The reduction of maternal mortality is one of the key Millennium Development Goals and is measured by two indicators: (1) a reduction in the maternal mortality ratio (MMR) by three quarters between 1999-2015 and (2) the proportion of deliveries with skilled health personnel. Nepal has made significant progress with regard to the first of these indicators, reducing the MMR from one of the highest in the world. However, a major challenge remains the under-utilisation of health services and, in particular, encouraging women to give birth within a health facility with a skilled birth attendant. This project seeks to identify barriers to facility birth in non-government organisation (NGO) maternity hospitals in Nepal. This information will inform strategies to promote skilled care at birth and further reduce the MMR in Nepal.  


To explore the perceptions, attitudes and practice of health care providers (nurses, midwives, and doctors) based in two NGO maternity hospitals in Nepal, which are open to poor people in their catchment area.  


This is a mixed-methods study:

  • Systematic literature review (completed);
  • Non-participant observations in and around two NGO maternity hospitals (one urban and one rural) (completed);
  • Interviews with health care providers (nurses, midwives, and doctors) working in the hospitals (completed).

BU researchers


Padam Simkhada (University of Sheffield)  


Milne L, van Teijlingen E, Hundley V, Simkhada P and Ireland J (2015) Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study. BMC Pregnancy and Childbirth 15:142.

Milne L, Ireland J, van Teijlingen E, Hundley V and Simkhada P (2018) Gender inequalities and childbearing: A qualitative study of two maternity units in Nepal. Journal of Asian Midwives 5 (1):13–30.

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