NEPAL NEONATAL PROBLEMS AND SOLUTIONS

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Introduction

Neo-natal health is an issue which affects the well being of different nations. As a result,

the governments of the various countries tend to come up with policies and legislations which

ensure that there are different guiding principles to the cases of neonatal health. Based on the

statistics shared by Bhusal et al. notes that in the global statistics, 40 % of the deaths occurring to

children under five occur during the neonatal period.1 As a result, it is pertinent to observe the

problems experienced in the neo-natal period and mechanisms which can be set in place to

counter these uncertainties. In his assessment of improving neonatal health in Nepal, Joshi et al.

aver that neonatal mortality is 33 per 1000 live births, and this account to eight times that of

developed regions. 2 Considering such statistics, it is appropriate to have in place conclusive

mechanism which ensures that the deaths are reduced and there is improved neo-natal care in the

nation. There are different factors which facilitate the occurrence of these deaths, and this

includes the poorly developed social amenities, inadequate research on neonatal care, the living

or the social standards of the people among many other reasons. Given the fact that Nepal is a

developing country, the legislation set in place also plays an immense role in the development of

healthcare. In this case, there are different laws, international and national laws which can

address the problems faced by women during the neonatal period. Therefore, this essay seeks to

evaluate the issues and the mechanisms which can be set in place to address the neonatal issues

experienced in Nepal.

1
Bhusal, Chetkant, Sigma Bhattarai, and Ravi Kumar Bhaskar. "Maternal health in Nepal
progress, challenges and opportunities." Int J Med Health Res 1, no. 3 (2015): 68-73
2
Joshi, Reesha, Sheetal Sharma, and Edwin Van Teijlingen. "Improving neonatal health
in Nepal: major challenges to achieving millennium development goal 4." Health Science
Journal 7, no. 3 (2013): 247-257.
 2

Neo-natal problems in Nepal

Limited Healthcare Infrastructure

One of the issues facing neo-natal care in Nepal is the quality of care provided during the

pregnancy period and childbirth. Based on professional medical requirements, the mothers need

to be provided adequate health care which ensures that they have safe deliveries which guarantee

low infant mortality.3 Limited healthcare infrastructure is a problem which affects the necessary

healthcare procedures which pregnant women need to attend. On the other hand, there are

different health hazards and conditions which the pregnant women are subjected to such as

gestational diabetes mellitus which ends up affecting the fetus. Further, the health institutions in

the rural areas do not have adequate incubators and or radiant warmers, and thus, this leads to

cases of pneumonia resulting in the death of the children.

In this case, there are is also the unbalanced distribution of health practitioners in the

country. The more skilled practitioners are concentrated in the urban areas, whereas the unskilled

individuals are posted to the rural areas. Therefore, this is detrimental when it comes to dire

situations which require the input of persons with higher expertise regarding such issues.4

Antenatal care

3
Colombini, Manuela, Susannah H. Mayhew, Ben Hawkins, Meera Bista, Sunil Kumar
Joshi, Berit Schei, and Charlotte Watts. "Agenda setting and framing of gender-based
violence in Nepal: how it became a health issue." Health policy and planning 31, no. 4
(2015): 493-503.

4
Shrestha, Gambhir, Prajwal Paudel, Parashu Ram Shrestha, Shambhu Prasad Jnawali,
Deepak Jha, Tek Raj Ojha, and Bikash Lamichhane. "Free Newborn Care Services: A
New Initiative in Nepal." Journal of Nepal Health Research Council 16, no. 3 (2018):
340-344.
 3

According to statistics by Gautam et al. most of the maternal and neonatal mortality is

linked to the type of care provided to the mothers during the period. According to information by

the National Safe Motherhood Program, 50.1 % had at least four visits whereas 15% had none.

Some of the factors backing this evidence are baby shyness and the presence of male health

providers. Additionally, restricted mobility of women brought forth by family restrictions on

finance and constraints on transport. With such conditions, there are bound to be many

complications which surround the neo-natal process. Nepal medical College is an example of the

entities in Nepal which shares profound information regarding neonatal care.

Delivery Practices

Delivery practices are also significant in the entire process of evaluating neo-natal care.

In general, pregnancy is perceived as a delicate process which is vulnerable and on the other

hand a natural event that is clouded with social and religious ramifications.5 Therefore, in some

instances it is not considered as a medical process. As a result, close to 63% of the births in

Nepal take place at home, and 7.5% of these deliveries take place in cowsheds. 6 Additionally,

the persons administering such procedures are not qualified, and this impedes the efforts to curb

infant mortality. Further, there are very minimal hygiene practices which are observed and this

detrimental to the entire process hence, there is need to check on the welfare of breastfeeding

mothers at any point.

5
Thapa, J. K., P. Manandhar, R. K. Subedi, S. Dahal, N. B. Mahotra, and A. Pandey.
"Assessing Health Status of Khanigaun Village Development Committee in Nuwakot
District of Nepal." Journal of Nepal Health Research Council (2016).

6
Joshi, Reesha, Sheetal Sharma, and Edwin Van Teijlingen. "Improving neonatal health
in Nepal: major challenges to achieving millennium development goal 4." Health Science
Journal 7, no. 3 (2013): 247-257.
 4

The case of delivery practices also extends to breastfeeding conditions. Based on the

statistics collected in Eastern Nepal indicates that all newborns were breastfed but only 57%

initiated the training within the first hour and 9% of the breastfeeding population discarded

colostrum. On the other hand, cultural and social beliefs play a significant part in affecting the

mortality rate. Some communities opted to provide the children with ghee, oil or honey, a ritual

which was regarded to cleanse the inside of the baby. Even though the practices have been

conducted over the years, most of these components can be contaminated and might lead to

severe infections on the part of the children.

Affordability

In the age of evolving medical practices, poverty is an attribute which affects the status of

neonatal care in Nepal. Close to 24.8% live below the international poverty line based on the

data collected in 2011.7 With such conditions, most people are unable to receive adequate care,

and the case is worse when the delivery process is faced with complications. Therefore, lack of

insurance and the dependence of out-of-pocket expenditure are some of the prospects which

contribute to the increased cases of mortality in Nepal.

Therefore, affordability is an aspect which needs to be addressed through setting in place

proper regulations which ensure that individuals irrespective of their economic conditions are

able to access proper medical care which reduces the mortality rate in the nation.

Lack Of Women Empowerment

7
Joshi, Reesha, Sheetal Sharma, and Edwin Van Teijlingen. "Improving neonatal health
in Nepal: major challenges to achieving millennium development goal 4." Health Science
Journal 7, no. 3 (2013): 247-257.
 5

Woman empowerment is a facet which has not been provided profound attention in the

nation and this can be perceived as a factor which promotes the increased infant mortality in

Nepal.8 Dhimal notes that women in Nepal tend to have a low social status and thus, this is also

translated in neo-natal care. For instance, marriages occur very early in Nepal and as result, the

married women have not fully developed to undertake child bearing practices and this promotes

the effects of poor and complicated births.

Inadequate mental and physical maturity on the part of teenage mothers leads to preterm

deliveries and thus, this makes the children susceptible to death. On the other hand, the young

teenagers are unaware of the steps of conception and this leads to dangerous delivery processes

which threaten not only the life of the baby but also the well being of the mother. From this, it is

evident that lack of empowerment and poor cultural practices can be seen as major contributors

to the neonatal problems experienced in the country.

Mechanisms of Addressing neo-natal problems

There are different mechanisms which can be used to highlight the problems affecting neonatal

health care in Nepal. There are different evidence-based practices which are applicable in the

situation and can play a critical in improving the overall, condition in the nation. For instance,

undertaking community and social programs which advocate and educate on the importance of

adopting modern medicine. Most people in the country are reluctant to make use of modern

medicine due to the existing myths and misconceptions regarding its use. Therefore, undertaking

such programs will be significant in enhancing the fight against infant mortality.

8
Dhimal, Meghnath, M. Dhimal, K. Karki, Doreen Montag, D. Groneberg, and Ulrich
Kuch. "Tracking health-related Sustainable Development Goals (SDGs) in
Nepal." Journal of Health and Social Sciences 2, no. 2 (2017): 143-148.
 6

The other significant avenue which can be considered is the application of law in

addressing the issues. The law serves as a guiding principle which will ensure that the health

institutions are in a position to handle the issues which affect neonatal care. The laws can be

applied on the national or the international scale depending on the issue in contention. Legal

underpinnings are significant because they can guarantee the well being of the mothers and their

children regarding issues of conception, gestation period and the post-neonatal situation.

The Shortcomings of The Established Laws

Even though there are laws which address provision of are for individuals, there are

minimal policies and regulations which touch on issues relating to neonatal care. The statement

implies that the legislative confines provide a blanket directive which does not have massive

effects on the status and conditions of persons experiencing the condition and practice of

childbirth. In this case, the UN is an example of a body which has been on the forefront

championing for the rights of woman and the entire process of neo-natal care. Under the

Universal Periodic Review (UPR) the body can scrutinize the human protection rights set in

place and how it affects the well-being of the society. Such initiatives play a significant part in

handling the neo-natal issue faced in Nepal. The rules and regulations set in place need to

coincide with the regulations of the nation and this is the point which affects the laws set in place

to address the condition. Therefore, it is critical to assess the specific laws which can play a vital

role in addressing the issues highlighted regarding neonatal care in Nepal.

Solutions to the problems

On the aspect of limited healthcare infrastructure, the application of art 2(1) ICESCR will

be significant in addressing the condition in Nepal. The government of the nation needs to come
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up with appropriate avenues that can be explored in the process of establishing long lasting

social amenities. The government has the mandate of providing adequate health care to its

citizens and this is possible through proper utilization of the taxes and also making use of foreign

aid. By doing so, health accessibility will also be possible for persons living in rural areas.9 The

application of article 12(1) of the International Covenant of Economic, Social and Cultural

Rights (ICESCR) affirms that every citizen has the right to access the best form of health care

which will ensure there is swift recovery in the long run.10

The issue of women empowerment can be addressed through the consideration of the

Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) Art

12.11 The international regulation recognizes that equality is a factor which needs to be

incorporated in the health sector and this is achievable though the application of this law. As a

result, women will not be subjected to ancient and backward practices such as early marriages.

Moreover, there will be reduced teenage pregnancy because the persons responsible for the vices

will be subjected to such laws.

The problem of affordability is pertinent in addressing the issue facing mortality rate in

Nepal. The statement implies that the government needs to come up with resolute procedures

which are essential in solving the issue. Article 7 (b) of ICESCR affirms that it is the

9
Shrestha, Gambhir, Prajwal Paudel, Parashu Ram Shrestha, Shambhu Prasad Jnawali,
Deepak Jha, Tek Raj Ojha, and Bikash Lamichhane. "Free Newborn Care Services: A
New Initiative in Nepal." Journal of Nepal Health Research Council 16, no. 3 (2018):
340-344.
10
Sital, Kalantry, Jocelyn E. Getgen, and Steven Arrigg Koh. "Enhancing enforcement of
economic, social, and cultural rights using indicators: A focus on the right to education in the
ICESCR." In Economic, Social and Cultural Rights, pp. 211-268. Routledge, 2017.
11
Cook, Rebecca J., and Simone Cusack. "The Committee on the Elimination of
Discrimination against Women." Edward Elgar Publishing Ltd., 2018.
 8

responsibility of all the parties, both the global organization and the internal government needs to

safe and health working conditions in the health institutions for the workers. Further article 10

(2) states that special protection should be accorded to the mother during the period. Working

mothers should be accorded paid leave with adequate social security benefits which will ensure

that they are in a position to cater for the health concerns.

The delivery practices can be solved by considering the laws of Nepal and the global

rules set to guide such facets. Part I article 2 (a) reiterates the essence of equality on both men

and women under the constitution. Further, part I article 2 e of CEDAW reiterates the essence of

respecting the decisions and eliminating discrimination amongst women from any given group.

The UN, WHO and UNICEF are part of the major global entities which campaign against ill

cultural rites such as female genital mutilation (FGM). In this case, the law discriminates any

efforts to legalize such ideologies in the community and thus, the complications faced at

childbirth will be eradicated.

Conclusion

In summary, there are many problems facing neonatal care in Nepal and thus, it is

appropriate to incorporate the internal legal framework and the international legal underpinnings

which are vital in addressing the issue. In this case, health laws need to be applied in the process

of proving neonatal care to ensure that there is adequate progress in the process. Evidently,

bodies such as the UN play a central role in ensuring that all persons access proper neonatal care

in the long run.

Bibliography

Bhusal, Chetkant, Sigma Bhattarai, and Ravi Kumar Bhaskar. "Maternal health in Nepal

progress, challenges and opportunities." Int J Med Health Res 1, no. 3 (2015): 68-73.

Colombini, Manuela, Susannah H. Mayhew, Ben Hawkins, Meera Bista, Sunil Kumar Joshi,

Berit Schei, and Charlotte Watts. "Agenda setting and framing of gender-based violence

in Nepal: how it became a health issue." Health policy and planning 31, no. 4 (2015):

493-503.

Cook, Rebecca J., and Simone Cusack. "The Committee on the Elimination of Discrimination

against Women." Edward Elgar Publishing Ltd., 2018.

Dhimal, Meghnath, M. Dhimal, K. Karki, Doreen Montag, D. Groneberg, and Ulrich Kuch.

"Tracking health-related Sustainable Development Goals (SDGs) in Nepal." Journal of

Health and Social Sciences 2, no. 2 (2017): 143-148.

Gautam, Madhav, and Prabodh Risal. "Infertility: An Emerging Public Health Issue in

Nepal." Annals of Clinical Chemistry and Laboratory Medicine 3, no. 1 (2017): 1-2.

Joshi, Reesha, Sheetal Sharma, and Edwin Van Teijlingen. "Improving neonatal health in Nepal:

major challenges to achieving millennium development goal 4." Health Science

Journal 7, no. 3 (2013): 247-257.

Mahara, Gehendra, Jill Barr, Janeeta Thomas, Wei Wang, and Xiuhua Guo. "Maternal health and

its affecting factors in Nepal." Family Medicine and Community Health 4, no. 3 (2016):

30-34..
 10

OHCHR. "International Covenant on Economic, Social and Cultural Rights: Adopted and

opened for signature, ratification and accession by General Assembly resolution 2200A

(XXI) of 16 December 1966, entry into force 3 January 1976, in accordance with article

27." (1966).

Sanjel, Keshab, Sharad Raj Onta, Archana Amatya, and Prem Basel. "Patterns and determinants

of essential neonatal care utilization among underprivileged ethnic groups in Midwest

Nepal: a mixed method study." BMC pregnancy and childbirth 19, no. 1 (2019): 1-10.

Shrestha, Gambhir, Prajwal Paudel, Parashu Ram Shrestha, Shambhu Prasad Jnawali, Deepak

Jha, Tek Raj Ojha, and Bikash Lamichhane. "Free Newborn Care Services: A New

Initiative in Nepal." Journal of Nepal Health Research Council 16, no. 3 (2018): 340-

344.

Sital, Kalantry, Jocelyn E. Getgen, and Steven Arrigg Koh. "Enhancing enforcement of

economic, social, and cultural rights using indicators: A focus on the right to education in

the ICESCR." In Economic, Social and Cultural Rights, pp. 211-268. Routledge, 2017.

Thapa, J. K., P. Manandhar, R. K. Subedi, S. Dahal, N. B. Mahotra, and A. Pandey. "Assessing

Health Status of Khanigaun Village Development Committee in Nuwakot District of

Nepal." Journal of Nepal Health Research Council (2016).