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Spreading safe motherhood messages in Nepal

In rural Nepal few mothers use modern obstetric and midwifery services. Since 1997 the Nepal Safer Motherhood Project (NSMP) has been working with the Government of Nepal to reduce maternal mortality and to enable pregnant women to make informed decisions. The project’s success owes much to its use of Key Informant Monitoring (KIM).

An article from the University of Wales Swansea, UK discusses how KIM has been used to monitor safe motherhood programmes to ensure that pregnant women have safe deliveries.

KIM is based on the participatory ethnographic evaluation and research (PEER) method, in which women from the community – who have the trust of their peers - are trained as peer researchers. Using conversational interviewing, the peer researchers encourage respondents to talk not about themselves but about ‘other women like them’. This approach allows women to discuss sensitive topics without embarrassment.

The research has helped programme managers understand the environment within which maternal health, pregnancy, and childbirth decisions are made. Information on women’s ability to make decisions, their perceptions of barriers to obstetric services and opinions on the quality of maternal health care helps in designing better programmes.

Village Development Committees (VDCs), the lowest tier of government in Nepal, have confidence in the researchers because they are local women. As a result of the project VDCs are working with the Safe Motherhood Project to alert women and traditional healers to obstetric danger signs and the need to seek care in the case of complications. Engaging the VDCs in the KIM process has led to their supporting the establishment of emergency transport systems to carry women in need of obstetric care to hospitals on locally-made stretchers, and to their putting up curtains in clinics so that pregnant women have privacy during antenatal check-ups.

KIM has revealed that:

Local women researchers have promoted behaviour change: some have convinced family members to take women with obstetric complications to hospital.
Many women choose traditional healers as their first service providers: the NSMP recognises this and offers training courses to make traditional healers aware of the dangers of pregnancy and delivery.
Training traditional healers has helped: healers now refer more women to clinics.

Lessons from the KIM approach include:

The PEER method is best suited to urban and peri-urban environments where there are wide peer networks and diverse communities which give women a sense of anonymity and allow them to talk of ‘others like them’.
Rural communities in Nepal are small in population size and power structures and social hierarchies could limit women’s social and physical mobility: in such contexts PEER requires adaptation, as was done with KIM.

Source(s):
‘Using Key Informant Monitoring in safe motherhood programming in Nepal’ Development in Practice, Vol 15, no. 2, pp. 151-164, by Neil Price and Deepa Pokharel, April 2005 Full document.

Funded by: UK Department for International Development (DFID) (AG1196)

id21 Research Highlight: 5 August 2005

Further Information:
Neil Price
Centre for Development Studies
University of Wales Swansea
Swansea
SA2 8PP
UK

Tel: +44 (0) 1792 295975/295877
Fax: +44 (0) 1792 295682
Contact the contributor: n.l.price@swansea.ac.uk

Centre for Development Studies, University of Wales, Swansea

Deepa Pokharel
Nepal Safer Motherhood Project
PO Box 7830
Kathmandu
Nepal

Contact the contributor: deepa@nsmp.org.np

Nepal Safer Motherhood Project

Options Consultancy Services Limited
Cap House
9-12 Long Lane
London EC1A 9HA
UK

Tel: +44 (0)20 7776 3900
Fax: +44 (0)20 7776 3978
Contact the contributor: nsmp@options.co.uk

Options Consultancy Services Limited

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