MATERNAL AND NEWBORN HEALTH CARE PRACTICES AMONG RECENTLY DELIVERED WOMEN IN NEPAL March 2019 This publication was produced at the request of the United States Agency for International May 2011 Development. It was prepared independently by CAMRIS International. DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. MATERNAL AND NEWBORN HEALTH CARE PRACTICES AMONG RECENTLY DELIVERED WOMEN IN NEPAL March 2019 Contract Number AID-367-C-15-00001 Cover photograph: An enumerator administering the baseline survey questionnaire to a Recently Delivered Women in Kavre district. Credit: Suzanne Penfold Taylor i STUDY TEAM MEMBERS Suzanne Penfold Taylor, Team Leader, MEL Activity Manorama Adhikari, DCOP, MEL Activity Nira Joshi, National Consultant, New ERA Ganesh Sharma, Statistician/Data Analyst, MEL Activity iii TABLE OF CONTENTS Study Team Members ......................................................................................................................... iii Table of Contents ................................................................................................................................ iv List of Tables ...................................................................................................................................... xii Acronyms and Abbreviations .......................................................................................................... xvi KEY INDICATORS SUMMARY TABLE .................................................................................... xvii Executive Summary .......................................................................................................................... xix Chapter 1: Background and Introduction ......................................................................................... 1 1.1 Background ........................................................................................................... 1 1.2 Survey Objectives ................................................................................................. 2 Chapter 2: Methods ............................................................................................................................. 3 2.1 Study Population and Sample Size ................................................................... 3 2.2 Survey Sample Selection ..................................................................................... 3 2.2.1 Selection of Districts ............................................................................................ 3 2.2.2 Selection of Clusters ............................................................................................. 4 2.2.3 Selection of Households and Recently Delivered Women ............................ 4 2.3 Survey Tools ......................................................................................................... 5 2.4 Implementation of Survey .................................................................................. 6 2.4.3 Field Test of the Survey Instruments ................................................................ 7 2.5 Refresher Training and Data Collection ........................................................... 7 2.6 Quality Control..................................................................................................... 9 2.7 Data Entry, Cleaning, and Analysis .................................................................. 9 2.8 Research Ethics ................................................................................................... 10 Chapter 3: Sample Characteristics .................................................................................................. 11 3.1 Socio-Demographic Characteristics of the Respondents ............................. 11 3.2 Housing Characteristics .................................................................................... 12 3.3 Household Possessions ..................................................................................... 13 3.4 Sources of Drinking Water ............................................................................... 13 3.5 Types of Toilet Facility ...................................................................................... 14 3.6 Household Wealth Quintiles ............................................................................ 14 Chapter 4: RDW Knowledge about FCHV and Health Mother's Group .................................... 15 4.1 Recently Delviered Women’s Knowledge about Female Community Health Volunteers (FCHVs) ............................................................................................... 15 4.2 Health Mother's Groups .................................................................................... 16 Chapter 5: Antenatal Care ................................................................................................................ 18 5.1 Antenatal Care Service Utilization .................................................................. 18 5.2 Types of Services and Counseling Received During Antenatal Care (ANC) 21 5.3 Tetanus Toxoid Immunization ......................................................................... 23 5.4 Intake of Iron Folic Acid Tables and Deworming Tablets ........................... 24 5.5 Knowledge about Danger Signs and Service Seeking Behavior During Pregnancy 25 5.6 Danger Sign Encountered During Pregnancy and Management of the Problems 26 5.7 Birth Preparedness ............................................................................................. 27 5.8 CHX Knowledge and Receipt .......................................................................... 28 Chapter 6: Delivery Care and Coverage of Misoprostol or Matri Surakshya Chakki (MSC) ... 30 iv 6.1 Assistance During Delivery .............................................................................. 30 6.2 Place of Delivery ................................................................................................ 32 6.3 Access to Services during Delivery ................................................................. 33 6.4 Experienced Danger Signs During and After Delivery of the Last Child . 35 6.5 Awareness of Misoprostol “Matri Suraksha Chakki” .................................. 36 Chapter 7: Postpartum Care ............................................................................................................ 39 7.1 Female Community Health Volunter Home Visits During the Postpartum Period 39 7.2 Postpartum Checkups ....................................................................................... 40 7.3 Intake of Iron Folic Acid Tablets and Vitamin A Capsule in the Postpartum Period ............................................................................................................... 43 7.4 Awareness of Danger Signs During the Postpartum Period (PP) .............. 44 Chapter 8: Immediate Newborn Care in Home Deliveries, and Application of Substances to the Cord ..................................................................................................................................................... 45 8.1 Immediate Newborn Care Among Home Deliveries ................................... 45 8.2 Umbilical Cord Cutting Practices .................................................................... 46 8.3 Application of Substances to the Umbilical Cord (all live births) .............. 47 8.4 Problems with the Umbilical Cord (All Live Births) .................................... 51 Chapter 9: Newborn Care During the First Month ........................................................................ 52 9.1 Knowledge of Issues in Newborn Care .......................................................... 52 9.2 Access to Neonatal Checkup Services............................................................. 53 9.3 Health Issues Encountered by Neonates and Treatment-Seeking Behaviors After Encountering Health Problems ................................................................................ 54 9.4 Child’s Weight and Size at Birth ...................................................................... 55 9.5 Care for Newborn Perceived to be Smaller Than Average .......................... 56 Chapter 10: Infant and Young Child Feeding Practices ................................................................ 57 10.1 Initiation of Breastfeeding ................................................................................ 57 10.2 Exclusive Breastfeeding Practices .................................................................... 59 10.3 Introduction of Complementary Foods .......................................................... 60 10.4 Minimum Dietary Diversity ............................................................................. 61 10.5 Types of Complementary Foods ...................................................................... 62 Chapter 11: Postpartum Family Planning ....................................................................................... 63 11.1 Family Planning Practices ................................................................................. 63 Chapter 12: Conclusions ................................................................................................................... 64 REFERENCES ..................................................................................................................................