Nepal

Motherhood in Nepal remains a high-risk enterprise even in the 21st century. One of the poorest nations in the world, Nepal has a total population of 27.1 million. Situated along the Himalaya Mountains between India and Tibet, the nation has few roads and people often walk for days to access the limited health care facilities.

The estimated maternal mortality rate (MMR) in 2005, according to World Health Organization, was 830 deaths per 100,000 live births (for comparison, Canada's is 7 per 100,000). In real terms, this means that every two hours one woman dies from childbirth or pregnancy-related complications in Nepal. Maternal child health programs implemented through joint government and nongovernment organizational initiatives have led to a dramatic drop in the MMR between 1996 and 2006. However, 82 percent of women still give birth at home without the support of a skilled birth attendant or midwife.

The average number of births per woman in Nepal is 3.35, but there are wide variations between urban and rural populations. The total fertility rate in 2001 among the better-educated and wealthier women in the urban center of Kathmandu, the nation's capital city, is closer to replacement levels [Page 906]of 2.1 children per woman. In rural areas, where a majority of the population resides and poverty and lower levels of education are the norm, rates still reach as high as at 4.1 children per woman. In addition, early-arranged marriage, sometimes before girls reach puberty, is still common practice, and the proportion of women giving birth before 20 years of age remains high in comparison to most other Asian nations.

The use of family planning methods in Nepal, both natural and modern, has increased steadily from 29 percent in 1996 to 48 percent in 2006. There is a correlation between access to contraception and reduced maternal mortality. However, in Nepal, strictly applied government family planning targets and forced or coerced sterilization programs are not uncommon. Prior to 2002, Nepal had one of the strictest abortion policies in the world, criminalizing and imprisoning women who sought abortions. Abortion has since been legalized with few restrictions, but access is still limited by geography and economic hardship.

Ten years of armed conflict ended in a peace agreement in 2006 between Maoist insurgents and the government, but the conflict left rural development initiatives in disarray and significantly increased hardships for women and children. There are virtually no government initiatives or state welfare supports for single mothers, who suffer social stigmatization and often rejection by their own families. Hinduism and Buddhism are the most prevalent religions practiced. Both religious traditions place a high value on motherhood as part of the cycle of birth and reincarnation.