Women's Health World Conference 2026

Abstract

Introduction: Nepal has made progress in reducing of maternal mortality, yet the country remains short of the SDG 2030 target. Increased institutional deliveries have contributed to this decline, but quality of care during childbirth remains a concern, with disrespect and mistreatment of women during childbirth still prevalent. 

Methods: Data from the Nepal Health Facility Survey (NHFS) 2021 were analyzed for 428 observed normal deliveries. RMC was assessed using 13 items from the labor and delivery observation checklist., mapped to the Bowser and Hill framework and scored across six domains on a 100-point scale. Deliveries scoring at or above the mean were classified as “RMC” and those below as “Non-RMC.” Frequencies, percentages, means, and standard deviations were used to describe the data, while multivariable logistic regression examined associations with facility and maternal factors.

Results: Overall, 53.8% received RMC (mean 69.1 ± 18.6). Protection from abuse was the strongest domain (mean 95.5 ± 12.7), with most women not experiencing physical (97.4%) or verbal abuse (96.2%), whereas privacy and confidentiality (mean 48.4 ± 35.5; visual/auditory privacy 57.9%, drape use 39.0%) and timely care (mean 43.3 ± 49.6; prompt attention 43.3%) were the weakest. Rights to information and informed consent were inconsistently upheld (mean 71.1 ± 45.4; procedures explained 71.1%). Although dignity and respect (mean 76.4 ± 26.8) and non-discrimination (mean 79.8 ± 25.0; discrimination 1.7%) were relatively stronger, gaps persisted in communication and language support (61.2%). Rural residence and province of delivery were significant predictors of RMC.

Conclusion: The provision of RMC in Nepal shows substantial gaps, particularly in privacy, timely care, and effective communication, and varies across geographic and provincial contexts. Strengthening facility infrastructure, building provider capacity in respectful, woman-centered care and implementing context-specific strategies are essential to ensure equitable, dignified, and high-quality maternity care nationwide.