{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:22:39Z","timestamp":1791091359051,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2001,12,25]],"date-time":"2001-12-25T00:00:00Z","timestamp":1009238400000},"content-version":"vor","delay-in-days":480,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2000,9]]},"abstract":"<jats:p><jats:bold>Summary<\/jats:bold> This study assesses the performance of maternity care and its specific service components (preventive interventions in antenatal care, antenatal screening, referral, obstetric care) in Banke District, Nepal, using a set of structure, process, and output\/outcome indicators. Data sources included health service documents in 14 first level health units and two hospitals, covering 1378 pregnancies and 1323 deliveries, structured observations, antenatal exit interviews (<jats:italic>n\u00a0<\/jats:italic>=\u00a0136) and interviews with maternity users (<jats:italic>n\u00a0<\/jats:italic>=\u00a0146). Coverage of antenatal care (28%) and skilled delivery care (16%) was low. In antenatal care, preventive interventions were only partially implemented (effective iron supplementation in 17% of users). On average one minute was spent on individual counselling per consultation. 41% of pregnancies were identified as high risk and 15% received referral advice, which was followed in only 32%. Hospital deliveries accounted for 9.8% of all deliveries. Hospital\u2010based maternal mortality was 6.8\/1000 births and the stillbirth rate 70\/1000. High rates of stillbirth were observed in breech delivery (258\/1000 births), caesarean section (143\/1000) and twin delivery (133\/1000). The risk of stillbirth was higher for rural women (RR 2.3; 95% CI 1.51\u20133.50) and appeared to be related to low socio\u2010economic status. Emergency admissions were rare and accounted for 3.4% of hospital deliveries or only 0.4% of all expected deliveries. There was hardly any accumulation of high\u2010risk pregnancies at hospital. The population\u2010based rate of caesarean section was 1.1% (urban 2.3%, rural 0.2%). The estimated unmet obstetric need was high (82 cases or 61% of expected live\u2010threatening maternal conditions did not receive appropriate intervention). The limited effectiveness of maternity care is the result of deficiencies of all service components. We propose a two\u2010pronged approach by starting quality improvement of maternity care from both ends of maternity services: preventive interventions for all women and hospital\u2010based obstetric care. Antenatal screening needs to be rationalized by reducing inflated risk catalogues that result in stereotypical and often rejected referral advice.<\/jats:p>","DOI":"10.1046\/j.1365-3156.2000.00611.x","type":"journal-article","created":{"date-parts":[[2003,3,12]],"date-time":"2003-03-12T21:36:02Z","timestamp":1047504962000},"page":"657-665","source":"Crossref","is-referenced-by-count":53,"title":["Maternity care in rural Nepal: a health service analysis"],"prefix":"10.1111","volume":"5","author":[{"given":"Albrecht","family":"Jahn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Dar Iang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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