Evaluation of Maternal Health Intervention in rural Nepal


Antenatal care (ANC) is routine care for the pregnant woman. The World Health Organisation (WHO) recommends four ANC visits for every woman. Many rural women in Nepal have fewer ANC visits and some have none at all. We found that many economic and sociocultural factors affect the uptake of ANC in Nepal. For example, the family (mother-in-law) is very influential, and a poor relationship between mother–in–law and daughter–in–law can influence the uptake of ANC.


The aim is to evaluate the impact of a specially designed health promotion intervention to improve the uptake of both ante-natal and post-natal care in rural Nepal.


1.) Improve well-being through decrease in maternal, neonatal and infant mortality rates and diseases relating to reproductive and sexual health practices.

2.) Assist relevant national training bodies to produce health promotion curricula into training for all health staff.


We designed a number of interventions which were:

(a) community–driven and using a ‘bottom-up’ approach;

(b) evidenced-based;

(c) low cost;

(d) using as much as possible existing resources;

(e) focused on prevention;

and (f) targeted poorest rural people.


Some of our expected outcomes include:

1.) Increased knowledge & behaviour among target groups regarding sexual & reproductive health activities;

2.) Improved ANC and postnatal care services & practices;

3.) Improved capacity of community to identify, negotiate and solve health related problems;

4.) Improved knowledge & training for local & national health staff to deliver relevant, timely, accessible services.



  • Green Tara Trust UK, London

BU researchers

  • Edwin van Teijlingen
  • Sheetal Sharma, BU PhD student


  • Padam Simkhada, Sheffield University
  • Bibha Simkhada, Green Tara Nepal
  • Sally Woodes Rogers, University of Aberdeen
  • Jane Stephens, Green Tara Trust UK


Publications to date from this study:

  • Simkhada B, van Teijlingen E, Porter, M, Simkhada, P. (2006) Major problems and key issues in Maternal Health in Nepal (Review), Kathmandu Univ Med J, 4 (2): 261-266.
  • Dhakal S., Chapman, G, Simkhada P., van Teijlingen E. et al. (2007) Utilisation of postnatal care among rural women in Nepal, BMC Pregnancy & Childbirth 7 :19. web address: www.biomedcentral.com/content/pdf/1471-2393-7-19.pdf
  • Simkhada B., van Teijlingen E, Porter M., Simkhada P. (2007) Factors affecting the utilisation of antenatal care in        developing countries: a systematic review of the literature, J Advanc Nurs 61 (3): 244-260.
  • Kirkpatrick P., van Teijlingen E. (2009) Lost in Translation: Reflecting on a Model to Reduce Translation and                Interpretation Bias, Open Nurs J, 3 (8): 25-32
  • Acharya DR, Bhattarai R, Poobalan A, van Teijlingen E.R., Chapman, G. (2010) Factors associated with teenage          pregnancy in South Asia: a systematic review. Health Sciences J 4 (1): 3-14. web address: www.hsj.gr/volume4/issue1/402.pdf
  • Simkhada P., van Teijlingen E, Kadel S., Stephens J, Sharma, S., Sharma, M. (2009) Reliability of National Data Sets: Evidence from a Detailed Small Area Study in Rural Kathmandu Valley, Nepal. Asian J Epidemiol 2(2):44-48.
  • Acharya, D.R., van Teijlingen, E.R., Simkhada P. (2009) Opportunities & challenges in school-based sex and sexual health education in Nepal. Kathmandu Univ Med J 7(4): 445-453
  • Teijlingen van, E., Simkhada, P., Ireland, J.C.M. (2010) Lessons learnt from undertaking maternity-care research in developing countries. Evidenced-based Midwifery 8(1): 12-16.
  • Simkhada, B., Porter, M., van Teijlingen, E. (2010) The role of mothers-in-law in antenatal care decision-making in Nepal: A qualitative study. BMC Pregnancy & Childbirth 10(34) www.biomedcentral.com/content/pdf/1471-2393-10-34.pdf
  • Acharya, D.R., Bell, J.S., Simkhada, P., van Teijlingen E., Regmi, P.R. (2010) Women’s autonomy in decision-making for health care: A demographic study in Nepal. Reprod Health 9(15).
  • Dhakal, S., van Teijlingen, E., Simkhada, P., Dhakal, K.B., Stephens J., Chapman, G., Raja, A.E. (2011) Antenatal care among women in rural Nepal: A community-based study. Online J Rural Nurs Health Care 11 (2): 76-87. http://rnojournal.binghamton.edu/index.php/RNO/article/view/20/17
  • Dhakal, S., van Teijlingen, E., Raja, A.E., Dhakal, K.B. (2011) Skilled care at birth among rural women in Nepal: practice and challenges J Health, PopNutrition 29 (4): 371-378.