' :ofxf/
ue{ktgsf hl6ntfx?sf] /f]syfd tyf pkrf/
hgg]lGb|osf] ;+s|d0f, of} g/f]u tyf Pr=cfO=leP8\ ;sf] /f]syfd tyf pkrf/
afFemf]kgsf] /f]syfd tyf pkrf/
lszf]/ lszf]/Lsf] k|hgg\ :jf:Yo
pd]/ 9Ns]sf dlxnfx?sf] k|hgg\ :jf:Yo
n}ls lx+;f


kl/jf/ lgof]hg
;'/lIft dft[Tj
gjhft lzz' :ofxf/
ue{ktgsf hl6ntfx?sf] /f]syfd tyf pkrf/
hgg]lGb|osf] ;+s|d0f, of}g/f]u tyf Pr=cfO=leP8\;sf] /f]syfd tyf pkrf/
afFemf]kgsf] /f]syfd tyf pkrf/
lszf]/ lszf]/Lsf] k|hgg\ :jf:Yo
pd]/ 9Ns]sf dlxnfx?sf] k|hgg\ :jf:Yo
n}+lus lx+;f

..

Trends in Total Fertility Rate, 1976-2011

6.33
5.9

5.1
4.6

4.1

MDG
3.1

2.6

2.5

CPR
67

44
35
24

26

43.2

CPR
(ModernMethod)
CPR
43.2

42.8

37.7

CPR

d=k=If]lqo :jf:Yo tflnd s]Gb|, ;'v]{t

 (UnmetNeed)

..
=27%
=10%
=17%

1519years

UnmetNeed

National

Mid-Western

Mid-West Hill

..
% ..... ..

% .. ..

%

....

..

%.. SideEffect

% ..

Place of Maternal Death

19%
40%

Home
Facility
Others

41%

25

MMR Study, 2008/09

Cause of Maternal Death

1998

Cause

52%

Haemorrhage
Post Partum Haemorrhage

2009

24%

47%

19%

5%

5%

16%

6%

Eclampsia/pre eclampsia

14%

21%

Puperial Sepsis

12%

5%

5%

7%

Anetpartum Haemorrhage
Obstructed Labour

Unsafe Abortion
Source:

Maternal Mortality and Morbidity Survey 1998

Maternal Mortality and Morbidity Survey 2009

hl6ntfsf] cfwf/df d[To'sf] ;dofjlw

;dofjwL - ;dofjwL
306fdf_
-lbgdf_

hl6ntfsf] lsl;d
aRrf hlGd;s]kl5
/Qm>fj

x'g]

cTolws @ 306f

uef{j:yfsf] /Qm>fj

!@ 306f

kf7]3/ RofltP/ x'g] /Qm>fj

! lbg

pRr /Qmrfk, z/L/ ;'lGgg] / sfDg]

cj:yf (Pre-Eclampsia / Eclampsia) ePdf

@ lbg

k|;'lt Joyf ufx|f] x'g' / jRrf c8\lsg'

# lbg

;'Ts]/L ;DaGwL ;+qmd0f x'g'

^ lbg

Source: Indonesia's "(Prevention of PPH Program)" Cadre's Handbook



,

,

;"/lIft dft[Tj ;]jfx?

u')f:tl/o ue{jlt ;]jf (ANC)
bIfk|;'tLsdL{jf^ k|;'lt tyf gjhft lzz' ;]jf (Deliverybyskilledattendantand
newborncare)
cfktsflng k|;"lt ;]jf (EOC)
;'Ts]/L ;]jf (PNC)
kl/jf/ lgof]hg ;]jf
;'/lIFt ue{ktg ;]jf
Ufe{ktgsf] hl^ntfsf] pkrf/ tyf /f]syfd

ANC Check-up
ANC Visit

Institutional Delivery
Chart Title

Chart Title
35.3

58.3
53.1

29.1
43.3

National

Mid-Western

Mid West Hill

24.5

National

Mid Western

Mid West Hill


Education

Education

79.5
97.2
89.7
78.8

74.6
69

67.9

InstitutionalDelivery
35.3

29.1
24.5

National

Mid Western

Mid West Hill

AssistanceDuringDelivery

National

Mid-West Hill

UseofCleanhomeDeliveryKitsandother
instrumentstocutumbilicalcord

National

Mid-west Hill

National

National

Mid-West Hill

Mid-West Hill

StrategiestoAdress3Delays
1. Promotingbirthpreparednessandcomplicationreadinessincluding
awarenessraisingandimprovingtheavailabilityoffunds,transport
andbloodsupplies.
2. Encouragingforinstitutionaldelivery.
3. Expansionof24houremergencyobstetriccareservices(basicand
comprehensive)atselectedpublichealthfacilitiesineverydistrict

hLjg ;'/IffM ue{jtL dlxnfsf] klxrfg,

ue{jtL / pgsf kl/jf/sf ;b:ox?nfO{ k/fdz{

FCHV provides Jeevan Surakshya Card to pregnant mother after

counseling her and her family at community.


34.2
35.5
1.2
2.2
60.2
55.7
6.2
4.5
1.2
1.7
0.6
0.4
2.9
3.4
25.7
35.8
National

Mid West Hill


ComponantofAama
SafeDeliveryIncentiveProgram
freeinstitutionaldeliverycare
incentivetohealthworkerforhomedelivery
incentivetowomenfor4ANCvisits
NyanoJhola

 SDIP
NRs.1,500inmountain,
NRs.1,000inhilland
NRs.500inTerairegion.
Normaldeliveryhealthfacilities
withlessthan25bedsreceive NRs.1,000;
25ormorebedsreceive

NRs.1,500.

Complicateddeliveries NRs.3,000
CSections

NRs.7,000.

Tencomplications
1. APHrequiringbloodtransfusion
2. PPHrequiringbloodtransfusionorMRPorexploration
3. Severepreeclampsia
4. Eclampsia,
5. RetainedplacentawithMRP
6. PuerperalSepsis
7. Instrumentaldelivery
8. Multipledelivery
9. RHNegative
10. Postabortionmanagementcasesthatincludebloodtransfusionfor
haemorrhageadmissionlongerthan24hourswithIVantibioticsforsepsis

g]kfndf lzz' tyf afn d[To'b/sf] t'ngf

Under five mortality rate
Infant mortality rate
Neonatal mortality rate

153
118
102

91
79
64
50

46

39

Marked decline in infant

and child mortality
61
48
33

54

46
33

but less improvement with neonatal

mortalityand no change from 2006-2011

54

Source: NDHS

54
34
15

NewBornCarePractive
Chart Title

National

Mid-West Hill

Shock

Severe Vaginal Bleeding

Infection / Sepsis

Intra abdominal injury

Ectopic pregnancy


CACService
PACService
SafeAbortionLawsandPolicy

KnowledgethatAbortionislegalinNepal

National

Mid-west hill

PregnancyOutcome

National

Mid-west Hill

MainReasonforhavingmostrecentabortion
National

National

 ,
...








4Cs

HIV/AIDS

ART
PMTCT

4Cs

HeardofHIV/AIDS

National

Mid-west Hill

KnowledgeofHIVPreventionMethod
(Women)
Chart Title

National

Mid-Hill

PercentagewithComprehensiveknowledge
aboutAIDSWomen
Comprehensive Knowledge
consistent use of condom during
intercourse and Having just one
uninfected faithful partner can reduce the
chance of getting HIV.
A healthy person can have the AIDS Virus
The AIDS Virus cannot be transmitted by
mosquito bites
A person cannot become infected by
sharing food with a person who has the
AIDS Virus
The AIDS virus cannot be transmitted by
touching someone who has AIDS
Women

Men

KnowledgeofPMTCTofHIV
Chart Title

National

Mid-West Hill

SelfReportingofSTI
Chart Title

National

Mid-west Hill



(%)
,
RiskTakingBehavior(Violence,RTA,DrugAbuse,Revenge)
Suicide
MentalhealthProblem
NutritionalProblem
Longlastingimpactonhealth

ltdL t 5f]/L xf]Og, 5f]/f

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ltdLn] 5f]/fn] klg
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:jtGq

sDhf]/

zlQmjfg

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sdfpg]

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sdnf]

;'/Iff k|bfg ug]{

ldnfg;f/

lhl4jfg

8/fpg]

axfb'/

 (SEX)

k|fs[lts leGgtfsf] cfwf/df dlxnf / k'?if eg]/

5'6\6fpg]nfO{ ln+u (Sex)elgG5 . :qL / k'?if
h}ljs tyf k|fs[lts ?kn] km/s 5g . olx ln+u jf
c+u km/ssf sf/0f dlxnfn] ue{wf/0f ug]{,
k'?ifn] z'qmsL6 bfg ug{ ;S5g . of] h}ljs
leGgtfnfO{ abNg ;lsb}g .

 (GENDER)
;fdflhs d"NodfGotfsf cfwf/df dlxnf k'?ifn] lgjf{x
ug]{ a]Unfa]Un} e"ldsf eGg] a'emfp5 .
n}lu+sstf eg]sf] lnsf]
;fdflhs tyf ;f+:s[lts
lj:n]if0f xf] h:tf] ;dfhn] dlxnf tyf k'?if eGgFn] s]
a'em\5, s:tf] Joaxf/ sf]
ck]Iff u5{, s:tf]
lhDd]jf/L lbG5 .
;fdflhs ln+ue]b eGgfn] dlxnf / k'?if ePs}
gftfn] ;dfg kl/l:ylt / kl/j]zdf klg km/s Jojxf/ Ul/G5 .

n}lu+s lx+;f<
k'?ifn] dlxnf dfly, dlxnf n] k'?ifdfly tyf dlxnf k'?ifn] t]>f]
ln+L dfly / t]>f] lnn] dlxnf k'?if dfly lnsf cfwf/df ul/g]
lx+;f g} n}ls cfwf/df ul/g] lx+;f xf] .
N}fls cfwf./df x'g] lx+;f eGgn] s'g} klg k|sf/sf] lx+;f
hf] n}ls c;dfgtf tyf :t/Ls/0f nfO{ :yflktug]{, an k'ofpg]
ub{5 .
dlxnf / k'?ifaLrsf] h}ljs leGgtfnfO{ cfwf/ agfO{
;dfhf/f :yflkt pgLx?sf] e"ldsf, lhDd]jf/L, Jojxf/, ck]Iff tyf
cj;/ cfbLsf] dfGoftfsf] cf8df ul/g] lx+;fnfO{ n}ls lx+;f
elgG5 . h'g zlSt ;+/rgfdf cfwfl/t 5 .

Dflxnfdfly x'g] lx+;fsf] lhjg rqm

Dflxnf ePs} sf/0f x'g]

lx+;f
ln+u klxrxfgsf nflu afWo agfO{g] e'|0fxTof ug'{ .
uef{j:yfsf] ;dodf zf/Ll/s tyf dfgl;s oftfgf lbg' .
5f]l/ hGdfpbf cfdfnfO{ sd kf]lifnf] vfgf lbg] .
/fd|f] xl:k6ndf aRrf hGdfpg gn}hfg] .
dlxnfnfO{ cf}ifBf]krf/af6 al~rt u/fpg' .
ue{jtL ePsf] ;dodf al9 eGbf al9 sfddf nufpg' .
Ufe{jlt tyf c:j:y ePsf] a]nfdf ;f;l/l/s ;Dks{ /fVg afWo agfpg] .
5f]/fsf] rfxfgfdf 5f]l/ 5f]l/ hGdfpbf kf7]3/sf] ;d:of
Kl/jf/ lgof]hgsf ;fwg al9 k|of]u ubf{ zfl/l/s ;d:of
;'Ts]l/ cj:yfdf 5'gx'b}g elg /fd|f] :ofxf/ tyf x]/rfxf gx'g]

 3/sf k'?ifx?nfO{ ld7f] ld7f] / klxnf vfg lbg] gku] kl5 ef]s} /xg'sf/0f
Uof:l6s /f]lu al9 dlxnfx? X"g' .
vfglkg tyf :ofxf/ gug]{, pkrf/ vf]k glbg]
afnljjfxn] kf7]3/df ;d:of
of}+g b'Jo{jxf/ ,zf]if0f, aNtsf/, r]lna]l6 a]rlavgsf] lzsf/ / a]Zofa[lQdf
h:tf 36\gfn] Pr cfOle /f]usf] l;sf/ x'g] .
leleGg dfgl;s, dgf]a}1flgs tyf zf/Ll/s b'Jo{axf/, lx+;fn] l8k|];g tyf
kfun x'g' .
afn >d zf]if0f, sdnx/L, b]psL, s'df/L, em'df k|yf cflb
sDhf]/ dgl:ytL agfpg]]
3/of;L sfdsf] af]emn] ubf{ sdhf]/ x'g' .

n}ls hGo lx+;fn] dlxnf:jf:Yodf kfg]

{ k|efjx?
k|hgg\ :jf:Yodf kg]{ k|efjx?M ljleGg of}g /f]ux?jf6 ;
+qmldtx'g', clglR5t ue{wf/0f x'g', c;'/lIft tj/n] ue{ktg ug'{,
ue{ktg x'g', sd tf}nsf] jRrf hGdg', of}gfdf ;+qmd0f x'g',
af+emf]kg x'g' cflb n}ls hGo lx+;fsf sf/0f dlxnfx?sf] k|hgg\
:jf:Yodf k/]sf gsf/fTds c;/x? x'g\ .
zfl//Ls :jf:Yodf kg]{ k|efjx?M n}ls hGo lx+;fsf sf/0f x'g]
zfl//Ls oftgfn] ubf{ dlxnfx?sf] k|hgg\ c+udf rf]6 k6s nfu]/
u+le/ c;/ k'/\ofPsf] x'G5 . ljleGg c+ue+u e} zfl//Ls ckfu+tf tyf
czSttf jf]s]/ dlxnfx? k'/f lhGbuL ljtfpg' kg]{ jfWotf x'G5 .

n}ls lx+;fn] dlxnf:jf:Yodf kfg]{ k|

efjx? ===
Dfgl;s :jf:Yodf kg]{ k|efjx?M zfl//Ls, dfglzs tyf ;fdflhs oftgfsf sf/0f dlxnfx?
df ljleGg dfglzs c;/ u/]sf] kfO{G5 . dlxnfx? emf]qmfo/ j:g', jf}nfpg', vfgf vfg
dg gnfUg', l8k|]zg x'g', cfTdan 36\g', ljgf sf/0f t;L{g', s/fpg', lgb|f gnfUg'
O{Toflb n}ls hGo lx+;fsf sf/0f dlxnfx?df b]vfkg]{ dfglzs c;/x? x'g\ .
d[To' hGo k|efjx?M n}ls hGo lx+;fsf sf/0f dlxnfx? Pr=cfO{=le= P8\;sf]
lzsf/e} csfndf d[To'sf] d'vdf kb{5g\ . To;}ul/ lszf]/ cj:yfdf ue{wf/0f ug]{, o;
cj:yfdf /fd|f] ;+u x]/rfx gkfpg', :jf:Yo ;'ljwf gkfpg', c;'/lIft ue{ktg ug'{ cflbsf/0f
jf6 dft[d[To' x'g'sf ;fy} k|f}9 cj:yfdf x'g] kf7]3/sf] SofG;/, :tg SofG;/sf] sf/0f
dlxnfsf] d[To' x'g] u/sf] 5 . ljleGg zfl//Ls, dfglzs tyf ;fdflhs oftgfsf sf/0f dlxnfx?
sf] xTof x'g] u/]sf] 5 eg] sltko dlxnfx? o;}sf/0f cfTdxTof ug{ jfWo ePsf 5g\ .