This article provides a background on Nepal as a whole, with a focus on the nation's childbearing and birthing practices. While modern Western medicine has disseminated across the country to varying degrees, different regions in Nepal continue to practice obstetric and newborn care according to traditional beliefs, attitudes, and customs.
Background
Health and illness theories
Indigenous Nepali theories of illness differ from that of the modern Western world. They do not believe in the germ theory; instead, they believe that illness is caused by malevolent powers that enter the body, disturbing the normal balance and creating sickness. It is up to the healer (dhami-jhankris) to try to release the malevolent power that is causing disease and restore balance in the body system to make it function normally again. These indigenous beliefs are similar to the faith healing traditions still practiced today. Faith healing is based on the belief that illness is due to attacks by different types of spirits. The healers must identify the type of spirit and make an offering to appease the spirit or forcibly remove the spirit with a spirit bone (usually a human femur). These rituals often include colorful costumes, chanting, singing, dancing, and drumming, as well as a sacrifice of a rooster or a black goat. These ceremonies are done by dhami-jhankri (shamans), pandit-lama-gubhaju-pujari (priests of different ethnic and religious groups), and jyotishi (astrologers).
There are two other main healing traditions in Nepal, namely Ayurveda, Tibetan medicine, and faith healing. Ayurveda is based on the tridosha theory of disease, where the three doshas, or humors, are Vata (wind), Pitta (gall) and Kapha (mucus). Disturbance is the equilibrium of these humors results in disease. The traditional healers can be divided into faith healers and medical providers. The medical providers include Baidhya-Kabiraj, who use elixirs, metal preparations and herbs to treat illness, and Jadi-butiwala, who only use herbs for treatment. Tibetan medicine (gso ba rig pa) is based on the belief that the physical world, including our bodies, are a product of our individual perception, and it is the mind that brings on illness to the body. The Tibetan medical practitioners, Amchis, help direct the patient towards increased self-awareness to restore balance and harmony between the body and the forces of the universe.
Health statistics
The current total population sex ratio in Nepal is 0.98 males/female. Female life expectancy at birth in 68.92 years, compared to 66.18 years for males. The fertility rate is 2.24 children born per woman, and the birth rate is 20.64 births per 1,000 people. The mother's mean age at first birth is 20.1 years old. 49.7% of the population use contraception. It is unclear what the abortion rate is in the country, likely because it is considered taboo, so women are less likely to report it.
Maternal mortality rates have dropped significantly from 539 per 100,000 live births in 1996 to 258 deaths per 100,000 live births in 2015. For this achievement, the country has been honored at the 2010 Millennium Development Goals Review Summit. Leading causes of maternal mortality are postpartum hemorrhage (46%), obstructed labor (16%), complications of pregnancy induced hypertension and eclampsia (14%), and puerperal sepsis (12%) in 2015. 67% of maternal mortality occurs at home, 11% occurs at a health facility, and 11% occur on the way to a health facility. 90% of maternal deaths occur in a rural setting.
There has been an increase in the percentage of births attended by skilled personnel (doctors, nurses, midwives), from 4% in 1990 to 53% in 2015. Skilled birth attendance (SBA) in the urban setting is 72.7%, compared to 32.3% in the rural setting. SBA among the poorest 20% of the population is 10.7%, whereas among the richest 20% of the population, it is 81.5%.
The under-five mortality rate has dropped from 142 deaths per 1,000 live births in 1990 to 42 deaths per 1,000 live births in 2012. Infant mortality (under-one) is 39.14 deaths per 1,000 live births. Neonatal mortality rate is 24 per 1,000 live births.