During 2020-2022, Countdown worked in Nepal and six other countries to understand the drivers of the major declines in maternal and newborn mortality over the past decades, as part of the Global Health Exemplars studies of Gates Ventures.
Countdown’s exemplar study in Nepal was a partnership between the South Asian Institute for Policy Analysis and Leadership (SAIPAL), the Family Welfare Division in the Ministry of Health and Population, and the London School of Hygiene and Tropical Medicine. All the Countdown exemplar studies had a similar mixed methods design.
Between 2000 and 2017, Nepal’s neonatal mortality rate (NMR) decreased from 40 to 21 per 1000 live births, while the maternal mortality rate (MMR) more than halved from an estimated 553 to 186 per 100,000 live births. This translated to average annual rates of reduction of about 6% for maternal mortality and 4% for newborn mortality. These decreases exceeded South Asia’s regional mean annual reduction of about 5% for MMR and 3% for NMR during those years. Moreover, Nepal’s annual reductions for MMR and NMR outpaced the global averages of 3% for MMR and NMR. Nepal’s better than average performance remained after adjusting for economic growth as measured by GNI per capita).
Data availability and quality on neonatal mortality is very good, while data on maternal mortality are less available. Despite the 1996-2006 Maoist insurgency and the 2015 earthquake, trends don’t appear distorted by national level conflicts or disasters. Mountainous areas present a challenge to service provision. The HIV prevalence among adults age 15-49 is 0.1%, below the 1% threshold considered generalized and severe, but masks a concentrated epidemic among at-risk populations.