Nepal faces a very high Maternal Mortality Rate of 258/100,000 live births. This can be explained by poor antenatal care attendance and unsafe home deliveries. In Nepal, the vast majority of births still take place at home. Infant Mortality Rate is relatively high with 46/1000 live births. Although Nepal has made great progress toward providing access to safe drinking water and sanitation for its population (over 80% coverage water supply and over 60% sanitation coverage), challenges exist related to sustainability of the services and providing services to remaining un-served.
Women face unequal power relations due to a patriarchal social structure and the exploitative nature of the socio-cultural system. Most of the families have male members taking up the role of household head. Men make decisions for women not only in terms of property rights but also regarding the permission to go outside from their home.
Kapilvastu (or Kapilbastu) is a district in the Terai (lowland) area in province number 5 of Nepal (before the 2015 restructuring it was a district of the Western Region in Lumbini zone). Kapilvastu has a population of over half a million people (data from 2011), of which 50% are women. The district has a diverse population in terms of castes and ethnic groups.
The project started with an inception phase in 2018 during which local partners were identified and baseline information was gathered in the selected implementations wards. The baseline showed that there exist many misconceptions about pregnancy, delivery and infant care. For example, 59% of the women think that it is okay for healthy women to deliver at home and 49% did give birth at home, 27% of the women do not know that they have to attend 3 ante-natal check-ups, 9% of the women do not feel comfortable when attending the antenatal clinic however for Muslim women this is much higher (28%), and 49% of babies and mothers did not receive post-natal care during the first 24 hrs after delivery. The situation varies significantly between the 4 wards in which the programme will be implemented and between the caste, ethical and religious back ground of the women. Even though the women in the 4 wards as a group can already be identified as vulnerable within this large women group the Madeshi, Dalit, Muslim and Janajati women are potentially even more vulnerable and disadvantaged.
Aim of project:
Through this learning project Simavi aims to support women (specifically disadvantaged women) to practice healthy and hygienic behavior during their pregnancy, delivery and after birth, by making use of sustainable and improved WASH and maternal health care services, based on their own free and informed choices.
- Women know how to and want to practice healthy and hygienic behavior
- Families and communities are supportive of women practicing healthy and hygienic behavior
- Sustainable WASH and maternal care services are in place
- Disadvantaged women fully participate in decision-making processes to ensure that their rights and needs are recognised
The project will work through 3 pillars based on Simavi’s ToC. Throughout the project specific attention will be paid to ensure that disadvantage women will fully participate and their rights and needs are recognised, and that the other groups within the society will be inclusive towards them and support them.
The first pillar (knowing how to and wanting to) focusses on improving the health and hygiene related decision making of women especially before, during and after pregnancy by: ensuring they have the right information to base their decisions on, setting up systems to ensure they have the means to go to the health centre, stimulating women to deliver with skilled birth attendance, and improving their knowledge on new born care.
The second pillar (being allowed to) will work on ensuring the people around the women will be supportive towards the women by: ensuring the key influencers (for example men, mothers in law, other in-laws, peers) have the right knowledge, attitude and skills to support the women to attend antenatal check-ups, deliver at the clinic and go to post-natal check-ups, support them in their health and hygiene behavior, respect their choices and be inclusive towards minorities and the most vulnerable.
The third pillar relates to having access to quality health and WASH services. Hereto health workers, and health volunteers will be trained on hygiene standards and on providing quality services related to pregnancy and child birth and care as per national standards, WASH committees will be supported with knowledge and skills to sustainably improve WASH facilities at the health facilities and in the communities, and through advocacy methods, like social accountability or budget tracking, the local government will be pressured to provide quality services.
At the end of the project the women will demonstrate sufficient knowledge on hygiene practices and safe deliveries, they will feel more confident to make their own decisions regarding pregnancy and delivery and they will feel supported to practice healthy and hygienic behavior.
The women have resources available for practicing health and hygienic behavior during and after pregnancy and at delivery, they perceive the maternal care services in place as accessible, affordable, inclusive and of quality. The skilled birth attendants practice hygiene behavior during pregnancies, deliveries and post-natal care while the communities are engaged in WASH and SRHR, the decision makers (key influencers) are engaged and supportive and government / local authorities policies ensure access and quality of services at home and at health facilities. Disadvantaged women feel capable to voice their needs and rights, disadvantaged groups are structurally involved in the project and the community fights exclusion