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A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach
BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal’s perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulat...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417211/ https://www.ncbi.nlm.nih.gov/pubmed/30871523 http://dx.doi.org/10.1186/s12913-019-3979-3 |
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author | Paudel, Mohan Javanparast, Sara Dasvarma, Gouranga Newman, Lareen |
author_facet | Paudel, Mohan Javanparast, Sara Dasvarma, Gouranga Newman, Lareen |
author_sort | Paudel, Mohan |
collection | PubMed |
description | BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal’s perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS: Six key policy documents covering the period 2000–2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS: The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS: To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity. |
format | Online Article Text |
id | pubmed-6417211 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-64172112019-03-25 A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach Paudel, Mohan Javanparast, Sara Dasvarma, Gouranga Newman, Lareen BMC Health Serv Res Research Article BACKGROUND: Nepal formulated a range of policies related to maternal and neonatal survival, especially after the year 2000. Nevertheless, Nepal’s perinatal mortality remains high, particularly in disadvantaged regions. Policy analysis can uncover the underlying values, strategies and policy formulation processes that shape the potential to reduce in-country health inequities. This paper provides a critical account of the main policy documents relevant to perinatal survival in Nepal. METHODS: Six key policy documents covering the period 2000–2015 were reviewed using an adapted framework and were analyzed through qualitative content analysis. RESULTS: The analysis shows that the policies focused mainly on the system: improvement in provision of birthing facilities; targeting staff (Skilled Birth Attendants) and health service users by providing cash incentives to staff for bringing patients to services, and to users (pregnant women) to attend health institutions. Despite a growing focus on saving women and newborn babies, there is a poor policy focus and direction on preventing stillbirth. The policy documents were found to emphasize tensions between birthing at home and at health institutions on the one hand, and between strategies to provide culturally appropriate, woman-centered care in communities and medically orientated services on the other. Policies acknowledge the need to provide and address woman-centered care, equity, social inclusion, and a rights-based approach, and identify the community based approach as the mode of service delivery. Over and above this, all policy documents are aimed at the national level, and there is no specific policy direction for the separate ecological, cultural or geographic regions such as the mountainous region, which continues to exhibit higher mortality rates and has different cultural and demographic characteristics to the rest of Nepal. CONCLUSIONS: To better address the continuing high perinatal mortality rates, particularly in disadvantaged areas, national health policies should pay more attention to the inequity in healthcare access and in perinatal outcomes by integrating both stillbirth prevention and neonatal survival as policy agenda items. To ensure effective translation of policy into practice, it is imperative to tailor the strategies according to acknowledged policy values such as rights, inclusion and socio-cultural identity. BioMed Central 2019-03-14 /pmc/articles/PMC6417211/ /pubmed/30871523 http://dx.doi.org/10.1186/s12913-019-3979-3 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Paudel, Mohan Javanparast, Sara Dasvarma, Gouranga Newman, Lareen A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title | A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title_full | A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title_fullStr | A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title_full_unstemmed | A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title_short | A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach |
title_sort | critical account of the policy context shaping perinatal survival in nepal: policy tension of socio-cultural versus a medical approach |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417211/ https://www.ncbi.nlm.nih.gov/pubmed/30871523 http://dx.doi.org/10.1186/s12913-019-3979-3 |
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