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Indexing Mothers, Children: The Case of Nepal

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Nepal ranks 13th among the 33 least developed countries in the 2007 Mother’s Index. The report credits political will for decreasing child mortality.

Among the 33 least developed countries, Nepal ranks at the top 13th in Mother’s Index Ranking and at top 8th in Children’s Index Ranking. The rankings are based on the health, security and well-being of mothers and/or children.

Nepal is among five countries that made the major progress in reducing child deaths. The other countries are Egypt, Indonesia, Bangladesh, and the Philippines. These countries focused on family planning.

Despite a GNI of only $1,530 and a decade of civil conflict, Nepal has cut its under-5 death rate almost in half in the past 15 years. Key to this success has been improving the availability of lifesaving child health measures. For example, in the past 10 years, immunization rates have increased from 43 to 83 percent, and over 95 percent of children 5 to 59 months of age receive at least one annual vitamin A supplement.

An innovative approach called “community case management” has given community health workers and parents the knowledge and tools they need to take action. Political will was also an important factor in the success in Malawi, Tanzania, Nepal and Bangladesh. Egypt, which has cut the death rate of children under age five by 68 percent since 1990, more than any other country, has shown a particular commitment to children's health.

More than half of Nepal’s children under 5 can now be treated for diarrhea and pneumonia close to home – often by a carefully selected and trained female health worker in their own community. This means parents do not have to make long, costly and often dangerous journeys to medical facilities when their children are ill, so they are more likely to seek treatment (and also to seek it earlier, before problems become life-threatening). Nepal’s Ministry of Health, in partnership with John Snow International and Save the Children, has recently begun training community health workers to administer antibiotics to treat sepsis in newborns.

Another key to Nepal’s success in saving children’s lives has been the increased use of modern contraception to delay and space births at healthy intervals. Over 44 percent of Nepali women now use modern contraceptives – up from 26 percent in 199673 – greatly reducing the number of high-risk pregnancies. But there is more to do. Over half of deaths among children under 5 occur in the first month of life, and over 80 percent of births in Nepal are not attended by skilled personnel, placing both mother and newborn at greater risk of death. And nearly half of all children under 5 are underweight for their age.

Nepal, an even poorer country than Bangladesh, is making steady gains in saving children’s lives, with a 49 percent reduction in child mortality in the last 15 years.

In terms of Mothers Index Ranking, European countries – along with New Zealand and Australia – dominate the top positions (The top 10 include: Sweden, Iceland, Norway, New Zealand, Australia, Denmark, Finland, Belgium, Spain, Germany) while countries in sub-Saharan Africa (The bottom 10 include Djibouti, Burkina Faso, Ethiopia, Eritrea, Angola, Guinea-Bissau, Chad, Yemen, Sierra Leone, Niger) dominate the lowest tier. The United States places 26th this year.

While most industrialized countries cluster tightly at the top of the Index – with the majority of these countries performing well on all indicators – the highest-ranking countries attain very high scores for mother’s and children’s health, educational and economic status.

The 10 bottom-ranked countries in this year’s Mothers’ Index are a reverse image of the top 10, performing poorly on all indicators. Conditions for mothers and their children in these countries are devastating.

The data collected for the Mothers’ Index document the tremendous gaps between rich and poor countries and the urgent need to accelerate progress in the health and well-being of mothers and their children. The data also highlight the regional dimension of this tragedy. Ten of the bottom 11 countries are in sub-Saharan Africa. That region also accounts for 18 of the 20 lowest-ranking countries.

Individual country comparisons are especially startling when one considers the human suffering behind the statistics: Fewer than 15 percent of births are attended by skilled health personnel in Afghanistan, Bangladesh, Chad, Ethiopia and Nepal. Over the course of her lifetime, 1 woman in 7 will die in pregnancy or childbirth in Angola, Malawi and Niger; the maternal death risk is 1 in 6 in Afghanistan and Sierra Leone.

Nearly half of all children under age 5 are suffering from moderate or severe malnutrition in Bangladesh, Burundi, Cambodia, India, Nepal, Timor-Leste and Yemen. More than 60 percent of the population of Afghanistan and Papua New Guinea lacks access to safe water in Ethiopia and Somalia.

Statistics are far more than numbers. It is the human despair and lost opportunities behind these numbers that call for changes to ensure that mothers everywhere have the basic tools they need to break the cycle of poverty and improve their own quality of life, as well as that of their children, and generations to come.

There are at least five interventions to address five of the most dangerous threats to children’s survival: newborn disorders, malnutrition, pneumonia, diarrhea and measles. These interventions include skilled care during childbirth, breastfeeding, measles immunization, oral dehydration therapy, and pneumonia care.

Effective tools to fight these killers are not expensive. Yet millions of children are still dying because they are not being reached with these proven, lifesaving solutions.

To read the full report, click here (in pdf format).

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Brihát Śhānti Sámjhautā, 2006
(Comprehensive Peace Agreement)

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