Baseline Survey for CB-MNC Program in Jhapa District

Baseline Survey for CB-MNC Program in 

Jhapa District 

By Valley Research Group (VaRG) 

Post Box 4112 

Kathmandu, Nepal 

December 2006 

This study was made possible by the generous support of the American people through the United States Agency for 

International Development (USAID). The contents are the responsibility of NFHP II and and do not necessarily 

reflect the views of USAID or the United States Government.

Preface 

This year, the Nepal Family Health Program (with new funding support from USAID) has begun to 

support a new public-sector initiative aiming to improve maternal and neonatal health through 

interventions primarily at the community level. This program (Community-Based Maternal- 

Neonatal Care) builds on similar work done under SNL and the MIRA project. It is intended to be an 

important learning activity which can helpfully contribute to the development of a common 

approach that can be taken to full national scale in the coming years. 

For such a learning experience, it is very important that we be in a position to assess which 

aspects of our work, which approaches, which elements, are working well and which are not. For 

that purpose, considerable effort has been given to developing robust provision for monitoring 

and evaluation. We have been helped in this effort by colleagues from Johns Hopkins University. 

Since important objectives of our work are to increase utilization of key maternal/ neonatal 

health interventions and to increase frequency of healthful household practices, we need to be in 

a position to measure impact at the household level. For that purpose, baseline household 

surveys have been conducted in Jhapa and Banke. The results presented in this report are very 

helpful for us both in orienting program design decisions and as a basis for comparison, 

measuring impact through a follow-on survey. 

I would like to particularly thank Bharat Ban, our colleagues at Valley Research Group, Bob 

McPherson and Abdullah Baqui and for their intellectual contributions and hard work, ensuring a 

high quality and programmatically useful product. 

Dr. Stephen Hodgins 

Chief of the Party 

Nepal Family Health Program 

December 2005 

i

Acknowledgements 

First of all, we would like to extend our sincere thanks to Nepal Family Health Program (NFHP) 

for entrusting VaRG to carry out such an important research task. We are thankful to Dr. Stephen 

Hodgins, Chief of Party, Mr. Ashoke Shrestha, Deputy Chief of Party Program and Mr. Don 

Boring, Deputy Chief of Party Finance and Administration for their continued support and 

encouragement during the study. Similarly, we are thankful to Mr. Bharat Ban, Team Leader, 

M&E Unit for his technical inputs and administrative support during the entire period of the 

study. We highly recognize the technical inputs provided by Dr. Robert McPherson, Technical 

Advisor, JHSPH/HARP to us throughout the study period. We would also like to thank Mr. 

Sushil Karki and Ms. Sabita Tuladhar for their support during the study. 

We must acknowledge the valuable comments and suggestions provided by the Team 

Leaders/Members of different Units of NFHP during the finalization of survey instruments and 

study report. Our thanks go to Dr. Swaraj Rajbhandari, Team Leader, Mr. Ram Chandra Silwal, 

Dr. Asha Pun and Ms. Radha Rai, RH Unit for their technical inputs. We would also like to 

thank for the support provided by the NFHP Team Leader of Biratnagar Field Office and Family 

Health Field Officer of Jhapa during the data collection. 

We would also like to extend our sincere thanks to Dr. Abdullah Baqui, Johns Hopkins University, 

Baltimore, USA, and Mrs. Nazma Begum from ICDDR-Bangladesh for their support during the data 

analysis. 

We would also like to extend our sincere thanks to Dr. John Quinley, Technical Advisor, Mr. 

Dharampal Prasad Raman, CTO/NFHP and Mr. Sita Ram Devkota, Program Specialist, HFP 

Division, USAID for their valuable comments and suggestions on the survey instruments and the 

draft report. 

Our thanks also go to the government officials of Jhapa district for their kind cooperation during data 

collection. We would also appreciate the cooperation extended to the study team by the District 

Health Officer, and PHC, Health Post and Sub-health Post staffs of Jhapa district. 

Finally, VaRG is indebted to all the respondents for their valuable time, patience in responding 

questions and cooperation during interview, without which this study would not have been 

complete. 

Valley Research Group (VaRG) 

December 2005 

ii

Contents 

Preface 

Acknowledgements 

List of tables 

List of figures 

Study area 

Study team 

Abbreviations 

Executive Summary 

Page 

i 

ii 

v 

xii 

xv 

xvi 

xvii 

xviii 

Chapter 1 Newborn Health in Nepal 1 

1.1 Magnitude of the newborn health problems at the global level 1 

1.2 Newborn health in Nepal 1 

1.3 Role of Nepal Family Health Program to strengthen national 

maternal and neonatal health programming 2 

1.4 Objectives of CB-MNC Baseline Survey 3 

Chapter 2 Methodology and Data Collection 4 

2.1 Study population 4 

2.2 Sample design 4 

2.3 Description of instruments 6 

2.4 Design and pre-testing of instruments 8 

2.5 Field organization and data collection 8 

2.6 Data cleaning and analysis 8 

Chapter 3 Characteristics of the Households and Respondents 10 

3.1 Characteristics of the sampled households 10 

3.2 Characteristics of the respondents 13 

Chapter 4 Familiarity with FCHVs and PHC ORC 20 

4.1 Familiarity with the FCHVs and mothers group 20 

4.2 Familiarity with PHC ORC 24 

Chapter 5 Marriage, Fertility and Family Planning Use by RDW 26 

5.1 Marriage and fertility 26 

5.2 Knowledge of family planning methods 29 

5.3 Use of family planning methods 30 

5.4 Interpersonal communication and counseling on family 

planning 36 

iii

Chapter 6 Antenatal Care and Delivery Services 41 

6.1 Knowledge about antenatal care 42 

6.2 Prevalence of danger signs during pregnancy 44 

6.3 Utilization of ANC 46 

6.4 Knowledge and attitudes towards delivery services and birth 

preparedness 62 

6.5 Support from family members during pregnancy 65 

6.6 Danger signs during delivery 68 

6.7 Knowledge about sources of delivery services 74 

6.8 Utilization of delivery services 77 

6.9 Behavior change communication 84 

Chapter 7 Postpartum, Immediate Newborn and Newborn Care 91 

7.1 Postpartum services from health workers or health facility 92 

7.2 Danger signs during postpartum period 104 

7.3 Family support during postpartum period 107 

7.4 Knowledge about postpartum hemorrhage 109 

7.5 Immediate newborn care 112 

7.6 Newborn care during first month 122 

Chapter 8 

Birth Preparedness, Access to Emergency Funds and 

Transportation 135 

8.1 Birth preparedness 136 

8.2 Access to emergency funds and transportation 148 

References 153 

Annexes 

Annex 1 List of sampled wards by Village Development Committee 156 

Annex 2 Methods for calculation of asset index for CB-MNC baseline survey 157 

Annex 3 

CB-MNC Baseline Survey of Recently Delivered Women: List of 

Indicators 159 

Annex 4 Survey Instruments 169 

iv

List of Tables 

Table 2.1 Distribution of clusters, households and respondents 6 

Table 3.1 Percent distribution of household population by age and sex 10 

Table 3.2 

Page 

Percent distribution of household population aged 10 years and above by marital 

status 11 

Table 3.3 Percent distribution of households by source of drinking water 12 

Table 3.4 Percent distribution of households having toilets 12 

Table 3.5 Percent distribution of households by main materials used in the houses 13 

Table 3.6 Percent distribution of RDW and their husbands by age group 14 

Table 3.7 

Percent distribution of mothers-in-law and fathers-in-law of RDW by their age 

group 14 

Table 3.8 Percent distribution of RDW, husbands, MIL and FIL by ethnicity 15 

Table 3.9 Percent distribution of RDW, husbands, MIL and FIL by their level of education 15 

Table 3.10 Percent distribution of RDW by their husbands level of education 16 

Table 3.11 Percent distribution of RDW by their occupation 16 

Table 3.12 Percent distribution of RDW by their husband’s occupation 17 

Table 3.13 

Table 3.14 

Table 3.15 

Table 3.16 

Percent distribution of RDW, husbands, MIL and FIL by frequency of listening 

radio and watching TV 17 

Percent distribution of RDW, husbands, MIL and FIL by exposure to radio and TV 

Percent distribution of RDW mode of transportation and distance to reach the 

health facility or health provider 18 

Percent distribution of RDW reporting any problems experienced to seek from 

health facility due to absence of health care providers or on security ground in the 

past 12 months 19 

Table 4.1 Percentage of RDW who know their FCHV by selected background characteristics 21 

Table 4.2 

Table 4.3 

Table 4.4 

Percent distribution of RDW who knows the name and ethnicity of the FCHV 

working in their areas 22 

Percent distribution of RDW by knowledge about types of help or services the 

FCHVs provide in their areas 22 

Percent distribution of RDW who have heard of the Primary Health Care Outreach 

Clinic (PHC ORC) by selected background characteristics 24 

Table 5.1 Percent distribution of RDW by age at first marriage 27 

Table 5.2 Percent distribution of RDW by age at first pregnancy 27 

Table 5.3 Percent distribution of RDW by number of children ever born and currently living 28 

Table 5.4 

Mean number of children even born and currently living among the RDW by their 

selected background characteristics 29 

Table 5.5 Percent distribution of RDW by knowledge of different family planning methods 30 

18 

v

Table 5.6 

Table 5.7 

Table 5.8 

Table 5.9 

Percent distribution of RDW (whose most recent delivery occurred between two 

and eleven months prior to the survey) and husbands by type of FP methods first 

used after the delivery of their last child 31 


and eleven months prior to the survey) and husbands currently using any family 

planning methods 32 


and eleven months prior to the survey who were not currently pregnant) currently 

using FP methods by their selected background characteristics 33 


and eleven months prior to the survey) and husbands by reasons for not using any 

family planning methods 35 

Table 5.10 Percent distribution of RDW by source or knowledge about source of supply of FP 36 

Table 5.11 

Table 5.12 

Table 5.13 

Table 6.1 

Table 6.2 

Table 6.3 

Table 6.4 

Table 6.5 

Table 6.6 

Table 6.7 

Table 6.8 

Table 6.9 

Table 6.10 

Percent distribution of RDW (among those whose most recent delivery took place 

between two and eleven months prior to the survey) and husbands by time at 

which they were first counseled on birth spacing or family planning following the 

birth of the recent child and person providing counseling 38 

Percent distribution of husbands of RDW who discussed the practice of FP with 

their wives following their recent birth by selected background characteristics 40 

Percent distribution of husbands of RDW by opinion regarding contraception and 

pregnancy 40 

Percent distribution of RDW, husbands, MIL and FIL reporting the number of 

times a woman should receive check ups from a trained health workers during 

pregnancy 42 

Percent of RDW who stated correct knowledge (4 visits) regarding the number of 

recommended ANC visits by their selected background characteristics 44 

Percent distribution of RDW, husbands, MIL and FIL by knowledge about 

symptoms during pregnancy indicating the need to seek immediate care 44 

Percent distribution of RDW experiencing different types of pregnancy related 

problems during their last pregnancy 45 

Percent distribution of RDW by place of visit or persons consulted for the 

management of problems during their last pregnancy 45 

Percent distribution of RDW, husbands, MIL and FIL by knowledge about the 

places for consultation for danger signs that may appear during pregnancy 46 

Percent distribution of RDW who received ANC during their last pregnancy by 


Percent distribution of RDW mentioning the places from where they got ANC 

during their last pregnancy 48 

Percent of RDW who received pregnancy check ups at least four times during their 

last pregnancy by selected background characteristics 49 

Percent distribution of RDW by timing of receiving first antenatal services during 

their last pregnancy 50 

Table 6.11 Percent distribution of RDW by types of ANC received during their last pregnancy 50 

vi

Table 6.12 

Table 6.13 

Table 6.14 

Percent distribution of RDW by persons accompanied at least once while visiting 

health facility or health personnel for ANC (among RDW who made at least one 

ANC visit) 51 

Percent distribution of husbands and MIL who accompanied their wives/DIL at 

least one time for ANC during their last pregnancy 51 

Percent distribution of RDW by places they visited for their most recent antenatal 

care 52 

Table 6.15 Percent distribution of RDW meeting the FCHVs during their last pregnancy 53 

Table 6.16 

Table 6.17 

Table 6.18 

Table 6.19 

Table 6.20 

Table 6.21 

Table 6.22 

Table 6.23 

Table 6.24 

Table 6.25 

Table 6.26 

Table 6.27 

Table 6.28 

Table 6.29 

Table 6.30 

Table 6.31 

Percent distribution of RDW who met FCHV for services or advice during their 

last pregnancy prior to their most recent delivery by selected background 

characteristics 54 

Percent distribution of RDW who received advice from FCHVs on various topics 

related to pregnancy, delivery and postpartum care during their last pregnancy 56 

Percent distribution of husbands and MIL who received advice from FCHVs on 

various topics related to pregnancy, delivery and postpartum care during their 

wife’s/ DIL’s last pregnancy 57 

Percent distribution of RDW by type of counseling received from health care 

providers any time during their last pregnancy 58 

Percent distribution of RDW by number of TT vaccines taken (based on recall) 

during last pregnancy by selected background characteristics 59 

Percent distribution of RDW by number of times they received TT vaccines during 

their life time 60 

Percent distribution of RDW who used iron/folic acid tablets and deworming 

tablets during their last pregnancy by selected background characteristics 61 

Percent distribution of RDW by number of days taking and source of supply of 

iron/folic acid tablets, among RDW who took iron/folic tablets during most recent 

pregnancy 62 

Percent distribution of RDW, husbands and MIL by their opinion regarding the things 

that need to be kept clean during childbirth 63 

Percent distribution of husbands and MIL regarding their attitude towards different 

aspects of birth preparedness 64 

Percent distribution of FIL by their perception on different aspects of pregnancy and 

delivery services 64 

Percent distribution of RDW receiving care and support from their husbands and 

family members during last pregnancy as responded by RDW, their husbands and 

MIL 66 

Percent distribution of RDW mentioning the persons in the family providing care 

and support during their last pregnancy 67 

Percent distribution of RDW, husbands, MIL and FIL reporting the person in the 

family who decided the person who would attend their or their wife’s/DIL’s most 

recent delivery 68 

Percent distribution of RDW, husbands, MIL and FIL mentioning the 

signs/symptoms during labor which need immediate care 69 

Percent distribution of RDW, husbands, MIL and FIL by their opinion on extent of 

danger of various signs and symptoms that may appear during delivery 70 

vii

Table 6.32 

Table 6.33 

Table 6.34 

Percent distribution of RDW experiencing problems during the delivery of their 

last child 71 

Percent distribution of RDW by places of visit or persons consulted for the 

management of problems appeared during delivery 71 

Percent distribution of RDW and the MIL reporting that they (their DIL) had 

bleeding immediately following the birth of their last child and number of clothes 

used to absorb blood during the first 24 hours after delivery 73 

Table 6.35 Percent distribution of RDW who experienced any of the problems in the first 6 

hours following the delivery of their last child 74 

Table 6.36 

Table 6.37 

Table 6.38 

Table 6.39 

Table 6.40 

Table 6.41 

Table 6.42 

Table 6.43 

Table 6.44 

Table 6.45 

Table 6.46 

Table 6.47 

Table 6.48 

Table 7.1 

Table 7.2 


trained health provider who would attend a delivery in their homes 75 

Percent distribution of RDW, husbands, MIL and FIL by their knowledge about 

the health facility where they or their wives/DIL could go to deliver the child 75 

Percent distribution of RDW, husbands, MIL and FIL by their knowledge about 

the health facility where they or their wives/DIL could go to deliver the child in 

case of problems during delivery at home 76 

Percent distribution of RDW by persons assisting during delivery of their youngest 

child by selected background characteristics 78 

Percent distribution of RDW reporting the persons who were present outside the 

room during the delivery of last birth 79 

Percent distribution of RDW by place of delivery of their last child by their 


Percent distribution of RDW, husbands, MIL and FIL by reasons for not delivering 

their last child or grandchild at the health facility 82 

Percent distribution of RDW, husbands, MIL and FIL by knowledge regarding 

persons to be present at birth to help deliver the baby safely 83 

Percent distribution of RDW, husbands, MIL and FIL by reasons for not seeking 

assistance from the trained health workers during last delivery 84 

Percent distribution of RDW, husbands, and MIL reporting source from where 

they got information or messages on attendance of a trained health workers during 

delivery 86 

Percent distribution of RDW, husbands, MIL and FIL by their opinion regarding 

the need of attending delivery by trained health workers and the reasons for it 87 

Percent distribution of RDW with regards to social network support, self-efficacy and 

intent to utilize trained health worker at delivery 88 

Percentage of respondents whose most recent delivery was live birth with positive 

factors in relation to utilization of a trained health worker at delivery 89 

Percent distribution of RDW by types of services, help or advice received from 

FCHV during 6 weeks following their last delivery, among RDW who were more 

than 2 months post-delivery and who reported meeting the FCHVs for services or 

advice within 6 weeks following their recent delivery 93 

Percent distribution of RDW received advices on various aspects related to 

postpartum services in the 6 weeks following their last delivery from FCHV, 

among RDW who were more than 2 months post-delivery and who reported 

meeting the FCHVs for services or advice within 6 weeks following their recent 

delivery 94 

viii

Table 7.3 

Table 7.4 

Table 7.5 

Table 7.6 

Table 7.7 

Table 7.8 

Table 7.9 

Table 7.10 

Table 7.11 

Table 7.12 

Table 7.13 

Table 7.14 

Table 7.15 

Table 7.16 

Table 7.17 

Percent distribution of RDW by person who checked their health during the first 

three days and 4 days to 6 weeks after birth, among RDW who were more than 2 

months post-delivery 95 

Percent distribution of RDW who had received postpartum care within six weeks 

of delivery from a trained provider by their selected background characteristics, 

among RDW who were more than 2 months post-delivery 97 

Percent distribution of RDW by type of health facility they visited within 6 weeks 

of their most recent delivery for their health check ups or for child immunization, 

among RDW who were more than 2 months post-delivery and who visited a health 

facility for check ups 99 

Percent distribution of RDW reporting about types of services or activities 

conducted by the health workers during their postnatal check ups, among RDW 

who were more than 2 months post-delivery and who visited a health facility for 

check ups 99 

Percent distribution of RDW reporting about types of services or activities 

conducted by the health workers during their postnatal check ups, among RDW 

who were more than 2 months post-delivery and who visited a health facility with 

their child for postnatal check ups 100 

Percent distribution of RDW receiving iron/folic acid tablets following their most 

recent delivery 100 

Percent distribution of RDW who took a Vitamin A capsules in the first 42 days 

after delivery by selected background characteristics, among those who delivered 

2-11 months prior to the survey 102 

Percent distribution of RDW, husbands, MIL and FIL by opinion regarding the 

timing of first check ups by mothers and newborn from the health workers 104 

Percent distribution of RDW, husbands, MIL and FIL who had heard the messages 

“mothers and newborns should have their health checked by a health worker with 

24 hours after birth” 104 

Percent distribution of RDW, husbands, MIL and FIL by knowledge of symptoms 

of the mother indicating the need for her to seek immediate health care during the 

6 weeks after delivery 105 

Percent distribution of persons consulted or places visited by RDW when they had 

serious health problems within 6 weeks after their most recent birth 106 

Percent distribution of RDW by amount and type of support received from the 

family members during their first six weeks following the delivery of the last child 108 

Percent distribution of RDW by persons who provided support during their 

postpartum period of the last birth among RDW who reported receiving more 

support from their family members than usual during their 6 weeks of postpartum 

period 108 


availability of services for the management of danger signs that may appear during 

six weeks following the delivery 109 

Percent distribution of RDW, husbands, MIL and FIL by type of information they 

heard about bleeding after child birth and their sources 111 

ix

Table 7.18 

Table 7.19 

Table 7.20 

Table 7.21 

Table 7.22 

Table 7.23 

Table 7.24 

Table 7.25 

Table 7.26 

Table 7.27 

Table 7.28 

Table 7.29 

Table 7.30 

Table 7.31 

Table 7.32 

Table 7.33 

Table 7.34 

Table 7.35 

Table 7.36 

Percent distribution of RDW who used a clean delivery kit or newborn’s cord was 

cut with a clean or new instrument during last delivery by selected background 


Percent distribution of RDW who applied anything on the stump after the baby’s 

cord was cut by their selected background characteristics 115 

Percent distribution of RDW by types of substances applied to the cord stump of 

the newborn 116 

Percent distribution of RDW, husbands, MIL and FIL reporting the timing of 

bathing the newborn after the birth 118 

Percent distribution of RDW reporting that their babies cried immediately after 

birth and help needed for breathing or crying the child after birth 119 

Percent distribution of knowledge of RDW, husbands, MIL and FIL regarding the 

correct timing of initiating the breast milk for the first time to the newborn 120 

Percent distribution of RDW, husbands, MIL and FIL who have heard the message 

on “a newborn should be breast fed within one hour after birth” 120 

Percent distribution of RDW by types of foods given to their children below one 

year of age in the day or night preceding the survey date 122 

Percent distribution of RDW who breastfed their infant exclusively at zero to five 

months by infant’s age 122 


symptoms among the infant within 7 days after delivery indicating the need to seek 

immediate health care 123 

Percent distribution of RDW, husbands, MIL and FIL by knowledge about source 

of health services if a child has danger signs 124 

Percent distribution of RDW by persons consulted for the first time for the check 

up of their child within 3 days and between 4 days to 4 weeks following the birth, 

among RDW whose child(ren) born in their most recent delivery was either still 

alive or who died at an age of 2 months or greater 125 

Percent distribution of RDW whose infant received newborn care within four 

weeks of delivery from a trained health provider by their selected background 

characteristics, among those who delivered 2-11 months prior to the survey 126 

Percent distribution of RDW receiving counseling on newborn issues from health 

worker, FCHV or TBA, among those who delivered 2-11 months prior to the 

survey 128 

Percent distribution of RDW whose infant had experienced complications in the 

first four weeks following the delivery 128 

Percent distribution of RDW by person consulted or places visited for the 

treatment of complications occurred to their last child within four weeks after birth 

Percent distribution of RDW by time that they sought medical help when their 

child had complications within four weeks after birth and age of the child at that 

time 130 

Percent distribution of RDW who first sought medical help according to the health 

problems to their newborn 131 

Percent distribution of RDW places visited or persons consulted when their child 

had problems within 4 weeks following the birth 132 

x 

129

Table 7.37 

Table 8.1 

Table 8.2 

Table 8.3 

Table 8.4 

Table 8.5 

Table 8.6 

Table 8.7 

Table 8.8 

Table 8.9 

Table 8.10 

Table 8.11 

Table 8.12 

Table 8.13 

Table 8.14 

Table 8.15 

Table 8.16 

Table 8.17 

Table 8.18 

Percent distribution of RDW who had to come back from the health facility 

without getting desired services related to their or their newborn’s health 134 

Percent distribution of RDW, husbands, MIL and FIL reporting any types of the 

preparation made for the last delivery 136 

Percent distribution of RDW who made any preparations during their last 

pregnancy for their delivery by selected background characteristics 137 

Percent distribution of RDW by ways of managing expenses incurred during the 

delivery of the last child among all RDW 138 

Percent distribution of RDW by ways of managing expenses incurred during the 

delivery of the last child according to the place of delivery or type of assistance 

received, among RDW whose most recent delivery resulted in live birth 138 

Percent distribution of RDW who or whose family members arranged money for 

care during the delivery 139 

Percent distribution of family members of RDW regarding how they arranged 

money for care during the delivery, among all respondents 139 

Percent distribution of RDW who had arranged ahead of time for someone to 

attend their last delivery 140 

Percent distribution of RDW who arranged ahead of time a trained health worker 

to attend their last delivery by their selected background characteristics 141 

Percent distribution of RDW by prior arrangement of place to deliver their last 

child 142 

Percent distribution of RDW who arranged to deliver their last child in a health 

facility by their selected background characteristics 143 

Percent distribution of RDW who made any preparation for care of the mother and 

newborn during the first month following the delivery by selected background 


Percent distribution of RDW, husbands, MIL and FIL by types of preparations for 

emergencies during their or their wife/DIL’s pregnancy, delivery or after delivery 145 

Percent distribution of RDW who made any preparation for emergencies during 

pregnancy, delivery, or after delivery by their selected background characteristics 146 

Percent distribution of husbands, MIL and FIL reporting the main decision makers 

in the family with respect to the emergency care during their wives/DIL pregnancy 

or delivery 147 

Percent distribution of RDW, husbands, MIL and FIL by knowledge about 

existence of group that lend money to women who need it for an emergency during 

pregnancy or delivery 149 


availability of transportation for women who need it for an emergency during 

pregnancy or delivery 150 

Percent distribution of RDW by type of transport used to go health facility or 

health personnel due to obstetric problems during their last delivery 151 

Percent distribution of RDW by amount they spent for transport while going to the 

health facility or health personnel due to obstetric problems during their last 

delivery 152 

xi

List of Figures 

Page 

Figure 3.1 Percent distribution of respondents having different items in their households 11 

Figure 3.2 Percent distribution of literate population by type 15 

Figure 3.3 Percent distribution of RDW by their SES index 19 

Figure 4.1 

Figure 4.2 

Figure 4.3 

Figure 4.4 

Figure 4.5 

Percent distribution of RDW, husbands, MIL and FIL who know the FCHV 

working in their areas 20 

Percent distribution of the RDW by knowledge about the existence of mothers’ 

group in their areas 23 

Percent distribution of RDW who attended mothers’ group’s meetings during last 

pregnancy 23 

Percent distribution of RDW who have heard of PHC ORC and date of month the 

clinic is organized in their areas 24 

Percent distribution of RDW who received various types of services from the PHC 

ORC following their most recent pregnancy 25 

Figure 5.1 Percent distribution of RDW by number of times they became pregnant 28 

Figure 5.2 

Figure 5.3 

Figure 5.4 

Percent distribution of RDW by status on birth registration of their youngest child 

(among those who are alive) with the VDC 29 


and eleven months prior to survey) and husbands who reported using at least one 

FP method following the delivery of their last child 31 


and eleven months prior to the survey and who were not currently pregnant) 

currently using FP methods by the age of their youngest child 34 

Figure 5.5 Percent distribution of RDW by their intention to use FP methods in future 35 

Figure 5.6 

Figure 5.7 

Figure 5.8 

Percent distribution of RDW (among those whose most recent delivery took place 

between two and eleven months prior to the survey) and husbands counseled by a 

health worker or FCHV on birth spacing or family planning at any time following 

their most recent delivery 37 

Percent distribution of RDW by type of FP information and services received from 

FCHVs following their most recent delivery among RDW who reported receiving 

any type of information and services and whose most recent delivery occurred 

between two and eleven months prior to the survey 39 

Percent distribution of respondents (husbands of RDW) who discussed the practice 

of FP with their wife after following her recent birth 39 

Figure 6.1 

Figure 6.2 

Figure 6.3 

Percent of RDW by number of times they received pregnancy check ups during 


Percent distribution of husbands, MIL and FIL who met the FCHVs for 

information or advice when their wife/DIL’s was pregnant last time 55 

Percent of RDW reporting that FCHVs discussed specific plans for delivery during 


xii

Figure 6.4 

Figure 6.5 

Figure 6.6 

Figure 6.7 

Figure 6.8 

Figure 6.9 

Figure 6.10 

Figure 6.11 

Figure 6.12 

Figure 6.13 

Percent distribution of RDW who discussed with their husbands for planning of 

their last delivery, and husbands and MIL who discussed with other about planning 

for their wives/DIL’s delivery 65 

Percent distribution of RDW by amount of food they consumed during their last 

pregnancy 66 

Percent distribution of RDW whose last delivery was caesarean section or had an 

instrumental delivery 72 

Percent distribution of RDW who were given an injection after the birth of their 

youngest child in order to prevent them from postpartum hemorrhage among RDW 

who had live birth and did not have caesarean section 73 

Percent distribution of RDW by distance to the health facility where they could go 

for emergency services associated with delivery 76 

Percent distribution of husbands, MIL and FIL who were present at their 

wives/DIL’s most recent delivery 79 

Percent distribution of RDW whose last delivery taken place at the health facility 

was as per pre-plan or only due to the problems during pregnancy or labor 81 

Percent distribution of respondents who considered it to be important for the 

delivery to be attended by trained health personnel and actual use status of these 

services during the recent delivery 83 

Percent distribution of RDW, husbands and MIL who had seen, heard or read 

anything about the need of attendance of a trained health worker during delivery 

on the radio or TV or in the newspaper or anywhere else in the past 3 months 85 

Percent distribution of RDW who have ever encouraged to their friends or family 

members to arrange for a trained health workers for their delivery 89 

Figure 7.1 

Figure 7.2 

Figure 7.3 

Figure 7.4 

Figure 7.5 

Percent distribution of RDW who met with FCHV during the 6 weeks following 

their recent delivery outside the mothers’ group to receive services or advice, 

among RDW who were more than 2 months post-delivery 93 

Percent distribution of RDW who were checked by trained health worker, FCHV 

or traditional birth attendant on their health during the first three days and 4 days 

to 6 weeks after birth, among RDW who were more than 2 months post-delivery 95 

Percent distribution of RDW visiting a health facility or PHC ORC 6 weeks after 

their most recent delivery for check up or to have their child vaccinated, among 

RDW who were more than 2 months post-delivery 98 

Percent distribution of RDW who received specific counseling on maternal danger 

signs or issues from health workers, FCHV or TBA following their delivery 103 

Percent distribution of RDW who had experienced problems during 6 weeks 

following their most recent delivery 106 

Figure 7.6 Percent distribution of RDW by amount of food they consumed during the first 6 

months after their most recent delivery 107 

Figure 7.7 

Figure 7.8 

Percent distribution of RDW, husbands, MIL and FIL who had been exposed to 

information about bleeding after childbirth during their or their wives/DIL’s last 

pregnancy 110 

Percent distribution of RDW, husbands, MIL and FIL who received information 

about the medicine that can be taken to reduce bleeding after childbirth during 

their or their wives/DIL’s last pregnancy 111 

xiii

Figure 7.9 

Figure 7.10 

Figure 7.11 

Percent distribution of RDW reporting the time when the cord of their last child 

was cut 112 

Percent distribution of RDW who dried and wrapped their newborn before the 

placenta was delivered 117 

Percent distribution of RDW regarding the placement of their newborn before the 

placenta was delivered 117 

Figure 7.12 Percent distribution of RDW by time when they first bathed their youngest child 118 

Figure 7.13 Percent distribution of RDW by initiation of breastfeeding to their last child 121 

Figure 7.14 

Figure 7.15 

Percent distribution of RDW when newborns were checked for the first time by the 

health care providers within 4 weeks following the birth 124 

Percent distribution of children aged 6-11 months receiving vitamin A capsules 

during Baisakh 2062 distribution 127 

Figure 7.16 Percent distribution of RDW reporting the size of their child at birth 133 

Figure 7.17 

Percent distribution of RDW by time when the child was first weighed among 

RDW whose infant has been weighed at any time 133 

Figure 8.1 

Percent distribution of husbands, MIL and FIL of the RDW reporting the existence 

of individuals in their areas that loan money to women who need it for an 

emergency during pregnancy or delivery 148 

xiv

Baseline Survey for CB-MNC Program in Jhapa District 

FAR-WESTERN 

REGION 

HUMLA 

MID WESTERN REGION 

CHINA 

DARCHULA 

BAITADI 

DADEL- 

DHURA 

DOTI 

BAJHANG 

BAJURA 

JUMLA 

MUGU 

DOLPA 

WESTERN REGION 

KANCHAN 

- PUR 

 

KAILALII 

ACHHAM KALIKOT JHAPA 

BARDIYA 

DAILEKH JAJARKOT 

SURKHET 

BANKE 

SALYAN 

DANG 

RUKUM 

ROLPA 

INDIA 

SINDHU- 

PALCHOK 

PYUT- 

HAN 

ARGHAK 

HACHI 

B A G L UN G 

MYAGDI 

GULMI 

MUSTANG 

PARBAT 

KASKI 

SYANGJA TANAHU 

KAPIL- 

BASTU 

PALPA 

NAWAL 

RUPAN- 

DEHI PARASI 

MANANG 

GORKHA 

LAMJUNG 

CHITWAN 

DHADING 

PARSA 

NUWAKOT 

RASUWA 

KATHMMANDU 

BHAK 

LALIT 

CENTRAL REGION 

SANKHUWA- 

SABHA 

KAVRE 

SARLAHI 

SINDHULI 

DOLAKHA 

DHANUSA 

RAMECHHAP 

TERHA- 

THUM 

SULUK- 

HUMBU 

BARA RAUT- 

AHAT 

MAHO- 

TARI 

MAKAWAN- 

PUR 

OKHAL- 

DHUNGA 

BHOJ- 

KHOTANG PUR 

UDAYAPUR DHAN- PANCHTHAR 

KUTA 

SIRAHA 

SAPTARI SUNSARI 

EASTERN REGION 

TAPLEJUNG 

MORANG 

ILAM 

Study district 

xv

Study Team 

Mr. Shailes Neupane 

Mr. Purushottam Risal 

Mr. Bijaya Shrestha 

Mr. Hari Sharan Giri 

Mr. Bishnu Hari Devkota 

Mr. Subodh Pathak 

Mr. Prakash KC 

Mr. Balchandra Devkota 

Mr. Bashanta Regmi 

Ms. Trishna Bajracharya 

Mr. Devendra Ghimire 

Mr. Babu Ram Roka 

Team Leader 

Consultant 

Computer Programmer 

Computer Programmer 

Computer Support 



Research Assistant 

Research Assistant 

Data editing and coding 



Field Supervisors and Interviewers 

Mr. Devendra Ghimire 

Mr. Radheshyam Gautam 

Mr. Ram Kumar Upreti 

Mr. Ram Prasad Khanal 

Mr. Subash Devkota 

Ms. Arina Karki 

Ms. Binamrata Subedi 

Ms. Goma Sangraulla 

Ms. Indira Mainali 

Ms. Nisha Rana Magar 

Ms. Phool Maya Thapa 

Ms. Radhika Baniya 

Ms. Rita Tyata 

Ms. Samjhana Pandey 

Ms. Sanita Sainju (Amatya) 

Ms. Sarita Dhakal 

Ms. Shova Parajuli 

Ms. Sita Pandey 

Ms. Tara Shrestha 

Ms. Tulasa Sedhain 

xvi

Abbreviations 

AHW 

ANC 

ANM 

ARI 

BCC 

BPP 

CB-MNC 

CBS 

CEB 

CM 

CMA 

DHS 

DIL 

FCHV 

FIL 

FP 

HA 

HIV/AIDS 

HMG 

HP 

HW 

MCHW 

MIL 

M&E 

MOH 

MMR 

NFHP 

NGO 

NS 

PHC ORC 

PHCC 

PNC 

PPH 

RDW 

Rs 

SCF US 

SD 

SES 

SHP 

SBA 

SLC 

STI 

TBA 

TT 

TTBA 

TV 

VaRG 

UNICEF 

WHO 

VDC 

VHW 

Auxiliary Health Worker 

Antenatal Care 

Assistant Nurse Mid-wife 

Acute Respiratory Infection 

Behavior Change Communication 

Birth Preparedness Package 

Community Based Maternal and Neonatal Care 

Central Bureau of Statistics 

Children Ever Born 

Currently married, 

Community Medical Auxiliary 

Demographic and Health Survey 

Daughter-in-law 

Female Community Health Volunteer 

Father-in-law 

Family Planning 

Health Assistant 

Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome 

His Majesty’s Government of Nepal 

Health Post 

Health Worker 

Maternal and Child Health Worker 

Mothers-in-law 

Monitoring and Evaluation 

Ministry of Health 

Maternal Mortality Rate 

Nepal Family Health Program 

Non-Governmental Organization 

Not Significant 

Primary Health Care Outreach Clinic 

Primary Health Care Center 

Postnatal Care 

Postpartum Hemorrhage 

Recently Delivered Women 

Nepalese Rupees 

Save the Children Federation US 

Standard Deviation 

Socio-Economic Status 

Subhealth Post 

Skilled Birth Attendant 

School Leaving Certificate 

Sexually Transmitted Infection 

Traditional Birth Attendant 

Tetanus Toxoid 

Trained Traditional Birth Attendant 

Television 

Valley Research Group 

United Nations Children Fund 

World Health Organization 

Village Development Committee 

Village Health Worker 

xvii

Executive Summary 

a) Introduction 

Recognizing the urgency to address both maternal and neonatal morbidity and mortality in an 

integrated manner, the Nepal Family Health Program (NFHP) intends to implement an integrated 

pilot intervention Community Based Maternal and Neonatal Care (CB-MNC) in three districts of 

Nepal namely, Jhapa, Banke and Kanchanpur. The overall purpose of this pilot project is to test the 

feasibility of development of an integrated community based approach to reduce maternal mortality 

due to postpartum hemorrhage (PPH) and other causes and neonatal mortality and increase use of 

contraceptives for birth spacing. The pilot project will include activities to increase awareness 

amongst the pregnant women and their family members on danger signs during antenatal, delivery 

and postnatal; getting themselves prepared for the delivery and the postnatal care of the mother and 

the child; and increasing demand for and utilization of appropriate health services. Aside from using 

known tools such as birth preparedness package (BPP), the pilot project is also aiming at 

demonstrating the feasibility of introducing Misoprostol distribution for prevention of PPH through 

the Ministry of Health service delivery system including the Female Community Health Volunteers 

(FCHVs). The Misoprostol distribution is planned to be made in the outset only in Banke district on 

pilot basis. The CB-MNC program will also provide some supply-side inputs to improve 

infrastructure at selected health facilities. 

The overall objective of the baseline survey was to establish benchmark for selected indicators to 

be monitored during the pilot interventions in relation to the level of knowledge and practices of 

maternal and newborn care among recently delivered women (RDW) and their family in the pilot 

areas. 

The study was carried out in the rural areas of Jhapa district. A three-stage sampling design was 

followed. In the first stage, 30 clusters (i.e., wards) were selected randomly; and in the second 

stage, clusters were mapped and divided into segments, and one segment was chosen. In the third 

stage, a starting household was chosen in the selected segment, following which the required 

number of respondents of different categories were selected. Information required for the 

purpose of the study was collected using quantitative techniques. The respondents in the survey 

composed of recently delivered women (RDW) who had given birth in the past 12 months 

regardless of whether the infant is currently alive or dead including stillbirths, their husbands, 

mothers-in-law (MIL) and fathers-in-law (FIL). A total of 900 RDW, 292 husbands, 264 MIL 

and 190 FIL of the RDW were interviewed from 30 clusters. Data collection was carried out 

during May and June 2005. 

b) Characteristics of households and respondents 

Household characteristics 

About two-thirds of the households had electricity facility and bicycle in their homes. About 

57% had radio and 43% had television set in their houses. Almost all the households had access 

to established water supply system such as piped water, well or tube well. Nearly half (48%) of 

xviii

the households reported that they have toilets in their houses. 

Characteristics of the respondents 

More than three-quarters of the husbands and over half of the RDW and FIL were found to be 

literate. Similarly, about 14% of the MIL was found to be literate. Brahmin, Chhetri, Tibeto- 

Burman, Tharu and Dalit were the major ethnic groups included in the present study. 

Males are more likely to listen the radio and watch TV compared to their female counterparts. A 

higher proportion (76%) of the husbands compared to other categories of respondents (66%- 

68%) have exposure to both the radio and TV. More than 12% of the RDW and MIL and about 

8% of the husbands and FIL neither listened to the radio or watched TV. 

On an average the respondents have to spend half an hour to reach the nearest health facility or 

health providers. 

The principal component method was used to develop a variable that measures socio-economic 

status (SES) based on household characteristics and possession of key household items. Based 

on the value of the SES variable, each RDW was classified into one of five SES quintiles. 

Nearly one-third of the RDW belonged to the highest SES quintile followed by about a quarter 

(23%) with the fourth level and 18% with the middle level SES quintile, and about 13% each 

belonged to the lowest and the second lowest SES quintile. 

c) Familiarity with FCHVs and PHC ORC 

Familiarity with the FCHVs and mothers group 

Over three-quarters of the RDW, husbands and MIL and 72% of the FIL reported knowing the 

FCHVs working in their areas. About 65% of the RDW said that FCHVs provide vitamin A 

capsules for mother and child followed by 47% said that they provide advices to the pregnant 

women. Nearly 38% of the RDW were also stated that FCHV provide advice and treatment for 

children’s diarrhea. Over three in every 10 RDW also mentioned that they provide advice to the 

postpartum mother, give advice to the mother for the care of newborn, and provide advice and 

treatment on children’s respiratory infection. 

About 13% of the RDW reported of the existence of a mother’s group in their areas and 66% 

said “no”, and about one-fifth did not know if there are mothers’ groups in their areas. Only 2% 

reported attending the mothers’ group meeting during their last pregnancy. 

Familiarity with PHC ORC 

Overall, 30% of the RDW had heard of the PHC ORC and 18% correctly mentioned the date of 

month on which the PHC ORC is conducted in their areas. A small percentage (3%-12%) of the 

RDW reported receiving specific services such as antenatal care, postnatal care, care of newborn, 

and FP information and services any time at the PHC ORC following their most recent 

pregnancy. 

xviiii

d) Marriage, fertility and family planning use by RDW 

Marriage and fertility 

The mean age at marriage among the RDW was estimated at 18.4 years. On an average, the 

responding RDW became pregnant for the first time when they were 20 years of age. 

The mean number of children ever born to RDW was 2.4 (1.2 each of sons and daughter) 

whereas the living children was 2.1 (1.0 son and 1.1 daughters). Only about 27% of the children 

below one year were registered with the VDCs. 

Use of FP methods 

Among the RDW not pregnant currently and whose most recent delivery took place between two 

and eleven months prior to the survey, and the husbands with wives not pregnant at the time of 

survey, 30% of the RDW and 46% of the husbands reported that they were currently using any 

method of FP, and 30% of the RDW and 38% of the husbands were currently using modern FP 

methods. The most commonly used current method was Depo Provera and condom. Brahmin and 

Chhetri women are more likely to use FP methods and Muslim women are less likely to use 

them. Exposure to media such as radio and TV appeared to be associated with the greater extent 

of use of family planning methods. The majority (83%) of the RDW who were not using any FP 

methods at the time of survey said they would use FP method in future. 

Interpersonal communication and counseling on family planning 

About 24% of the RDW (among RDW whose most recent delivery took place between two and 

eleven months prior to the survey) and 23% of husbands reported that a health worker or FCHV 

counseled them on birth spacing or family planning at any time following their most recent 

delivery. On an average they were first counseled by the health workers or FCHVs in 5.5 weeks 

after the delivery. 

Spousal discussion on FP use was high as about 74% of the husbands said that they discussed on 

the use of FP with their wives following their most recent deliveries. 

e) Antenatal care and delivery services 

Knowledge about antenatal care 

About a quarter of the respondents of all four categories (23%-29%) correctly mentioned that a 

women should get pregnancy check ups four times with a trained health worker. A higher 

proportion of them considered severe lower abdominal pain followed by vaginal bleeding and 

severe headache as danger symptoms during pregnancy that need immediate care from the health 

personnel. However, the percentage of respondents with knowledge about other danger signs 

such as convulsion, blurred vision and swelling of hands and face, and vaginal or white fluid 

discharges was low. Overall, 26% of the RDW were able to mention at least three of the above 

danger signs. 

xixi

Prevalence of danger signs during pregnancy 

About 48% of RDW said that they had experienced at least one of the pregnancy related 

problems during their last pregnancy. Over half (57%) of the RDW who experienced problems 

visited one or more types of health facilities to seek care for their health problem. 

Utilization of ANC 

Over three-quarters of the RDW reported that they had received ANC during their last 

pregnancy. About 74% of the RDW reported that they received ANC at least one time from a 

trained provider during their last pregnancy. However, only 45% had received ANC at least four 

times, and among those who received ANC only about 48% had received it during their first 

trimester. 

FCHVs were seen by about a quarter (24%) of the RDW for seeking advice or services during 

their last pregnancy. Of the RDW who met FCHVs during their last pregnancy, 47% reported 

that they were counseled by FCHVs in at least 3 out of 5 key birth preparedness topics. Over a 

quarter of the RDW who met FCHVs during their last pregnancy said they were counseled by 

FCHVs using flip chart. 

Overall, about 62% of the RDW reported that they received at least two doses of TT vaccines, 

68% iron/folic acid tablets and about 25% reported receiving deworming tablets during their last 

pregnancy. 

Knowledge and attitudes towards delivery services 

Over 97% of respondents of all categories stated that it very important for a delivery to be 

attended by a skilled birth attendant such as a doctor or nurse, midwife or MCHW. Nearly half 

(48%) of the RDW said that they had encouraged their friends or relatives to arrange a skilled 

birth attendant to be present during delivery. 

Support from family members during pregnancy 

Discussions between husbands and wives about the planning for delivery during last pregnancy 

was reported by more than 70% of the RDW. About 64% of the RDW reported that they 

received more than usual support from their family members during their last pregnancy. 

Danger signs during delivery 

Over 85% of the RDW and a slightly higher proportion of their husbands spontaneously recalled 

labor longer than 8 hours as a danger sign during labor. Excessive bleeding before or after 

delivery as the danger sign or symptom was recalled by over 60% of the RDW and MIL and over 

half of the husbands and FIL. Likewise, over half of the RDW and MIL and about 40% of the 

husbands and FIL recalled appearance of baby’s leg fist as the danger sign during labor. Over 

half (52%) of the RDW were able to mention at least three danger signs that may occur during 

delivery. 

xxi

Of the 889 RDW who had given live birth in the past 12 months, about 25% had experienced 

prolonged labor followed by 13% had problems of excessive bleeding and 7% experienced 

convulsion during their last delivery. About 2% of the RDW said baby’s hand, leg or cord came 

out first during delivery. About one-third (34%) of the RDW reported to have experienced at 

least one of the above four signs during the delivery of their last child. 

Among RDW whose most recent delivery was a live birth and not a caesarean section (n=841), 

nearly a quarter (23%) of them were given an injection (presumed to be Oxytocin) to prevent 

from postpartum hemorrhage after the baby was born. 

Knowledge about sources of delivery services 

When asked if they knew a health worker who would attend a birth at their home, relatively a 

higher proportion (26%-30%) of the respondents of all four types mentioned AHW or CMA who 

would attend delivery followed by ANM (12%-16%) and trained TBA (10%-14%) respectively. 

Overall, only 23% of respondents identified a skilled birth attendant (doctor, nurse, ANM, or 

MCHW) who would attend a home delivery. Overall, 98.5% of RDW named a health facility 

where they could go for their delivery. Almost all (98.8%) of the RDW who had given live birth 

in the past 12 months were able to identify a health facility in their community where they could 

go in case of an emergency while delivering at home. 

Utilization of delivery services 

About 43% of deliveries were assisted by the trained health workers (doctor, nurse, ANM, HA, 

AHW or MCHW), and 17% by TBA. More than one-third (36%) of the deliveries were only 

assisted by family members, relatives or friends. 

Over one-third (35%) of the RDW reported to have delivered their last child at the health 

facility. Among RDW who had a live birth, 21% of them gave birth at a health facility due to an 

obstetric emergency after planning to delivery at home. 

Behavior change communication 

Forty-two percent of RDW stated that they had seen, heard or read about the need of attendance 

of a trained health worker during delivery on the radio or TV or in the newspaper or any other 

means in the past 3 months. Overall, 49% of RDW had formal (electronic or print media) or 

informal (family members, friends, neighbors, etc) exposure to message regarding need of 

attendance of a trained health worker in the past three months. About 85% of RDW had correct 

knowledge regarding need for trained health worker at delivery while 98% of RDW indicated a 

positive attitude towards having their birth attended by a trained health worker. More than threequarters 

(77%) of RDW stated that their social network supported the utilization of a trained 

health worker at delivery while approximately half of RDW said that they had the ability ensure 

the presence of trained health workers during delivery (i.e., self-efficacy). Forty-five percent of 

RDW declared that a trained health worker would attend their next delivery, nearly half of RDW 

(48%) stated that they had advocated the use of a trained health worker during delivery. 

Overall, the survey results reveal that RDW who are younger, literate, belonging to Brahmin or 

Chhetri, exposed to media and belonging to high SES have higher knowledge and practices of 

xxii

ANC related services. Ethnicity wise data indicate that Tharu, Dalit and Muslim RDW have 

lower knowledge as well as practices. 

f) Postpartum, Immediate Newborn and Newborn Care 

Postpartum services from health workers or health facility 

Over half (53%) of the RDW who delivered 2-11 months prior to survey said that they were 

checked by a health care provider within 3 days following the birth. However, only 44% were 

checked by the trained health providers such as doctor, nurse, ANM, HA, AHW and MCHW. 

Likewise, 14% of the RDW said they received a check up from the health workers or FCHV or 

TBA between 4 days to 6 weeks after birth, and 11% of them received check ups from the 

trained health workers during this time period. Overall, 46% of the RDW who delivered more 

than 2 months prior to the survey said they received check-up services within 6 weeks of 

delivery of their last child from a trained health worker. 

Among those RDW who were more than 2 months post-delivery at the time of survey, about 

83% reported that they visited a health facility or PHC ORC approximately 6 weeks after the 

birth for a check up or to have their child vaccinated. The majority (82%) of the RDW who 

visited a health facility or PHC ORC received counseling on immunization while the other types 

of services were found to have been received by quite a small proportion of the respondents. 

Slightly over one in every 7 respondents reported receiving counseling on breastfeeding and one 

in every 10 received advice on newborn care and on family planning. Activities such as 

examination of abdomen, internal examination and asking question to client on the status of 

bleeding or abdominal pain was reported only by an insignificant percentage of RDW at these 

visits. 

Nearly 29% of all RDW whose last delivery was a live birth reported receiving iron/folic acid 

tablets following their most recent delivery. Only 36% of the RDW who delivered more than 2 

months prior to the survey had taken a vitamin A capsule during the 42 days following their most 

recent delivery. 

A small proportion of the RDW reported receiving counseling on various types of postpartum 

maternal danger signs or issues from the health workers following their delivery. Slightly over a 

quarter had received counseling on excessive bleeding and severe lower abdominal pain and 

slightly over one-fifth on high fever, severe headache and breast problems, and less than onefifth 

on convulsions and service sources from the health providers. The quality of postpartum 

counseling was assessed by calculating the percentage of RDW who were counseled in at least 

two maternal danger signs or issues among those RDW who received post-natal care from a 

trained provider within six weeks of delivery. The value of this indicator was found to be 46%. 

Danger signs during postpartum period 

Overall, over 90% of the RDW and MIL and nearly 90% of the husbands and FIL were able to 

mention at least one type of danger sign or symptom that may appear during postpartum period. 

The majority (67%-78%) of them named excessive bleeding as a symptom that needs immediate 

health care followed by high fever (48%-51%) and pain in lower abdomen or smelling vaginal 

discharge (36%-51%). Relatively a small proportion of the respondents of all types named 

xxiii

symptoms such as severe headache and convulsion and fit. Overall, only 40% of RDW were able 

to correctly name three or more danger signs. 30% of RDW experienced a danger sign during 

this period. Among those RDW, 29% sought care at a health facility after experiencing a danger 

sign during the postpartum period. 

Family support during postpartum period 

About 86% of the RDW reported receiving more support than usual from the family members 

during the first 6 weeks after their delivery while only about 2% mentioned less than usual. The 

response of the husbands and MIL was also consistent with the responses of RDW. 

Knowledge about postpartum hemorrhage 

About half of the respondents with a slightly higher proportion of the RDW (54%) reported 

receiving information about bleeding after childbirth during their or their wives/DIL’s last 

pregnancy. Nearly half (41%-47%) of the respondents of all four types reported to have heard 

that bleeding after childbirth could cause maternal death. Comparatively a higher percentage of 

RDW (47%) than other three types of respondents reported receiving information that bleeding 

after childbirth could cause death. 

Only a small proportion (15%-19%) of the respondents of all four types also said that they 

received information about a medicine that could be taken to reduce bleeding after childbirth 

during their or their wife’s/DIL’s last pregnancy. Overall, 16% of the RDW reported receiving 

information about a drug that could reduce bleeding after childbirth during their last pregnancy. 

Immediate newborn care 

About 63% of the RDW reported that the cord of their newborn was cut after delivering the 

placenta, and about 26% said that the cord was cut before the placenta was delivered. Among 

RDW who delivered at home, 90% either used a Clean Home Delivery Kit (CHDK) or a 

new/sterilized blade to cut the cord. Among RDW who delivered a live newborn at home, 95% 

said that a CHDK, “new thread”, or “boiled string or thread” was used to tie the cord. 

About 59% of the RDW said that they did not apply anything on the cord stump. About 11% of 

the RDW reported that they applied oil followed by 7% ash and 6% applied ointment or powder 

on the stump. The other substances that they applied on the stump of the cord were turmeric 

powder, sindoor and animal dung. 

Over half of the RDW reported that they dried their newborn (50%) and wrapped him/her in 

cloth (52%) before the placenta was delivered. Only 10% of the RDW correctly stated that a 

newborn should be given bath 24 hours after birth. However, about 17% of the newborns had 

their first bath delayed until after 24 hours of the birth. 

About 32% of RDW knew that a child should be breast fed immediately after the birth, while 

43% reported exposure to the message that a newborn should be breastfed for the first time 

immediately after birth. About one-third (33%) of RDW had initiated breastfeeding during the 

first hour after birth. 

xxiiii

Breastfeeding was found to be nearly universal in the study areas. Seventy-nine percent of the 

RDW said that they provided colostrums to their newborn. About 58% of RDW reported that 

they did not give anything to the newborn to eat or drink other than breast milk in the first 3 days 

of life. The exclusive breast-feeding rate of infants aged less than 6 months was estimated at 

54%. 

Newborn care during first month 

Overall, 26% of RDW whose most recent delivery resulted in a live birth were able to correctly 

name three or more newborn danger signs. More than 90% of the respondents of all four 

categories were able to mention at least one danger sign of the infant within 7 days after the birth 

needing immediate health care. Poor sucking or feeding (60%-67%), fast or difficult breathing 

(35%-49%) and feeling cold or too hot (25%-38%) were the main signs as reported by them. The 

highest proportion of the respondents of all four categories mentioned hospital (25%-37%) and 

private clinic or nursing home (20%-34%) as health facilities where health services could be 

sought if their newborn experienced any of the danger signs. 

Among RDW with live birth whose infant lived at least two months, 40% of newborns received 

care within one day after delivery from a trained provider, while 41% received care within three 

days of delivery from a trained provider. Overall, 45% of the RDW who delivered more than 2 

months prior to the survey reported that their newborns received care within four weeks of 

delivery from a trained provider. 

Of the 272 children 6 months or above at the time of the last National Vitamin A Day, 93% had 

received vitamin A capsule distributed during that time while 6% had not received such capsule. 

Overall, 53% of RDW who delivered more than 2 months prior to the survey were counseled by 

a health worker, FCHV or TBA in at least two newborn issues either prior to or following their 

deliveries. 

Overall, the survey results reveal that RDW who are younger, literate, belonging to Brahmin or 

Chhetri, exposed to media and belonging to high SES are more likely to receive postpartum and 

newborn care than their respective counterparts. 

g) Birth Preparedness, Access to Emergency Funds and Transportation 

Birth preparedness 

From 62 to 78 percent of the four types of respondents reported to have made some sort of 

preparation for childbirth. Slightly over half (51.1%) of all RDW were able to name two or more 

types of preparation that they made for delivery. The highest percentage of respondents of all 

four categories reported arranging money and foods. Quite a small proportion (

aside money specifically for care during delivery. Only about 9% of the RDW reported arranging 

a trained health worker to attend their last delivery. Overall, 15% of the RDW reported to have 

arranged prior to the delivery to give birth in a health facility. 

About a quarter (23%) of the RDW reported that they had prepared in advance for the care of the 

mother and newborn during the first month following the delivery. The highest percentage (21%) 

of the RDW had made financial preparation. The other types of preparation made by a few RDW 

(

Based on the findings of the study, the following recommendations are made: 

On knowledge and use of FCHVs and PHC ORC services 

Although a majority (>70%) of all the four type of respondents knew the FCHVs working in 

their areas, however, only a small percentage are aware about the types of help or services that 

the FCHVs provide. It is, therefore, necessary to inform people about types of health related 

information and services that the FCHVs in their areas provide. 

Mothers’ group meeting, considered as the most important platform for the rural women to learn 

new things about health matters, and sharing their problems and concerns with the fellow women, is 

attended only by a small proportion (

pregnancy check ups four times. Likewise, only about 47% of the RDW had received ANC at 

least four times and 48% had received ANC during their first trimester. Therefore, there is a need 

to inform the community about the importance of these aspects. 

Activities to encourage women to take TT vaccines, iron supplements and deworming tablets 

during pregnancy are suggested as only about 62% of the RDW had received at least two doses 

of TT vaccines, 68% received iron supplement and only 25% received deworming tablets during 

their last pregnancy. 

The practice of consuming more amount of food than usual during pregnancy was found only 

among 39% of the RDW, which calls for the need for creating awareness in the community 

about the value of consuming more amount of food during pregnancy. 

Although almost all the RDW had knowledge about the health facilities where they could 

deliver a child, only about 35% of them delivered their last child at the health facility, mostly 

after seeing some sort of danger signs or complications as among RDW whose delivery took 

place at a health facility 60% reported that they visited health facility for delivery only after the 

problems seen during labor. Overall, 43% of the deliveries were assisted by a trained health 

worker, however, the proportion of Tharu, Dalit and Muslim who received assistance from such 

health worker was quite low. Hence, the program needs to encourage community with more 

focus on Tharu, Dalit and Muslim community to take delivery services from the health facility or 

a trained health worker. 

On postpartum, immediate newborn and newborn care 

The survey results indicate that quite a small percentage (50%) of the respondents of all four types were unaware about the 

consequences of bleeding after childbirth. Thus, it is necessary to provide information about the 

need of prevention and timely treatment of bleeding after childbirth. 

The survey results suggest that the program should inform the people not to apply unhygienic 

substances such as ash, animal dung, sindoor, turmeric etc. on the cord stump of the baby; to 

give bath the newborns only after 24 hours of the birth; and to educate people about the 

importance of drying and wrapping the newborn immediately after birth as the correct practices 

in such aspects was found to be quite low in the study areas. 

Knowledge among all four types of respondents about different types of newborn danger signs 

xxviii

that warrant for immediate health care was found to be quite low as about 26% of the RDW were 

able to correctly name three or more danger signs or symptom of the infant. Hence, it is 

necessary to inform people on the various types of danger signs associated with the newborn. 

The practice of taking newborn for check ups to the health facility or being seen by health 

workers within 4 weeks following the birth was found among only about 53% of the RDW. 

Aside from modern health facility or trained health workers, the practice of consulting traditional 

healers during newborn sickness was found to be common. Therefore, the program should 

widely disseminate the information in its working areas about the need for check-ups of newborn 

within 4 weeks following the birth with the health workers. 

On birth preparedness 

The survey results indicate that quite a high percentage of the respondents did not arrange 

basic things such as birth attendant, finance, transport, blood, foods, clothes, etc. for delivery. 

Only 9% of the RDW reported arranging a trained health worker or TBA to attend their last 

delivery. Similarly, only 23% of the RDW had made any preparation for the care of mother and 

newborn. It is, therefore, necessary to disseminate information to the community about the need 

of making such preparations for both the normal period as well as emergencies during the 

pregnancy, delivery and postpartum period. 

Finally, the survey results reveal that knowledge and practices on various aspects of safe 

motherhood is particularly low among population groups that include illiterate women, Tharu, 

Muslim and Dalit populations in the study areas. Hence, the program should focus this section of 

the population. 

xxviiii

Chapter 1 

Newborn Health in Nepal 

1.1 Magnitude of the newborn health problems at the global level 

Newborn mortality has remained relatively high despite declines in global under-five and infant 

mortality rates during recent decades at global level. Estimates indicate 4 million newborns die 

globally each year (SCF US, 2002) and approximately 98% of these deaths occur in developing 

countries alone (Stoll, 1997). Another 4 million babies are stillborn during the last trimester of 

pregnancy. Perinatal mortality, which includes stillbirths of more than 22 weeks gestational age 

and newborn deaths during the first week of life, almost equals mortality during the entire first 

year of life (SCF US, 2002; CHRC 1999). Available estimates further indicate that about twothirds 

of infant deaths and 35% of under-five deaths occur in the first month of life (Lawn et al, 

2001). The situation indicates that the risk of dying per month is 10 to 15 times higher in the first 

month of life than in each of the remaining 11 months of infancy. The results of the available 

studies reveal that the risk of dying during the first month of life is also approximately 30 times 

greater than at any month during young childhood (months 12- 59) (UNICEF 2001; Bang 1993). 

Analysis of a recent study indicate the loss of healthy life from newborn deaths results in 8.2% of 

the disease burden or 27 million years of life lost burden in sub-Saharan Africa and 13.6% of the 

disease burden, or 53 million years of life lost in South Asia (Hyder, 2001). Moreover, the 

studies highlight that the currently available data on newborn outcomes in developing countries 

grossly underestimate the magnitude of problem, particularly the cause-specific mortality. The 

available data suggest that there should be a new focus on improving newborn health in order to 

achieve further gains in child survival, particularly with regards to outcomes in the perinatal 

period (UNICEF, 2001; WHO 1994; 1996; Moss et. al., 2002). 

1.2 Newborn health in Nepal 

The maternal mortality rate (539/100,000 live births) is still high in Nepal. In Nepal, neonatal 

mortality is 39 per 1000 live births, infant mortality 64, and under-five mortality is 91 per 1000 

live births (Nepal Demographic and Health Survey 2001). About 12 women die each day due to 

childbirth or from related complications; over 4,000 women die each year because they lack 

access to quality services. The major cause of maternal mortality rate (MMR) in Nepal is 

reported to be postpartum hemorrhage (Pathak, et. al., 1998). 

The main reasons for hospital admission of neonates were: Birth Asphyxia (7-31%), Septicemia 

(11-52%), Respiratory Distress Syndrome (12-32%) and Pre-maturity (3-15%). It has been 

postulated that neonatal mortality could be reduced dramatically if pregnant women and their 

families had adequate knowledge about danger signs and where, how and when to seek help 

from the health facilities. Moreover, whatever services are available are not accessible and 

affordable to the rural poor and marginalized section of the population, which forms the bulk of 

the whole. 

In line with the Nepal's Second Long-Term Health Plan (1997-2001) that stresses the need to 

improve the maternal and neonatal health outcomes, His Majesty’s Government of Nepal, 

through a network of Primary Health Care institutions, has laid emphasis on the provision of 

1

Essential Health Care Services at all levels of public health facilities with focused intervention 

on Family Planning and Mothers’ and Child Health. To achieve these goals, a number of national 

and sub-national programs have been implemented including EPI, promotion of routine antenatal 

and postnatal check-ups through health facilities, promotion of delivery by skilled attendants, 

regular and seasonal family planning services, maternal and neonatal tetanus elimination, and 

integrated management of childhood illness. Moreover, several trials have been or are being 

implemented in selected areas that may lead to the development of interventions that result in the 

reduction of maternal and neonatal mortality. 

1.3 Role of Nepal Family Health Program to strengthen national maternal and neonatal 

health programming 

Recognizing the urgency to address both maternal and neonatal morbidity and mortality in an 

integrated manner, the Nepal Family Health Program (NFHP) intends to implement an integrated 

pilot intervention — the Community-Based Maternal and Neonatal Care Program (CB-MNC) — 

in three districts of Nepal: namely, Jhapa, Banke and Kanchanpur. The overall purpose of this 

pilot project is to test the feasibility of development of an integrated community-based approach 

to reduce maternal mortality (with a primary focus on mortality due to PPH) and neonatal 

mortality and increase use of contraceptives for birth spacing. The pilot project aims to include 

the interventions to increase awareness amongst the pregnant women and their family on danger 

signs during antenatal, delivery and postnatal; getting themselves prepared for the delivery and 

the postnatal care of the mother and the child; and increasing demand for and utilization of 

appropriate health services. Aside from using known tools such as birth preparedness package 

(BPP), the pilot project is also aiming at demonstrating the feasibility of introducing Misoprostol 

distribution for prevention of PPH through the Ministry of Health service delivery system via 

Female Community Health Volunteers (FCHVs). The Misoprostol distribution is planned to be 

made in the outset only in Banke district on pilot basis. The CB-MNC will also provide some 

supply-side inputs to improve infrastructure at selected health facilities. 

The CB-MNC program is planned to be implemented for two years starting from the third 

quarter of 2005. The specific objectives of the program are to increase the following: 

• Percentage of women able to identify danger signs during antenatal, delivery and postnatal 

period 

• Coverage of antenatal and postnatal services 

• Use of skilled attendants and institutional delivery 

• The practice of essential newborn care at home 

• The percentage of women who accept postpartum family planning 

• The percentage of sick neonates referred to the health facilities 

The program area includes rural areas of three districts: Jhapa, Banke and Kanchanpur. The 

target population will be the women of reproductive age and newborn infants. In order to 

establish information and database in the selected indicators against which the changes brought 

about by the interventions could be assessed objectively after the program interventions, the 

NFHP commissioned a study and the study was entrusted to Valley Research Group (VaRG). 

2

1.4 Objectives of CB-MNC Baseline Survey 

The overall objective of the baseline survey was to establish benchmarks for selected indicators 

of knowledge and practices of maternal and newborn care among recently delivered women 

(RDW) and their family in the pilot areas that will be used to evaluate the CB-MNC. 

The specific objectives of the survey were to accomplish the following: 

i) assess the knowledge of women and their family about danger signs that could appear 

during antenatal, delivery and postnatal phase; 

ii) gather information about the current practices of receiving antenatal and postnatal services 

from the existing health facility or health personnel and community health volunteers; 

iii) obtain information about the current practices of using skilled attendants or institutions 

during delivery; 

iv) collect information on the current practices related to the management of newborn at home; 

v) gather information regarding current birth preparedness practices including knowledge of 

location of providers for mothers and newborns with danger signs; 

vi) examine the existing status of the use of family planning by the postpartum women; 

vii) examine the current practice of referring the sick neonates to the health facilities; and 

viii make recommendations for the smooth and effective implementation of the CB-MNC. 

3

Chapter 2 

Methodology and Data Collection 

2.1 Study population 

The study was mainly based on primary sources of information. Information required for the 

purpose of the study was collected using quantitative techniques. The respondents in the survey 

composed of recently delivered women (RDW), their husbands, mothers-in-law (MIL) and fathersin-law 

(FIL). RDW are defined as the women who have delivered in the past 12 months from the 

survey date (regardless of whether the infant is currently alive or dead), including stillbirths. The 

study was carried out in the rural areas of Jhapa district. The three municipalities (Damak, 

Bhadrapur and Mechinagar) in Jhapa district are excluded from the sample frame. 

2.2 Sample design 

The cluster sampling design was used to select the required number of sample population from the 

study areas. A three-stage sampling design was followed. In the first stage, 30 clusters (i.e., wards) 

were selected randomly. In the second stage, clusters were mapped and divided into segments, and 

one segment was then chosen. In the third stage, a starting household was chosen in the selected 

segment, following which the required number of respondents of different categories such as RDW, 

their husbands, mothers-in-laws and fathers-in-law were selected. Details of the sampling 

procedures are provided below. 

a) Stage 1: Selection of clusters/wards 

For the purpose of the study, the ward was treated as the primary sampling unit (PSU). The 

sample frame was constructed by listing all VDCs of the study district in alphabetical order 

within the six electoral constituencies. Each of the nine wards in each VDC was listed together 

with the number of households in the ward. Stratification of the sample frame in each of the six 

electoral constituencies of the district was done in order to ensure the representation of 

geographical distribution of the sample of wards. 

In the first stage of sampling, 30 wards were selected from the sampling frame using Probability 

Proportional to Size (PPS) principles. Selection of the wards was done in Kathmandu using the 

2001 Census Data of the Central Bureau of Statistics. The list of sampled wards by VDCs is 

presented in Annex 1. 

b) Stage 2: Selection of segment 

In a selected ward, prior to proceeding to the data collection activity, the survey team, in 

consultation with the local leaders and key informants, prepared a sketch map of the ward 

delineating mainly the public places, villages/settlements, forests, rivers, temples, farmlands, 

trails etc.. The purpose of preparing the sketch map was to locate the settlements within the ward 

and divide the ward into 3-6 segments in the sketch map using easily recognizable geographic 

criteria to define the segment borders. Dividing the ward into segments was followed by 

estimation of household number in each segment with the help of key informants and recorded in 

4

a form especially prepared for the purpose of the present study. Upon adding up the households 

of each segment, the field team chose one segment randomly using PPS. 

c) Stage 3: Selection of index household 

Surveyors then located the center of the selected segment and spun a bottle or pen. The survey 

team then walked from the center of the segment to the border of the segment in the direction 

shown by the bottle/pen, and noted and assigned a number to each of the houses situated within 

10-20 meters on either side of the path they walked. Finally, the team then randomly chose a 

number ”x” between 1 and the “total number of houses counted” using a random number table 

and identified the x th house along the path as the index household. 

d) Selection of respondents 

Interview with RDW 

Following the selection of the index household, the interviewers determined firstly the existence 

and availability of the eligible RDW in the index household. Interviewers interviewed the RDW 

if she existed and was available and they then proceeded to the next nearest household where 

they again determined the existence/availability of a RDW. The process was continued till 30 

RDW were interviewed in the selected ward. In case of the wards where the required number of 

30 RDW was not reached, the interviewers moved to an adjacent ward to interview RDW always 

obeying the rule "Go to the next nearest household" until the required number of respondents 

was reached. Accordingly, the interviewers interviewed RDW from households outside the 

selected ward in case of not reaching the required number of 30 RDW in the selected ward. All 

the RDW of the sampled households that slept the night prior to the survey day were considered 

as the eligible respondents for the purpose of the study. 

In order to get 900 RDW from 30 clusters, the team visited 9,156 households to fill-up the 

screening questionnaires to identify the RDW (Table 2.1), which implies that the field team had 

to visit on an average 10 households to find a RDW. This is more or less consistent with the 

earlier studies as in the DHS 2001 indicated about the availability of a RDW in every 7 th 

households visited. There was at least one RDW in 917 households from among the 9,156 

households visited. However, the RDW could not be interviewed in 31 households. Thus, 900 

RDW were interviewed from 886 households. The reasons for not interviewing 31 RDW from 

31 households were as follows: 

• RDW was in parent's home at the time of survey (n=20) 

• Unwillingness to be interviewed (n=7) 

• Physically weak to give interview due to sickness (n=2) 

• RDW not at home even in repeated visit of interviewer (n=2) 

Interview with husbands, MIL and FIL of RDW 

In addition to RDW, husbands, mothers-in-law and fathers-in-law of the interviewed RDW were 

also included in the present study. It was planned to include 10 each of the husbands, fathers-in-law 

and mothers-in-law from each of the sampled clusters, i.e. 300 respondents of each category; 

however, the planned number could not be reached, and only 292 husbands, 264 mothers-in-law and 

190 fathers-in-law of the RDW were successfully interviewed. The reason for not reaching the 

5

expected sample size for these respondent groups was that in the design of the study it was planned 

to include ten husbands, ten MIL and ten FIL of the interviewed RDW in each cluster. However, 

even while completing the interviews with 30 RDW in each cluster, the field team could not find 10 

respondents of each of these categories in some clusters. The study was designed in such a way that 

if the required samples of husbands, MIL and FIL were not met after interviewing the 30 RDW the 

field staff stopped interviewing without completing the quota for the husbands, MIL and FIL. 

Table 2.1 Distribution of clusters, households and respondents 

Description Target (n) Actual (n) 

Number of cluster 30 30 

Number of households visited - 9156 

Number of households having RDW and household roster filled up - 917 

Number of households where RDW interviewed - 886 

Number of RDW 900 900 

Number of husbands of RDW 300 292 

Number of mothers-in-law of RDW 300 264 

Number of fathers-in-law of RDW 300 190 

2.3 Description of instruments 

Five sets of structured questionnaires were used to collect information required for fulfilling the 

objectives of the study. The types of questionnaires used were as follows: 

a) Screening questionnaire 

This questionnaire contained information regarding the RDW and their newborn baby such as 

their name, date of birth of the youngest child, gender of child, and whether the child is currently 

living or not. This questionnaire was administered in each of the household of the sampled 

clusters to identify the recently delivered women (RDW). This information helped to identify 

whether or not there are eligible RDW in each household (see annex 4 for details). 

b) Household questionnaire 

The household questionnaire was administered among the heads of household or the 

knowledgeable persons in the household. Information regarding the usual members of the 

household was collected using household questionnaire. The information collected include the 

relationship of each member with the RDW, whether they usually live in the household or not, 

whether slept the night preceding the survey date or not, sex, age and marital status. In addition, 

information regarding household possessions such as electricity, bicycle, telephone, television, 

radio, source of drinking water, existence of toilet, and housing condition was collected from the 

household questionnaire (see annex 4 for details). 

c) Questionnaire for RDW 

All women aged 15-49 who gave birth in the last 12 months preceding the survey date were 

administered the RDW questionnaire. The information collected using the RDW questionnaire 

included age, sex, education, occupation, media exposure, fertility, knowledge and use of FCHV 

services, knowledge, attitude and practices regarding antenatal, delivery and postpartum period 

6

including newborn care. Likewise, information about postpartum hemorrhage, postpartum family 

planning and birth spacing and birth preparedness including access and utilization of emergency 

fund and transportation were also included in the RDW questionnaire (see annex 4 for details). 

There were a total of 12 sections in the RDW questionnaire, which are as follows: 

Section 1: Respondent’s Background 

Section 2: Fertility 

Section 3: FCHV Services: General and Antenatal 

Section 4: Antenatal Care 

Section 5: Delivery Care 

Section 6: Misoprostol and Postpartum Hemorrhage 

Section 7: Postpartum Care 

Section 8: Postpartum Family Planning and Birth Spacing 

Section 9: Immediate Newborn Care 

Section 10: Newborn Care During First Month 

Section 11: Birth Preparedness 

Section 12: Access to Emergency Funds and Transportation 

d) Questionnaire for husbands and mothers-in-law 

This module of questionnaire was administered to husbands and mothers-in-law of the RDW 

who were interviewed. The information in this set of the questionnaire included background 

characteristics such as age, literacy, education, exposure to media, knowledge and use of FCHV 

services, knowledge about and attitude towards safe motherhood, type of safe motherhood 

services received by their wives or daughters-in-law, knowledge, attitudes and practices of 

newborn care, birth preparedness, and utilization of emergency fund and mode of transport used 

by their wives or daughters-in-law during recent delivery. Similarly, information about the use of 

postpartum family planning services was also collected from the husbands of RDW (see annex 4 

for details). There were a total of 7 sections in the RDW questionnaire, which are as follows: 


Section 2: FCHV Services 

Section 3: Safe Motherhood 

Section 4: Postpartum Family Planning and Birth Spacing 

Section 5: Newborn Health 



e) Questionnaire for fathers-in-law 

This questionnaire includes information on background characteristics of respondents, 

knowledge about FCHVs working in their areas, knowledge and attitude towards safe 

motherhood services, knowledge about newborn health, type of preparation made for the recent 

delivery of their daughters-in-law, and knowledge about the availability of emergency fund and 

transport services and their utilization during the recent delivery of their daughters-in-law (see 

annex 4 for details). There were a total of 6 sections in the FIL questionnaire, which are as 

follows: 


Section 2: FCHV Services 



7



2.4 Design and pre-testing of instruments 

The questionnaires were developed first in English and finalized after receiving comments and 

suggestions from colleagues from partner organizations. The final version of the questionnaires 

in English were then translated into Nepali. The questionnaires were pre-tested with 22 RDW, 10 

mothers-in-law and 5 husbands of RDW each in the rural areas of Parsa and Lalitpur districts. 

One supervisor and 2 female interviewers were involved in pre-testing of the questionnaire. The 

survey instruments were modified based on the pretest findings and finalized in close consultation 

with NFHP. 

2.5 Field organization and data collection 

The study was conducted under the overall supervision and guidance of senior researchers assigned 

for the purpose of the study. They were assisted by other administrative and field staff. 

Five teams, each consisting of one supervisor and three female interviewers were mobilized for 

data collection. Each team covered 5-6 clusters over the duration of the field exercise. The field 

team members were given training for eight days before mobilizing them to the field. Short 

presentation, role-play and field practices were the methods followed in conducting the training. 

The officials of the NFHP also contributed their inputs in the training. The topics covered in the 

training/orientation included: a) introduction to the CB-MNC program, b) purpose of the study, c) 

nature of various instruments and their use, d) rapport building with local organizations and 

respondents, and e) orientation on the questionnaires and the guidelines. An interviewer manual was 

also prepared in order to maintain the consistency in the data collection process and to ensure 

quality in data collection work. One Field Research Assistant was also deputed in the study district 

in order to supervise and monitor the data collection work during the entire data collection period. 

Data collection was carried out during May and June 2005. The Supervisor in each team was in 

charge of mapping, segmentation, and selection of the index household. 

In addition, the Senior Researcher also visited the study areas to supervise and monitor the data 

collection activity. After one week of field activities, a one-day debriefing session among the field 

staff was organized in Birtamod in order to share the field workers’ experiences gained during data 

collection. The NFHP M&E Team Leader, and regional and district level officials of NFHP also 

participated during the debriefing workshops. The debriefing workshop was quite instrumental in 

providing necessary feedback and guidance to the field team. 

2.6 Data cleaning and analysis 

All completed questionnaires were brought to the VaRG office. The filled-in questionnaires were 

checked and coded by a team composed of a data editor and a coder. Then data were entered and 

validated by a computer processing team consisting of a computer programmer and data entry 

personnel. To ensure the accuracy and quality of data entry, 5% of the data were double entered by 

the data entry personnel and then both sets of data were compared to identify inconsistencies. 

Inconsistencies between two entries were negligible (0.2%). 

8

Upon completion of data entry, the printout of raw data was generated and checked against the 

questionnaires in order to detect data entry errors. Machine editing of the data was done for 

generating a cleaned data set. The data were then analyzed using the SPSS computer software 

package and analysis done using simple frequency tables and two/three way cross tabulations. All 

tests of the strength of association between selected variables that are described in this report have 

been conducted using the Chi Square test. 

During the data processing period, experts from the Johns Hopkins University and ICDDR- 

Bangladesh visited Kathmandu and provided necessary support and guidance to the data analysis 

team. 

9

Chapter 3 

Characteristics of the Households and Respondents 

This chapter deals with the age, sex and marital status of household members, household 

possession of selected items, drinking water facility, sanitation condition and type of house of the 

sampled households included in the study. Likewise the selected socio-economic and 

demographic characteristics of the recently delivered women (RDW), their husbands, mothersin-law 

(MIL) and fathers-in-law (FIL) are also discussed in this chapter. 

3.1 Characteristics of the sampled households 

The household level information was collected mostly from the head of the households (32.1%) 

and their spouses (45.3%). About 23% of the respondents were also the sons or daughters (8.0%) 

and daughters-in-law (14.6%) of the household heads. There were a total of 5,200 people in 886 

sampled households with the average of 5.9 persons in each household. Of the total household 

population, 47.5% were males and the rest (52.5%) were females with the sex ratio of 0.91; 

which is significantly lower than that of the CBS 2001 results of 0.99 (CBS, 2002). It is to be 

noted that the household characteristics only pertain to those households that have recently 

delivered women, therefore are not necessarily comparable to the census or the overall situation 

of households in the district. 

a) Age, sex and marital status of the household population 

Table 3.1 presents the distribution of household population by age and sex. Overall, 17% of the 

household population was less than one year of age, and 10% between 1-4 years old. About one 

in every 8 residents in the sampled households were adolescents (10-19 year old) and almost the 

same proportion were youth (20-24 years of age). More than a quarter (27.5%) of the household 

population was between 25-49 years of age and another 11% were over 50 years of age. The 

mean age of the household population was 21.1 years (Table 1). 

Table 3.1 Percent distribution of household population by age and sex 

Age in completed years Male Female Total 

Percent Number 

Less than one year 18.7 15.2 16.9 877 

1-4 9.7 9.9 9.8 511 

5-9 8.7 9.8 9.3 484 

10-14 4.8 6.3 5.6 289 

15-19 5.1 8.2 6.8 352 

20-24 9.8 16.6 13.3 693 

25-29 13.7 11.3 12.4 647 

30-34 8.8 4.3 6.4 334 

35-39 4.5 2.6 3.5 180 

40-44 2.3 2.3 2.3 119 

45-49 2.3 3.4 2.9 152 

50-54 3.4 3.1 3.3 170 

55-59 2.1 2.2 2.2 114 

60-64 2.5 2.6 2.6 135 

65 and above 3.5 2.1 2.8 143 

Total 2471 2729 100.0 5200 

10

Information regarding the marital status of all the household members aged 10 years or above 

was collected during survey. Table 3.2 presents the age-specific marital status of both the male 

and female population of the sampled households. Nearly three-quarters of the household 

population of both sexes were currently married and 2% of males and 7% of females reported to 

be either divorced, separated or to be a widow/widower. Age-wise data reveals that nearly threefifths 

of the females aged 15-19 years were currently married while in case of males this figure 

was only 9% indicating that females get married earlier than the males. 

Table 3.2 Percent distribution of household population aged 10 years and above by marital status 

Age group (in 

Male 

Female 

years) CM FM Both Number CM FM Both Number 

10-14 0.8 - 0.8 118 1.2 - 1.2 171 

15-19 9.4 - 9.4 127 57.3 - 57.3 225 

20-24 68.9 - 68.9 241 89.8 0.2 90.0 452 

25-29 87.9 0.3 88.2 338 94.8 1.3 96.1 309 

30+ 93.3 4.8 98.1 730 79.7 19.7 98.7 617 

Total 74.5 2.3 76.8 1554 74.5 6.9 81.4 1774 

CM= Currently married, FM= Formerly married: widow/widower, divorced/ separated. 

b) Household possession 

Information about the availability of electricity and telephone connection at home, and 

possession of bicycle, television and radio was collected from the respondents that provided 

household level information. The survey results reveal that a little higher than two-thirds (67.5%) 

of the households had electricity facility in their homes and almost the same percentage (68.6%) 

had bicycle. More than half (56.5%) of the households had radio and another 43% had television 

set in their houses. Only 2% of the respondents said they had telephone connection in their 

houses (Figure 3.1). 

Figure 3.1 Percent distribution of respondents having different items in their households 

Percent 

100 

80 

60 

40 

20 

0 

67.5 68.6 

56.5 

42.7 

1.8 

Electricity Bicycle Radio Television Telephone 

n=886 

c) Water and sanitation 

Information regarding the sources of drinking water and toilet facility was also collected from all 

the respondents that provided household level information. Almost all the households had access 

to established water supply system such as piped water, well or tube well while only a negligible 

(0.3%) proportion depended on traditional sources such as spring, kuwa, river, stream, pond and 

lake for their drinking purpose. More than three-quarters (76.6%) of the households mentioned 

11

tube well (private or public) as their main source of drinking water and another 13% mentioned 

well. One in every 10 households in the study areas had access to either private or public piped 

water for drinking purpose. 

Table 3.3 Percent distribution of households by source of drinking water 

Main source of drinking water Number Percent 

Piped into house/yard/plot 43 4.9 

Public/neighbor’s tap 50 5.6 

Well in house/yard/plot 64 7.2 

Public/neighbor’s well 47 5.3 

Tube well in yard/plot 475 53.6 

Public/neighbor’s tube well 204 23.0 

Spring/kuwa/ river/stream/pond/lake 3 0.3 

Total 886 100.0 

Nearly half of the households reported that they have toilets at their houses. Households with 

toilet had either the traditional pit (23.4%) or ventilated improved pit (24.0%) latrines while only 

a few (

Table 3.5 Percent distribution of households by main materials used in the houses 

Description Number Percent 

Main material of the floor 

Earth/mud/dung 654 73.8 

Cement 139 15.7 

Wood planks 87 9.8 

Other (Linoleum /carpet/ ceramic tiles, marble chips) 6 0.7 

Total 886 100.0 

Main material of the roof 

Metal 525 59.3 

Thatch 261 29.5 

Paddy straw 46 5.2 

Cement 43 4.9 

Other (Tiles/khapada/ plastics/ chitra/ leaf of sugarcane) 11 1.2 

Total 886 100.0 

Main material of the walls 

Bamboo with mud 591 66.7 

Bamboo with cement 95 10.7 

Cement 92 10.4 

Unfinished wood 57 6.4 

Bricks 36 4.1 

Other§ 15 1.7 

Total 886 100.0 

§ Other includes: adobe, cement blocks, wood planks, mud-plastered wooden wall, mud-mortared stone wall, mud only, clay 

mixed with cow dung and chopped paddy straw, tin, fenced by wild plants and lentil straw, Jheekrama Matole Lipeko, bamboo 

stick. 

3.2 Characteristics of the respondents 

This section presents the socio-demographic characteristics of the recently delivered women 

(RDW), their husbands, mothers-in-law and fathers-in-law. Age, literacy status, educational 

achievement, caste/ethnicity, occupation, and exposure to radio and television of the respondents 

are discussed in this section. 

a) Age, educational level, literacy status and caste or ethnicity 

Age composition 

A total of 900 RDW and 292 husbands, 264 MIL and 190 FIL of the RDW were included in the 

study. Table 3.6 shows the age distribution of RDW and their husbands. Nearly 70% of the 

RDW and about 51% husbands were between 20-29 years of age. Likewise, 18% of the RDW 

and 46% husbands were between 30-49 years old. Nearly 12% of the RDW compared to only 

1% of their husbands were between 15-19 years of age, indicating that quite a sizeable 

proportion of the females in the study areas give birth at younger age. The mean age of RDW 

was 25 years, which is 5 years lower than that of the husbands (30.1 years). 

13

Table 3.6 Percent distribution of RDW and their husbands by age group 

Age of respondent (age in completed years) RDW Husband 

Number Percent Number Percent 

15-19 107 11.9 3 1.0 

20-24 367 40.8 59 20.2 

25-29 262 29.1 91 31.2 

30-34 96 10.7 70 24.0 

35-39 49 5.4 38 13.0 

40-44 15 1.7 17 5.8 

45-49 4 0.4 8 2.7 

50+ - - 6 2.1 

Mean (SD) 25.0 (5.4) 30.1 (7.0) 

Median 24.0 29.0 

Total 900 100.0 292 100.0 

Table 3.7 shows the age composition of mothers-in-law and fathers-in-law of the RDW. More 

than 60% of the mothers-in-law and nearly 90% of the fathers-in-law were 50 years old or above. 

The mean age of the mothers-in-law was 53.4 years while this figure was 59.1 years in case of 

fathers-in-law. 

Table 3.7 Percent distribution of mothers-in-law and fathers-in-law of RDW by their age group 

Age of respondent (age in completed years) Mothers-in-law Fathers-in-law 


35-39 8 3.0 - - 

40-44 27 10.2 8 4.2 

45-49 58 22.0 15 7.9 

50-54 50 18.9 44 23.2 

55-59 47 17.8 32 16.8 

60-64 46 17.4 39 20.5 

65-69 11 4.2 20 10.5 

70 + 13 4.9 31 16.1 

Do not know 4 1.5 1 0.5 

Mean (SD) 53.4 (8.7) 59.1 (9.1) 

Median 52.0 - 59.0 - 

Total 264 100.0 190 100.0 

Caste/Ethnicity 

Table 3.8 presents the ethnic composition of the respondents of different categories. About three 

in every 10 RDW and husbands and 4 in every 10 MIL and FIL were either Brahmin or Chhetri 

by caste. About 15% of the RDW, husbands and MIL and 20% of the FIL belonged to Tibeto- 

Burman castes. About 18% of the husbands followed by 17% RDW and 13% each of MIL and 

FIL were Tharus by their castes. Similarly, about 16% of the husbands followed by 13% RDW 

and about 10% of the MIL and FIL were Dalit. The other ethnic groups included in the study 

were Muslim, other terai origin and other castes of population. According to the 2001 Census, 

Hill Brahmin (25.1%), followed by Chhetri (15.3%), Rajbanshi (9.2%) and Limbu (6.0%) were 

the four major ethnic groups of population in Jhapa district (CBS, 2003). 

14

Table 3.8 Percent distribution of RDW, husbands, MIL and FIL by ethnicity 

Ethnicity RDW Husband MIL FIL 

Brahmin/Chhetri 30.3 29.5 41.7 40.0 

Tibeto-Burman 15.6 14.0 15.9 19.5 

Tharu 16.6 17.5 13.3 13.2 

Dalit 12.7 15.8 9.8 8.9 

Muslim 7.2 4.8 7.2 4.7 

Other terai origin§ 11.1 11.3 6.4 7.4 

Other± 6.6 7.2 5.7 6.3 

Total (n) 900 292 264 190 

§ Other terai origin includes: Yadav, Kumhar, Rajbhar, Baniya, Kanu, Kurmi, Sudi, Kalwar, Teli, Kushuhawa, Other terai. 

± Other includes: Sanyasi, Newar, Bhujel, Dhimal, Tajpuriya. 

Literacy status 

Those respondents with completion of primary level of education or able to read Nepali language 

fluently were defined as the literates in the present study. Figure 3.2 shows the literacy status of 

the RDW and husbands, MIL and FIL of the RDW included in the study. More than threequarters 

of the husbands were found to be literate. Likewise, more than half of the RDW and 

their FIL were also reported to be literate. However, only 14% of the mothers-in-law in the study 

areas were found to be literate. 

Figure 3.2 Percent distribution of literate population by type 

Percent 

100 

80 

60 

40 

20 

0 

76 

57.1 

55.8 

13.6 

RDW Husband MIL FIL 

n= 900 RDW, 202 husbands, 264 MIL and 190 FIL 

Data presented in Table 3.9 reveals that more than three-quarters of the husbands followed by 

58% of the RDW reported that they have attended school. The majority of MIL (92.0%) and FIL 

(62.2%) reported that they had never attended schools. With regard to the level of education, 

most respondents of all categories who had attended school had attained either primary or 

secondary level of education. Nearly one-fifth (19.2%) of the husbands and 11% of RDW 

reported to have completed SLC or above level of education. The percentage of FIL and MIL 

completing SLC or above was only 5% and less than 1% respectively. 

Table 3.9 Percent distribution of RDW, husbands, MIL and FIL by their level of education 

Level of education RDW Husband MIL FIL 

No schooling 42.4 25.3 92.0 62.2 

Some primary 17.9 25.7 5.7 14.2 

Some secondary 28.8 29.8 1.9 18.9 

SLC or above 10.9 19.2 0.4 4.7 

Total (n) 900 292 264 190 

15

The RDW were also asked about their husband’s level of education. Nearly a quarter of the 

RDW said that their husbands had never attended school, and almost the same percentage said 

their husbands had attained some primary level of education. Over one-third of the RDW’s 

husbands had attained some secondary level of schooling, and about 17% had completed SLC or 

above level of education. 

Table 3.10 Percent distribution of RDW by their husbands level of education 

Husband’s level of education Number Percent 

No schooling 205 22.8 

Some primary 220 24.4 

Some secondary 322 35.8 

SLC or above 150 16.7 

Do not know 3 0.3 

Total 900 100.0 

b) Occupation of RDW and their husbands 

Information about the current working status of the RDW apart from their household chores was 

also collected. Nearly two-thirds of the RDW reported that they were engaged in other activities 

aside from their household chores. Among those RDW who reported that they were engaged in 

other activities aside from their household chores, most were engaged in agriculture (65.8%) 

followed by 25% were engaged in labor. Only a small proportion (8.9%) of these RDW were 

engaged in service and business. Of the 593 reporting to have involved in other jobs aside from 

their household chores 60% reported receiving payment for their work (either cash or in-kind) 

and the rest (39.8%) were not receiving any sort of payment for their work. 

Table 3.11 Percent distribution of RDW by their occupation 


Whether currently working (apart from own housework) 

Yes 593 65.9 

No 323 34.1 

Total 900 100.0 

Occupation or kind of work mainly do 

Labor 150 25.3 

Agriculture 390 65.8 

Private or government office/small business/ shopkeeper 53 8.9 

Total 593 100.0 

Whether paid or earn in cash or kind for this work 

Cash only 137 23.1 

Cash and kind 137 23.1 

In kind only 83 14.0 

Not paid 236 39.8 

Total 593 100.0 

All 900 RDW included in the study were also enquired about their husbands’ main occupation. 

Data presented in Table 3.12 reveal that most of the husbands of RDW in the study areas are 

engaged either in labor or agriculture. For instance, nearly 4 in every 10 RDW said their 

husbands were engaged in labor followed by 32% mentioned agriculture. Only a small 

16

proportion of the husbands of the RDW were reported to have been engaged in non-agriculture 

sectors such as private or government office employee (11.4%), small business (6.1%), and shop 

keeping (5.3%). 

Table 3.12 Percent distribution of RDW by their husband’s occupation 

Husband’s occupation Number Percent 

Labor 359 39.9 

Agriculture 285 31.7 

Private office employee 78 8.7 

Small business – sewing, carpentry 55 6.1 

Shopkeeper 48 5.3 

Government office employee 24 2.7 

Foreign employment 22 2.4 

Unemployed/ student/ incapacitated 16 1.7 

Other± 13 1.4 

Total 900 100.0 

± Other includes: driver, collecting, buying and selling of scrap utensil, butchery, medical shopkeeper, priest, barber. 

c) Exposure to television and radio 

In order to assess the level of exposure of the respondents to radio and television, all the RDW, 

husbands, MIL and FIL were asked about how frequently did they listen to radio and watch TV. 

Data presented in Table 3.13 reveal that the males are more likely to listen the radio compared to 

their female counterparts. For instance, about 56% of the husbands and FIL compared to 48% 

RDW and 45% MIL reported that they listened the radio almost every day. Likewise, more than 

one-fifth of the RDW and MIL as against only 12% of husbands and 15% of FIL reported not 

listening the radio at all. In case of TV, mothers-in-law are more likely to watch TV almost every 

day compared to the respondents of other categories. The study findings reveal that overall the 

responses given by different categories of the respondents are fairly similar. 

Table 3.13 Percent distribution of RDW, husbands, MIL and FIL by frequency of listening radio 

and watching TV 

Description RDW Husband MIL FIL 

(n=900) (n=292) (n=264) (n=190) 

Frequency of listening to the radio 

Almost every day 48.4 56.5 44.7 55.8 

At least once a week 16.3 17.5 19.7 18.4 

Less than once a week 15.0 13.7 12.5 11.1 

Not at all 20.2 12.3 23.1 14.7 

Frequency of watching TV 

Almost every day 43.8 45.2 48.9 45.8 

At least once a week 17.0 16.8 16.7 18.4 

Less than once a week 13.6 18.8 12.1 10.0 

Not at all 25.7 19.2 22.3 25.8 

Table 3.14 further presents data on exposure to media among the respondents of different types. 

The data indicate that a higher proportion of husbands compared to other categories of 

respondents have exposure to both the radio and TV. For instance, 76% of the husbands 

compared to less than 70% of RDW, MIL and FIL listened to radio and watched TV. Nearly 

17

14% of the MIL followed by 12% of RDW neither listened to radio nor watched TV at all while 

this figure was about 8% in case of husbands and FIL. Overall, the results provided by the 

respondents of different categories are pretty similar. 

Table 3.14 Percent distribution of RDW, husbands, MIL and FIL by exposure to radio and TV 

Exposure to radio/TV RDW Husband MIL FIL 

None 12.3 7.9 13.6 8.4 

Radio only 13.3 11.3 8.7 17.4 

TV only 7.9 4.5 9.5 6.3 

Both radio and TV 66.4 76.4 68.2 67.9 

Total (n) 900 292 264 190 

d) Access to health facility 

Information regarding the access to health facility including type of transport services that they 

generally use and travel cost was collected from all the RDW included in the study. Nearly threequarters 

(72.3%) of the RDW said that they usually go to the nearest health facility, nursing 

home, pharmacy or health provider on foot followed by 12% by bus and 11% by bicycle. The 

other modes of transport they generally use were rickshaw, jeep, van and motorcycle (Table 

3.15). The survey findings reveal that more than half (50.4%) of the RDW have access to health 

facility or health providers within the reach of less than half an hour and 29% within 30 minutes 

to one hour of distance. About one-fifth of the RDW have to spend one hour or more to reach the 

health facility. On an average they have to spend half an hour to reach the health facility or 

health providers. 

Table 3.15 Percent distribution of RDW mode of transportation and distance to reach the health 

facility or health provider 


Type of transport normally use to go to the health facility or 

health personnel 

Walking 651 72.3 

Bus 110 12.2 

Bicycle 98 10.9 

Rickshaw 27 3.0 

Jeep or van 11 1.2 

Other (motor cycle/ relative’s vehicle) 3 0.3 

Total 900 100.0 

Distance to the health facility or health personnel (in minutes) 

0-14 243 27.0 

15-29 211 23.4 

30-44 231 25.7 

45-59 33 3.7 

60 or above 181 20.1 


Mean (SD) 29.4 (23.3) 

Total 900 100.0 

Among those RDW (n=249) who reported using any transport means to go to the health facility 

or health personnel nearly half (48.1%; or n=120) of the RDW said that they have to spend 

18

money ranging from one rupees to Rs 49, and a few said that they have to spend 50 rupees or 

more for transportation. About 45% of the RDW said they do not have to spend money for 

transportation because they mostly use their own transport means (Table not shown). 

All the RDW were also asked whether they had to come back from the health facility without 

receiving health services in last 12 months because of the absence of staff. In response, about 

89% of the respondents reported of no such case while about 11% reported of such experience 

(Table 3.16). Similarly, the RDW were also enquired about their inability to visit the health 

facility to get health services during the past 12 months due to lack of security. In response, only 

a small proportion (

Chapter 4 

Familiarity with FCHVs and PHC ORC 

Information regarding the familiarity of the respondents of all four types with the FCHVs 

working in their areas including their knowledge about the services that the FCHVs provide in 

their areas was collected in the present study. Likewise, several questions related to Primary 

Health Care Outreach Clinics (PHC ORC) were also asked to the respondents. This chapter thus 

presents the findings on these aspects. Results for key CB-MNC Core Indicators for FCHV and 

PHC ORC are listed in the table below. 

CB-MNC Core Indicators for FCHVs and PHC ORC 

# Indicator Denominator 

(n) 

2.2 Percentage of RDW who know their FCHV 900 77.0 

2.7 Percentage of RDW who state that there is a mothers group in their area 900 13.3 

2.8 Percentage of RDW who attended a mothers group meeting during their last 

pregnancy 900 1.7 

2.10 Percentage of RDW who have heard of the Primary Health Care Outreach 

Clinic (PHC/ORC) 900 30.3 

2.12 Percentage of RDW who know when the PHC/ORC in their area is held 900 18.4 

2.11 Percentage of RDW who used the PHC/ORC prior to or following their most 

recent delivery for the following services: 

1. Antenatal care 

2. Postnatal care for mother 

3. Care for newborn child 

4. Family planning information or services 

5. Any service 

4.1 Familiarity with the FCHVs and mothers group 

900 

900 

900 

900 

900 

Estimates 

All the four types of respondents included in the study were asked if they knew the FCHVs 

working in their areas. More than three-quarters of the RDW, husbands and MIL and 72% of the 

FIL reported knowing the FCHVs working in their areas (Figure 4.1). 

Figure 4.1 Percent distribution of RDW, husbands, MIL and FIL who know the FCHV 

working in their areas 

12.4 

3.3 

8.3 

3.5 

18.0 

100 

80 

77.0 77.1 77.3 

71.6 

Percent 

60 

40 

20 

0 


n=900 RDW, 292 husbands, 264 MIL and 190 FIL 

20

Table 4.1 further shows differentials on the proportion of the RDW who know the FCHVs 

working in their areas by their age group, literacy status and ethnicity. Age-wise data reveal that 

a higher proportion of the women aged 30 years or above had known the FCHVs than their 

younger counterparts; however the observed difference was not statistically significant. Slightly 

a higher percentage of the illiterate RDW compared to the literate ones reported knowing the 

FCHV, but the difference is not statistically significant. Ethnicity wise data indicate that women 

belonging to other terai origin are more likely to know FCHVs while those belonging to Tibeto- 

Burman caste are less likely to know them. 

Table 4.1 Percentage of RDW who know their FCHV by selected background characteristics 

Background characteristics Percent Number 

Age of RDW (in years) 

ns 

15-19 71.0 107 

20-24 75.5 367 

25-29 77.5 262 

30-34 84.4 96 

35-49 82.4 68 

Literacy 

ns 

Illiterate 79.0 386 

Literate 75.5 514 

Ethnicity * 

Brahmin/Chhetri 77.3 273 

Tibeto-Burman 65.7 140 

Tharu 76.5 149 

Dalit 78.1 114 

Muslim 76.9 65 

Other terai origin 87.0 100 

Other 84.7 59 

Total 77.0 900 

*Significant at

Table 4.2 Percent distribution of RDW who knows the name and ethnicity of the FCHV working 

in their areas (n=900) 


Name of FCHV 

Mentioned FCHV’s name correctly 476 52.9 

Do not know FCHV’s name 217 24.1 

Do not know FCHV 207 23.0 

Ethnicity of FCHV 

Brahmin 259 28.8 

Chhetri 146 16.2 

Rai/Limbu/Gurung/Tamang/Magar 77 8.6 

Rajbhar 41 4.6 

Rajbanshi 37 4.1 

Dalit± 25 2.8 

Meche 20 2.2 

Other§ 30 3.3 


± Dalit includes: Damai, Kami, Sarki, BK, Lohar, Chamar, Dom, Marik, Ram, Harichan, Sunar, Kori, Khatik, Pasi, Soni, Lohari. 

§Other includes: Newar, Sudi, Tajpuriya 

All the RDW were also asked to mention about types of help or services that the FCHVs provide 

in their areas. In asking the questions, each kind of help or services to be provided by the FCHVs 

in the community were read out by the interviewers to the respondents. A higher percentage 

(64.7%) of the RDW stated that FCHVs provide vitamin A capsules for mother and child 

followed by 47% said that they provide advices to the pregnant women. Nearly 38% of the RDW 

noted that FCHV provide advice and treatment for children’s diarrhea. Over three in every 10 

RDW also said that FCHVs provided advice to the postpartum mother, give advice to mother for 

the care of newborn, and provide advice and treatment on children’s respiratory infection. Only 

about a quarter of the women said that FCHVs in their areas provide health information 

including mothers groups and distribute condoms and oral pills. A very small percentage of the 

women stated that FCHVs provide HIV/AIDS and STIs-related information in the community. 

Table 4.3 Percent distribution of RDW by knowledge about types of help or services the FCHVs 

provide in their areas (n=900) 

Types of help or services FCHV provides 

Percent 

Health information including mothers groups 24.2 

Provide advice to pregnant women 46.7 

Provide advice to postpartum mother 33.6 

Provide advice regarding newborn 30.2 

Provide advice and treatment regarding children’s diarrhea 37.8 

Provide advice and treatment regarding children’s respiratory infection 

33.3 

(including pneumonia) 

Supply condoms and pills 23.1 

Vitamin A for mother/child 64.7 

Provide HIV/AIDS/STI information 9.8 

22

All the RDW were also enquired if there is a mothers’ group in their respective areas. In 

response, only 13% of them reported that there is a mother’s group existing in their areas, while 

66% said “no” and about one-fifth did not know if there are mothers’ groups in their areas 

(Figure 4.2). 

Figure 4.2 Percent distribution of the RDW by knowledge about the existence of mothers’ 

group in their areas 

Do not know 

20.4% 

Yes 

13.3% 

No 

66.3% 

n=900 

Only 2% of RDW reported having attended a mothers’ group meetings during their last 

pregnancy (Figure 4.3). Among those who reported of attending the mothers’ group meeting, 

40% had attended only once followed by 25% 2-3 times and the rest had participated for times or 

more (Table not shown). 

Figure 4.3 Percent distribution of RDW who attended mothers’ group’s meetings during last 

pregnancy 

Attended 

1.7% 

n=900 

Not attended 

98.3% 

Those RDW (n=120) who reported of the existence of mothers’ group in their areas but not 

participating in the mothers group meetings during their last pregnancy were further asked about 

the reasons for not doing so. The most frequently cited reasons for not attending the group 

meetings as mentioned were (Table not shown): 

• Not interested (50.5%) 

• Nobody informed about the meeting (15.2%) 

• Did not know when it was held (8.6%) 

• Lack of time (8.6%) 

• Too far (2.9%) 

• Social exclusion (1.9%) 

23

4.2 Familiarity with PHC ORC 

All the RDW included in the study were also asked if they had heard of the primary health care 

outreach clinic (PHC ORC) including the date that the clinics are scheduled in their areas every 

month. Overall, 30% of the RDW reported that they had heard of the PHC ORC and 18% 

correctly mentioned the date of the month on which the PHC ORC is conducted in their areas 

(Figure 4.4). 

Figure 4.4 Percent distribution of RDW who have heard of PHC ORC and date of month the 

clinic is organized in their areas 

Percent 

30.3 

18.4 

100 

80 

60 

40 

20 

0 

Heard of PHC ORC 

Know when PHC ORC is organized 

n=900 

No significant difference was observed on the knowledge of PHC ORC among the RDW by their 

age group. However, significantly a higher proportion of literate women compared to the 

illiterate ones had heard about PHC ORC. The percentage of RDW who had heard of it was 

significantly lower among Tharu and Muslim, and higher among the Brahmin or Chhetri castes. 

Table 4.4 Percent distribution of RDW who have heard of the Primary Health Care Outreach 

Clinic (PHC ORC) by selected background characteristics 



ns 

15-19 28.0 107 

20-24 31.3 367 

25-29 27.9 262 

30-34 41.7 96 

35-49 22.1 68 

Literacy * 



Ethnicity * 



Tharu 13.4 149 

Dalit 27.2 114 



Other 49.2 59 

Total 30.3 900 

*Significant at

The RDW were also asked if they had received some specific services such as antenatal care, 

postnatal care, care of newborn, and FP information and services any time at the PHC ORC 

following their most recent pregnancy. The results are presented in Figure 4.5. The proportion of 

RDW receiving the above-mentioned services from the PHC ORC was quite low. For instance, 

about 12% of the RDW reported receiving ANC from the PHC ORC followed by 8% on care for 

newborn child. Only about 3% each of the RDW had received postnatal care and family planning 

information and services from the PHC ORC. Nearly one-fifth (18.0%) of the RDW had received 

at least one type of services from the PHC ORC. 

Figure 4.5 Percent distribution of RDW who received various types of services from the PHC 

ORC following their most recent pregnancy 

100 

80 

Percent 

60 

40 

20 

0 

12.4 

Antenatal care 

3.3 

Postnatal care for 

mother 

8.3 

Care for new born 

child 

3.5 

FP information or 

services 

18.0 

At least one 

n=900 

25

Chapter 5 

Marriage, Fertility and Family Planning Use by RDW 

Information on age at marriage, fertility, knowledge and use of family planning methods 

following the birth of the last child, as well as interpersonal communication and counseling on 

family planning was collected from all surveyed recently delivered women (RDW). Similarly, 

information related to use of family planning methods and interpersonal communication and 

counseling on family planning was also solicited from the husbands of surveyed RDW. This 

chapter presents the findings on these topics. Results for key CB-MNC Core Indicators are 

included in the table below. 

CB-MNC Core Indicators for marriage, fertility and family planning use by RDW 


Estimates 

(n) 

1.1 Percentage of children less than 1 year old whose birth is registered with 

VDC, among women whose last child is alive 871 26.3 

7.8 Percentage of RDW who were counseled by FCHVs or health worker to use 

birth spacing or FP at any time after their most recent delivery among women 775 24.4 

who delivered between 2-11 months prior to the survey. 

7.10 Percentage of RDW who were counseled by FCHVs to use birth spacing or 

FP at any time after their most recent delivery among women who delivered 775 14.2 

between 2-11 months prior to the survey. 

7.9 Mean number of weeks post-delivery at which RDW were first counseled on 

FP or birth spacing (among RDW who were counseled by FCHVs to use 187 5.5 

birth spacing or FP at any time after their most recent delivery and who 

delivered between 2-11 months prior to the survey.) 

7.2 Percentage of RDW who used any family planning method after their most 

recent delivery among women who delivered between 2-11 months prior to 775 36.3 

the survey. 

7.5 Percentage of RDW who are currently using a modern family planning 

method among women who delivered between 2-11 months prior to the 

766 29.9 

survey and who were not currently pregnant. 

7.4 Mean number of weeks post-delivery when RDW first started using any 

family planning method (among RDW who used any family planning method 281 13.4 

after their most recent delivery and who delivered between 2-11 months prior 

to the survey). 

7.7 Percentage of RDW who know where to go if they want to obtain FP 

methods or services (among RDW who are not currently using FP method) 629 94.8 

5.1 Marriage and fertility 

Marriage 

All the 900 RDW included in the study were asked about the age at which they first got married. 

About three in every 10 RDW got married before completing 17 years of age and about a quarter 

between the ages 17-18 years (Table 5.1). More than one-fifth reported getting married at the age 

between 19-20 years and another 20% got married at the age of 21 years or more. It should be 

noted that about 7% of the RDW reported to have been married even at an age less than 15 years. 

About 2% of the RDW, however, could not mention the age at which they got married. The 

26

mean age at marriage among the RDW was estimated at 18.4 years. 

Table 5.1 Percent distribution of RDW by age at first marriage 

Age at first marriage in completed years (Gauna i.e. official marriage 

for Terai origin) 

Number 

Percent 

Figure 5.1 Percent distribution of RDW by number of times they became pregnant 

5 times or more 

12.9% 

3-4 times 

23.4% 

1-2 times 

63.7% 

n= 900 

Table 5.3 shows data on mean number of ever born and currently living children among the 

RDW included in the present study. Nearly two-thirds (65.0%) of the RDW had experienced 1-2 

live births while 23% had experienced 3-4 live births. More than one in every 10 respondents 

had experienced 5 or more live births. Over two-thirds (67.2%) of the RDW had 1-2 living 

children and about a quarter (23.0%) had 2-3 living children. The mean number of children ever 

born to the responding women was 2.4 (1.2 each of sons and daughter) while the mean number 

of living children among respondents was 2.1 (1.0 son and 1.1 daughters). 

Table 5.3 Percent distribution of RDW by number of children ever born and currently living 

Number of children Children ever born Living children 

Sons Daughter Total Sons Daughters Total 

0 26.6 29.8 0.1 30.1 31.6 1.8 

1 43.8 39.9 36.9 45.8 41.3 39.3 

2 21.7 17.4 28.1 18.2 16.1 27.9 

3 4.3 7.4 16.6 4.4 6.9 17.0 

4 2.7 3.7 6.1 1.1 2.7 6.0 

5+ 1.0 1.8 12.2 0.3 1.4 8.0 

Mean 1.16 1.21 2.38 1.02 1.12 2.14 

SD 1.03 1.19 1.60 0.91 1.11 1.39 

Total (n) 900 900 900 900 900 900 

Table 5.4 further shows differential on mean number of children ever born and surviving among 

the RDW included in the present study according to their selected background characteristics. 

The mean number of children ever born was higher among the illiterate women than that of 

literate ones. By ethnicity, Muslim women followed by Dalit and other terai origins had more 

CEB than the women of other ethnic groups. Similarly, women with a higher socio-economic 

status had less number of CEB than those of low socio-economic status. The survey results also 

further indicate that those with more CEB have a larger percentage of children who are not 

currently alive (generally >10%) while those with lower CEB have a higher percentage of 

children that are currently alive (generally

Table 5.4 Mean number of children even born and currently living among the RDW by their 

selected background characteristics 

Background characteristics 

Number 

Children ever 

born 

Currently living 

children 

Literacy 

Illiterate 3.09 2.71 386 

Literate 1.85 1.72 514 

Ethnicity 

Brahmin/Chhetri 1.90 1.79 273 

Tibeto-Burman 2.13 1.91 140 

Tharu 2.51 2.21 149 

Dalit 2.68 2.41 114 

Muslim 3.86 3.38 65 

Other terai origin 2.69 2.33 100 

Other 2.12 1.95 59 

SES Index 

Lowest 3.28 2.82 119 

Second 2.84 2.55 124 

Middle 2.46 2.27 162 

Fourth 2.26 2.04 207 

Highest 1.85 1.70 288 

Total 2.38 2.14 900 

Birth registration 

Information regarding the birth registration status of the children (less than one year old and 

were alive at the time of survey) with the village development committees (VDCs) was also 

collected during the survey. Data presented in Figure 5.2 reveals that just over a quarter of the 

children reported to have been registered with the VDCs while 73% were not registered. 

Figure 5.2 Percent distribution of RDW by status on birth registration of their youngest child 

(among those who are alive) with the VDC 

Percent 

100 

80 

60 

40 

20 

0 

73.0 

26.3 

0.7 

Yes No Do not know 

n=871 

5.2 Knowledge of family planning methods 

All the RDW were asked to name the different family planning methods that they have ever 

heard of. This question was administered by having the surveyor read each method to the RDW 

and ask if she had heard of it. In response, almost all (97.9%) the RDW reported to have heard 

29

about injectable contraceptive (Depo Provera). About 96% of the respondents had heard about 

female sterilization and another 93% about male sterilization. Similarly, over 90% of the 

respondents were found to be aware of oral pills and condoms. More than 8 in every 10 RDW 

were found to be aware of Norplant and 7 in every 10 were aware of IUD. Nearly half (45.9%) 

of the RDW reported to have heard of periodic abstinence and another 36% mentioned 

withdrawal techniques of family planning (Table 5.5). 

Table 5.5 Percent distribution of RDW by knowledge of different family planning methods 

(n=900) 

Type of FP methods heard of Yes No 

Female sterilization 95.9 4.1 

Male sterilization 92.6 7.4 

Pill 91.1 8.9 

IUD 69.0 31.0 

Injection 97.9 2.1 

Condom 91.4 8.6 

Norplant 82.4 17.6 

Periodic abstinence 45.9 54.1 

Withdrawal 35.7 64.3 

5.3 Use of family planning methods 

All the RDW and their husbands were asked about the use of family planning methods after 

giving birth to their last child. They were also asked about their intention of using family 

planning methods in the future. Although the RDW who were asked these questions gave birth 

between 0 and 11 months prior to this survey, many of the remaining analyses in this chapter are 

conducted for respondents who delivered between 2 and 11 months prior to the survey in order 

to limit the sample to women who will be targeted by the CB-MNC by — and hopefully been 

exposed to — various interventions in the two months of post-delivery. Indicator estimates for 

other family members of the RDW include respondents whose wives/daughters-in-law delivered 

between 0-11 months prior to the survey. This section presents the findings on these issues. 

Ever use of FP methods 

All the RDW and their husbands were asked whether they themselves or their spouse had used 

any method to delay or avoid getting pregnant at any time after their most recent delivery. In 

response, about one-third (36.3%) of the RDW whose most recent delivery occurred between 

two and eleven months prior to the survey said they had used at least one FP method, and 31.9% 

had first used a modern family planning method. Comparatively a higher proportion of the 

husbands (46.6%) than that of RDW said they had used at least one family planning method 

following the delivery of their last child (Figure 5.3). 

30

Figure 5.3 Percent distribution of RDW (whose most recent delivery occurred between two and 

eleven months prior to survey) and husbands who reported using at least one FP method 

following the delivery of their last child 

100 

80 

Percent 

60 

40 

36.3 

46.6 

20 

0 

RDW 

Husband 

n= 775 RDW and 292 husband 

About 16% of the RDW and 18% of the husbands reported that they or their spouse started using 

Depo Provera first following the birth of their last child followed by 8% of the RDW and 14% of 

the husbands reported using condoms. Slightly a higher proportion of husbands (5.1%) as 

compared to RDW said that they started using female sterilization following the delivery of their 

last child. The use of male sterilization and other spacing methods was found to be quite low. 

Among those who reported using family planning methods following their recent birth, on 

average, both RDW (among those who delivered between 2 and 11 months prior to the survey) 

and husbands reported that they or their spouse first started using their first method in 13 weeks 

after their recent birth (Table not shown). 

Table 5.6 Percent distribution of RDW (whose most recent delivery occurred between two and 

eleven months prior to the survey) and husbands by type of FP methods first used after the 

delivery of their last child 

The first method used after the delivery RDW Husband 


Female sterilization 33 4.3 15 5.1 

Male sterilization 1 0.1 - - 

Pill 20 2.6 5 1.7 

IUD 2 0.3 1 0.3 

Depo-Provera 124 16.0 51 17.5 

Norplant 4 0.5 - - 

Condom 63 8.1 41 14.0 

Periodic abstinence 11 1.4 6 2.1 

Withdrawal 23 3.0 17 5.8 

None 494 63.7 156 53.4 

Total 775 100.0 292 100.0 

Current use of FP methods 

Those RDW whose most recent delivery took place between two and eleven months prior to the 

survey and who were not currently pregnant (n=766) and the husbands whose wives were not 

pregnant (n=287) were also asked if they were currently doing something or using any method to 

31

delay or avoid pregnancy. About 34% of these RDW and 46% of the husbands affirmed of 

currently using any method of family planning, and 29.9% of these RDW and 37.6% of the 

husbands were currently using modern family planning methods. The most commonly used 

current method was Depo Provera (15.4% among RDW and 17.4% among husbands), followed 

by condom (6.8% among RDW and 12.5% among husbands). About 5% of the RDW and 

husbands reported that they had chosen female sterilization. About 4% of the RDW and 8% of 

the husbands reported currently using natural family planning techniques such as periodic 

abstinence and withdrawal. 


eleven months prior to the survey) and husbands currently using any family planning methods 

Method currently using RDW Husband 


Female sterilization 37 4.8 15 5.2 

Male sterilization 1 0.1 1 0.3 

Pill 17 2.2 4 1.4 

IUD 2 0.3 2 0.7 

Depo-Provera 118 15.4 50 17.4 

Norplant 2 0.3 - - 

Condom 52 6.8 36 12.5 

Periodic abstinence 10 1.3 6 2.1 

Withdrawal 22 2.9 17 5.9 

None 505 65.9 156 54.4 

Total 766 100.0 287 100.0 

Differentials on the current use of family planning methods according to the selected background 

characteristics of the RDW (whose most recent delivery occurred between two and eleven 

months prior to the survey) is presented in Table 5.8. No significant difference was observed on 

the current use of family planning method according to the age of responding RDW. However, 

strong association on the use of FP method and literacy status of RDW was observed as 40% of 

the literate RDW as against only 27% illiterate reported to be currently using family planning 

method. Significantly a higher proportion of Brahmin and Chhetri women compared with other 

ethnic groups had currently using any family planning methods. Muslim women are significantly 

less likely to use family planning method than others. Exposure to media such as radio and TV 

appeared to be associated with the greater extent of use of family planning methods. For 

instance, more than 29% of the respondents with exposure to media compared to only 20% who 

did not have exposure to it were currently using family planning methods. Strong association 

between the socio-economic status of respondents and current use of family planning methods 

was also observed. However, no significant difference was observed between the use of family 

planning method and the number of living children that the women have and distance to the 

health facility. 

32


eleven months prior to the survey who were not currently pregnant) currently using FP methods 

by their selected background characteristics 



ns 

15-19 34.8 92 

20-24 36.2 309 

25-29 34.5 232 

30-34 27.7 83 

35-49 28.0 50 

Literacy * 



Ethnicity * 



Tharu 25.8 128 

Dalit 39.4 99 



Other 39.6 53 

Exposure to radio/TV * 

None 19.6 92 

Radio only 32.0 103 

TV only 29.5 61 

Both radio and TV 37.6 510 

Travel time to the nearest health facility 

ns 

Less than 30 minutes 35.8 391 

30 minutes or more 32.3 375 

Do not know - - 

Number of living children 

ns 

and the results are presented in Figure 5.4. A positive relationship was observed on the current 

use of family planning methods by the RDW according to the age of their youngest child. It 

means that the percentage of RDW currently using any family planning method increases with 

the increase in the age of their youngest child. For instance, more than half of the RDW with 

children aged 10 months or elder reported currently using family planning methods. 

Figure 5.4 Percent distribution of RDW (whose most recent delivery occurred between two and 

eleven months prior to the survey and who were not currently pregnant) currently using FP 

methods by the age of their youngest child 

100 

80 

Percent 

60 

40 

20 

38.9 

16.3 

28.2 

31.9 

43.9 

55.3 

34.1 

0 

No living child 2-3 month 4-5 month 6-7 month 8-9 month 10 month + Total 

Significant at


eleven months prior to the survey) and husbands by reasons for not using any family planning 

methods 

Reasons for not currently using a FP method 

RDW 

Husband 


No resumption of menses 186 36.8 61 39.1 

Child is too small/ recently delivery/ 

postpartum phase 28 5.5 38 24.4 

Confused about method 45 8.9 25 16.0 

Want more children/ want son 32 6.3 15 9.6 

Health/fertility concerns 45 8.9 14 9.0 

Infrequent sex 59 11.7 8 5.1 

Husband away from home/ do not live with 

husband 168 33.3 3 1.9 

Not available nearby 2 0.4 2 1.3 

Spouse did not like 17 3.4 2 1.3 

Inconvenient to use 3 0.6 2 1.3 

Religion 11 2.2 - - 

Other side effects (irregular menses/ 

dizziness/excessive bleeding, weight loss) 3 0.6 1 0.6 

Other± 18 3.6 4 2.6 

Total (n) 505 - 156 - 

± Other includes: lack of knowledge about FP methods, poor health/ not felling well, thought unnecessary, problems in uterus, 

with belief of delay in giving birth to a child/ no practice, thought expensive, should not use FP methods, do not know where FP 

methods are available, no one accompanying me, difficult to get pregnant, not available, menopausal or hysterectomy, not 

satisfied. 

Intention to use FP method in future 

Those RDW (n=629) who were not using any family planning method at the time of survey were 

enquired about their intention to use any method to delay or avoid pregnancy at any time in 

future. In response, the majority (83.0%) of the RDW said they would use family planning 

method in future. However, nearly one in every seven RDW did not show their willingness to 

use family planning methods in the future and about 2% were uncertain about it (Figure 5.5). 

Figure 5.5 Percent distribution of RDW by their intention to use FP methods in future 

No 

15.3% 

Do not know 

1.7% 

n=629 

Yes 

83.0% 

35

Source of supply of FP methods 

In order to examine the knowledge of RDW about the sources of supply of family planning 

methods both the current users and non-users were asked about the FP supply sources. The 

question asked to the current FP users was: Where did you obtain (current method) the last time? 

This question was slightly rephrased for the non-users as Where would you go if you want to get 

FP methods or services? Data presented in Table 5.10 reveal that the highest proportion of 

current users had obtained their current method from sub-health post (25.1%) followed by 

pharmacy (14.0%) and primary health care centers (13.3%). The other sources mentioned by a 

few percentage of RDW were: government hospital, PHC ORC, health post, private hospital and 

FCHVs. Among the non-users RDW, about one-fifth each mentioned that they would go to the 

subhealth post and primary health care center to get family planning methods. Likewise, about 

18% of the RDW said that they would go to government hospital and another 17% said they 

would go to health post for getting family planning methods. Only about 3% of the RDW said 

that they would go to FCHVs to obtain contraceptives. Among the non-users (n=629), about 

95% of the RDW were able to mention at least one sources from which they could obtain family 

planning methods. 

Table 5.10 Percent distribution of RDW by source or knowledge about source of supply of FP 

Source of supply FP methods Current users Non-users All respondents 

SHP 25.1 22.1 23.0 

PHC 13.3 19.2 17.4 

Government hospital 6.6 17.8 14.4 

Health post 4.4 16.7 13.0 

Pharmacy/chemist 14.0 5.2 7.9 

Private hospital / clinic/NGO clinic 6.2 6.2 6.2 

PHC ORC 5.2 2.5 3.3 

FCHV 3.3 2.7 2.9 

Private doctor - 0.5 0.3 

Other± 8.5 1.8 3.7 

Do not go any where due to religious ground/ 

husband died - 0.2 0.1 

Using natural method/withdrawal 12.2 - 3.7 

Do not know 1.1 5.1 3.9 

Total (n) 271 629 900 

± Other includes: immunization center, India, FP camp, TBA, traditional healers, shop, VHW, MCHW. 

5.4 Interpersonal communication and counseling on family planning 

All the RDW (among those whose most recent delivery took place between two and eleven 

months prior to the survey) and husbands were asked whether a health worker or FCHV 

counseled them on birth spacing or family planning at any time following their most recent 

delivery. The findings reveal that only about 24% of these RDW and 23% of husbands were 

counseled by a health worker or FCHV while over three quarters of the respondents were not 

(Figure 5.6). 

36

Figure 5.6 Percent distribution of RDW (among those whose most recent delivery took place 

between two and eleven months prior to the survey) and husbands counseled by a health 

worker or FCHV on birth spacing or family planning at any time following their most recent 

delivery 

100 

80 

75.6 

77.4 

Percent 

60 

40 

20 

24.4 

22.6 

0 

Yes 

No 

RDW 

Husband 

n= 775 RDW and 292 husband 

Among the respondents counseled by a health worker or FCHV, about 18% of the RDW and 

12% husbands reported that they were counseled on the same week of their most recent delivery. 

More than half (54.0%) of the RDW and nearly half (46.9%) of husbands reported that they were 

counseled within 1-7 weeks following the delivery. Over a quarter of the RDW and 35% of the 

husbands said that they were counseled by the health worker or FCHVs 8 or more weeks 

following the delivery of their recent child. On average, RDW (among those counseled by a 

health worker or FCHV and whose most recent delivery took place between two and eleven 

months prior to the survey) reported that they were first counseled by the health workers or 

FCHVs on FP 5.5 weeks after the delivery while husbands reported that this figure was 6 weeks. 

A higher percentage of these RDW (44.4%) and husbands (27.3%) reported that they first got 

counseling on birth spacing or family planning from FCHVs. Likewise, 22% of these RDW 

mentioned nurse or ANM and 12% mentioned HA or AHW who first provided counseling to 

them. A sizeable percentage of the RDW and husbands also mentioned that they first received 

counseling from doctor and HA or AHW. Assuming that nurses/ANMs are almost females, and 

HA/AHWs are almost all male, this information indicates that males are first counseled mostly 

by male health providers and females by the female health providers (Table 5.11). 

37

Table 5.11 Percent distribution of RDW (among those whose most recent delivery took place 

between two and eleven months prior to the survey) and husbands by time at which they were 

first counseled on birth spacing or family planning following the birth of the recent child and 

person providing counseling 

Description RDW Husband 


Time of counseling for the first time after 

delivery on birth spacing and FP (in weeks) 

Same week 33 17.5 8 12.1 

1-3weeks 50 26.5 15 22.7 

4-7 weeks 52 27.5 16 24.2 

8 weeks + 52 27.5 23 34.8 

Do not know 2 1.1 4 6.1 

Mean (SD) 5.5 (5.5) 6.4 (6.2) 

Total 189 100.0 66 100.0 

Person who counseled 

FCHV 84 44.4 18 27.3 

HA/AHW 22 11.6 15 22.7 

Doctor 20 10.6 11 16.7 

Nurse/ANM 41 21.7 9 13.6 

VHW 3 1.6 4 6.1 

TTBA 9 4.8 3 4.5 

MCHW 6 3.2 2 3.0 

Other± 3 1.6 4 6.1 

Do not know / Do not remember 1 0.5 - - 

Total 189 100.0 66 100.0 

± Other includes: sister, friends, medical shopkeeper, family members, UNESCO. 

Among 775 RDW whose most recent delivery took place between two and eleven months prior 

to the survey, 14.2% or n=110 said that they were counseled by FCHVs to use birth spacing or 

FP at any time after their most recent delivery. Data presented in Figure 5.7 reveal that about 

71% of the women received FP counseling from FCHVs followed by 35% received referral 

services. About 15% of RDW reported that they received condoms from FCHVs while the same 

percentage reported that they received pills from FCHVs. 

38

Figure 5.7 Percent distribution of RDW by type of FP information and services received from 

FCHVs following their most recent delivery among RDW who reported receiving any type of 

information and services and whose most recent delivery occurred between two and eleven 

months prior to the survey 

100 

80 

70.9 

Percent 

60 

40 

20 

15.5 14.5 

34.5 

0 

FP counseling Gave condoms Gave pills Referred for FP 

services 

n=110 

The 110 RDW who reported being counseled in FP by FCHVs following their most recent 

delivery and whose most recent delivery took place between two and eleven months prior to the 

survey were again prompted if the FCHVs used any BCC materials such as flip chart, pictures or 

posters to explain about family planning to them. In response, quite a small proportion of them 

said that they were shown these materials at that time. For instance, only 6% said that they were 

shown pictures followed by 5% each were shown flip chart and posters (Table not shown). 

The husbands of the RDW were also asked if they discussed the practice of family planning with 

their wives after the most recent delivery. In response, nearly three-quarters (73.6%) of them 

said they discussed about it with their wives, and about 26% of the respondents said they did not 

(Figure 5.8). 

Figure 5.8 Percent distribution of respondents (husbands of RDW) who discussed the practice 

of FP with their wife after following her recent birth 

Not discussed 

26.4% 

n=292 

Discussed 

73.6% 

Differentials on spousal discussion on the practice of FP according to the background 

characteristics of the husbands are presented in Table 5.12. Significantly a higher proportion of 

the literate husbands compared to the illiterates reported discussing about the practice of FP with 

their wives. Spousal communication on this aspect was significantly higher among other terai 

39

origin castes and much lower among the Tharus and Muslims. No significant difference was 

observed on the spousal discussion on this aspect across the socio-economic status of the 

respondents. 

Table 5.12 Percent distribution of husbands of RDW who discussed the practice of FP with their 

wives following their recent birth by selected background characteristics 


Literacy * 



Ethnicity * 



Tharu 52.9 51 

Dalit 69.6 46 



Other 71.4 21 

SES Index 

ns 

Lowest 61.1 36 

Second 67.6 37 

Middle 73.8 65 

Fourth 76.7 60 

Highest 78.7 94 

Total 73.6 292 

*Significant at

Chapter 6 

Antenatal Care and Delivery Services 

One of the objectives of the CBMNC program is to increase awareness among the community 

about the importance of safe motherhood services and encourage people to use such services for 

the good health of both the mother and newborn child. In view of these stipulated objectives, 

information related to knowledge of antenatal and delivery services, danger signs associated with 

pregnancy and delivery, attitude towards antenatal and delivery services, and utilization of these 

services was collected from recently delivered women (RDW), and husbands, mothers-in-law 

(MIL) and fathers-in-law (FIL) of RDW. In addition, information on exposure of respondents to 

the BCC materials on safe motherhood was also collected from RDW, husbands and MIL. This 

chapter thus presents findings on these aspects. Results for key CB-MNC Core Indicators are 

included in the table below. 

CB-MNC Core Indicators for antenatal care and delivery services 


Estimates 

(n) 

2.3 Percentage of RDW who met FCHVs during their last pregnancy 900 24.0 



2.11 Percentage of RDW who used the PHC/ORC prior to or following their 

most recent delivery for antenatal care 900 12.4 

3.1 Percentage of RDW who know at least three danger signs during pregnancy 900 25.9 

3.2 Percentage of RDW who know at least three danger signs during delivery 

among RDW with live birth 889 52.4 

6.2 Percentage of RDW who received pre-natal care at least one time by a 

trained provider during last pregnancy 900 74.2 

4.1 Percentage of RDW who received at least two doses of tetanus toxoid 

during last pregnancy 900 62.0 

4.4 Percentage of RDW who received/bought iron supplements while pregnant. 900 68.1 

4.6 Percentage of RDW who received/bought deworming tablets while 

900 25.4 

pregnant. 

10.1 Percentage of RDW who can identify a SBA who will attend a delivery in 

their home among RDW with live birth. 889 23.4 

11.2 Percentage of RDW who made preparations for delivery: 

• Any type of preparation 

• At least two types of preparation 

11.3 Percentage of RDW who arranged for a health worker or TBA to attend 

their last delivery 900 8.6 

6.5 Percentage of RDW whose birth was attended by a skilled provider (such as 

doctor, staff nurse, ANM or MCHW) among RDW with live birth 889 36.6 

11.15 Percentage of RDW who made preparations for emergencies: 


• At least two types of preparation 

900 

900 

900 

900 

67.9 

51.1 

48.7 

10.4 

41

6.1 Knowledge about antenatal care 

Knowledge about ANC 

It is recommended that a woman should have at least four health check-ups from the health 

personnel during her pregnancy. In order to assess their knowledge, all the four types 

respondents (RDW, husbands, MIL and FIL), they were asked about the number of check-ups 

that a woman should have with a trained health workers while she is pregnant. The findings 

reveal that only about a quarter of the respondents of all four categories correctly mentioned that 

a women should get pregnancy check ups four times with a trained health worker indicating the 

lack of correct knowledge among the majority of the respondents about this aspect. By 

respondent type, a higher proportion (29.8%) of RDW gave this response, followed by 26% 

husbands, 24% FIL and 23% MIL. Over half the RDW (54.0%) and husbands (52.8%) compared 

to 46% of the MIL and 42% FIL said that a woman should receive pregnancy check ups four 

times or more (Table 6.1). About a quarter of RDW and husbands, and more than one-third of 

the MIL and FIL did not know how many such check-ups a pregnant woman should have. 

Table 6.1 Percent distribution of RDW, husbands, MIL and FIL reporting the number of times a 

woman should receive check ups from a trained health workers during pregnancy 


(n=900) (n=292) (n=264) (n=190) 

Number of check ups a woman should have 

with a trained health worker 

1 0.6 0.7 0.8 - 

2 3.0 3.8 3.0 1.6 

3 15.1 17.5 14.0 16.8 

4 29.8 25.7 23.1 24.2 

5 + 24.2 27.1 22.7 17.4 

Do not know 27.3 25.3 36.4 40.0 

Heard the message “A pregnant woman should 

have her health checked four times by a 

trained health worker” (Multiple Response) 

From FCHV 13.1 6.8 9.5 5.8 

From health worker 17.8 13.4 12.1 13.7 

From friends 17.6 15.4 19.3 15.3 

Radio 26.1 35.6 26.5 31.1 

TV 14.6 21.9 15.5 18.4 

Newspaper/magazine 0.3 4.1 0.4 0.5 

Poster/pamphlet 0.3 0.7 - 0.5 

Other± 1.6 1.4 3.8 1.1 

Haven't heard the message 47.4 43.8 48.5 50.0 

Do not know - - - 1.1 

± Other includes: sisters-in-law, forest users’ group, meeting on child health, hoarding board, mother’s group meeting, family 

members, husband, book, TBA, relatives. 

All the four types of respondents were also asked if they had heard the message “A pregnant 

woman should have her health checked four times by a trained health worker”. About half of the 

RDW (52.7%), MIL (51.5%) and FIL (50.0%) and about 56% of the husbands reported that they 

had heard this message. About one-third of the husbands and FIL and over a quarter of the RDW 

and MIL reported to have heard this message from radio. Nearly one-fifth of the RDW also said 

42

they heard about it from health workers and FCHVs, and almost the same proportion of the MIL 

from their friends. About one-fifth of the husbands and FIL and about 15% of the RDW and MIL 

also said that they got the information about it from TV (Table 6.1). 

Table 6.2 further shows the data on RDW’s correct knowledge about the number of 

recommended visits by their selected background characteristics. A higher proportion of younger 

and literate women compared to the elder and illiterate ones were found with correct knowledge 

about recommended ANC visits. Data stratified by ethnic group indicate that the knowledge 

about number of recommended ANC visit to be much higher among Brahmin or Chhetri and 

lower among Muslim. Exposure to media appeared to be associated with the correct knowledge 

about the recommended number of ANC visits. Likewise, women with higher socio-economic 

status were found to be more knowledgeable about the number of recommended ANC visits than 

those from lower socio-economic status. 

Table 6.2 Percent of RDW who stated correct knowledge (4 visits) regarding the number of 

recommended ANC visits by their selected background characteristics 


Age of RDW (in years) * 

15-19 36.4 107 

20-24 32.2 367 

25-29 31.3 262 

30-34 22.9 96 

35-49 10.3 68 

Literacy * 



Ethnicity * 



Tharu 17.4 149 

Dalit 28.9 114 



Other 39.0 59 


None 13.5 111 


TV only 25.4 71 


SES Index * 

Lowest 16.0 119 

Second 19.4 124 

Middle 24.1 162 

Fourth 35.7 207 

Highest 38.9 288 

Total 29.8 900 

*Significant at

Knowledge about symptoms during pregnancy indicating the need to seek immediate care 

Table 6.3 presents the level of knowledge of the RDW, their husbands, MIL, and the FIL about 

the symptoms during pregnancy calling for the need to seek immediate care from the health 

facility or health workers. A higher proportion of respondents of all four types considered severe 

lower abdominal pain followed by vaginal bleeding and severe headache as danger symptoms 

during pregnancy that need immediate care from the health personnel. Knowledge about these 

symptoms was slightly higher among the MIL than other three types of respondents. Convulsion, 

blurred vision and swelling of hands and face, and vaginal or white fluid discharges were also 

regarded as the danger signs and symptoms that required immediate care, however, quite a small 

proportion of the respondents of all four types mentioned these three symptoms. Overall, 25.9% 

of the RDW were able to mention at least three of the above danger signs. The above findings 

suggest that the program should well inform the community that these symptoms are also 

dangers for the health of mother and fetus as well. 

Table 6.3 Percent distribution of RDW, husbands, MIL and FIL by knowledge about symptoms 

during pregnancy indicating the need to seek immediate care 

Type of symptoms during pregnancy that need to 

seek immediate care (Multiple Response) 


Vaginal bleeding (any amount) 50.4 39.0 53.8 40.0 

Severe lower abdominal pain 70.3 62.3 71.2 55.3 

Severe headache 33.1 29.8 37.1 24.2 

Convulsion 10.8 11.3 8.7 8.9 

Blurred vision and swelling of hands and face 25.8 15.1 22.0 10.5 

White fluid discharge/ vaginal discharge with foul 

smell 4.8 2.1 1.5 - 

Fever 3.4 5.5 4.9 4.7 

Dizziness 1.3 2.4 2.7 2.1 

No movement of fetus in the womb 5.8 1.7 2.7 2.1 

Nausea/vomiting 3.0 5.5 2.7 1.6 

Poor appetite 4.0 1.7 3.4 1.6 

Inverted position of fetus/ abnormal position of 

fetus 2.1 2.4 2.3 2.1 

Other± 5.4 5.8 3.4 4.2 

Do not know 8.6 19.5 10.6 25.8 

Total (n) 900 292 264 190 

± Other includes: swelling in hands and feet, body swelling, difficult urination, weakness, fetal death, diarrhea, urination more 

frequently, blurred vision, anemia, chest indrawing, nasal or oral bleeding, headache, high blood pressure, back pain. 

6.2 Prevalence of danger signs during pregnancy 

The RDW were also asked if they had experienced any danger signs during their last pregnancy. 

The major possible problems that could appear during pregnancy were read out by the 

interviewer during interview. The results are presented in Table 6.4. Nearly half (47.6% or 

n=428) of RDW said that they had experienced at least one of the pregnancy related problems 

during their pregnancy. More than a quarter (26.2%) of the RDW had problem with severe lower 

abdominal pain followed by 21% to have experienced severe headache and 19% blurred vision. 

Some other problems or complications faced by a sizeable proportion of the RDW were swelling 

of the hands, body or face (17.8%), convulsions (7.3%) and vaginal spotting or bleeding (2.8%). 

44

Table 6.4 Percent distribution of RDW experiencing different types of pregnancy related 

problems during their last pregnancy 

Types of problems experienced during pregnancy Yes No Number 

Blurred vision 19.4 80.6 900 

Severe lower abdominal pain 26.2 73.8 900 

Severe headache 21.3 78.7 900 

Convulsion 7.3 92.7 900 

Swelling of the hands, body or face 17.8 82.2 900 

Any vaginal spotting or bleeding 2.8 97.2 900 

At least one of the above 47.6 52.4 900 

On the questions about the health facility or health providers that they had visited for the 

treatment or consultation for the problems during last pregnancy, among the RDW who reported 

experiencing a danger sign, over one-third (36.4%) of the RDW mentioned PHCC, HP or SHP 

followed by 16% to private clinic or nursing home and 10% to hospitals (Table 6.5). A total of 

56.8% visited one or more types of health facilities to seek care for their health problem. About 

8% of the RDW bought medicines from pharmacy, 5% consulted Dhami Jhankri and another 4% 

resorted to traditional home treatment. More than a quarter (26.6%) of the RDW neither visited 

any place nor consulted any health personnel even when they had experienced problems during 

last pregnancy. 

Table 6.5 Percent distribution of RDW by place of visit or persons consulted for the management 

of problems during their last pregnancy 

Places visited or person consulted for the problems (Multiple 

Response) 

Number Percent 

PHCC /HP/ SHP 156 36.4 

Private clinic/ nursing home 68 15.9 

Hospital 42 9.8 

Bought medicine from pharmacy 32 7.5 

Consulted relative/neighbor/friend 26 6.1 

Consulted dhami / jhankri 23 5.4 

Traditional treatment at home 18 4.2 

Consulted FCHV 14 3.3 

Consulted other HW 10 2.3 

Given medicine at home 5 1.2 

Other§ 5 1.2 

Nothing 114 26.6 

Total (n) 428 - 

§ Other includes: consulted MCHW, consulted TBA, Gaon Ghar Clinic, FPAN. 

All the four types of respondents were also asked to mention the places where one could go or 

consult health personnel in case of danger signs that appear during pregnancy. In response, a 

higher proportion (26.0%-40.5%) of them said that they or their wives/daughters-in-law (DIL) 

could go to the hospital, and those with mention of this facility was much higher among FIL than 

other types of respondents (Table 6.6). Likewise, nearly one-fifth to over a quarter of the 

respondents with a higher proportion of RDW than other types mentioned PHCC (20.5%- 

45

27.3%), SHP (19.9%-23.2%) and private clinic or nursing home (18.4%-25.7%) where they 

could go for services. About 17% of the respondents of all types also mentioned health post as 

the sources of services for such danger signs. 

Table 6.6 Percent distribution of RDW, husbands, MIL and FIL by knowledge about the places 

for consultation for danger signs that may appear during pregnancy 

Knowledge about the places for health services for 

danger signs during pregnancy (Multiple Response) 


Hospital 26.0 31.5 36.0 40.5 

PHCC 27.3 26.4 24.2 20.5 

Health post 17.6 16.4 17.0 17.4 

Sub-health post 23.2 19.9 21.2 22.6 

PHC/OR clinic 0.9 0.3 - - 

Private clinic/nursing home 24.1 25.7 23.1 18.4 

Other § 3.4 2.0 1.1 0.5 

No where 0.2 - - - 

Do not know - - 1.1 1.6 

Total (n) 900 292 264 190 

§Other includes: CMA from medical shop, medical shop, medical shopkeeper, ANM from medical shop FPAN, Marie Stopes. 

6.3 Utilization of ANC 

Utilization of ANC 

Overall, over three quarters (77.7%) of the 900 RDW reported that they had received antenatal 

care (ANC) during their last pregnancy while 22% of the RDW said they did not. Table 6.7 

further shows differentials on the utilization of ANC by the RDW during the pregnancy prior to 

their most recent delivery. Those RDW who are younger, literate, and belonged to Brahmin or 

Chhetri castes are more likely to receive ANC than their respective counterparts. A higher 

percentage of RDW exposed to media as compared to those with no exposure reported receiving 

ANC during their last pregnancy. Likewise, utilization of ANC was higher among the women of 

low parity and among those who belonged to the highest SES. 

46

Table 6.7 Percent distribution of RDW who received ANC during their last pregnancy by 




15-19 85.0 107 

20-24 83.1 367 

25-29 77.5 262 

30-34 66.7 96 

35-49 52.9 68 

Literacy * 



Ethnicity * 



Tharu 57.0 149 

Dalit 69.3 114 



Other 88.1 59 


None 49.5 111 


TV only 70.4 71 



ns 



Do not know - 1 

Number of living children * 

pregnancy followed by 36% consulted doctor and 32% to HA or AHW. Some RDW also 

mentioned that they consulted MCHW (16.0%), FCHV (10.4%) and VHW (5.6%). Overall, 

74.2% of the 900 RDW reported that they received prenatal care at least one time from a trained 

provider during their last pregnancy. 

Table 6.8 Percent distribution of RDW mentioning the places from where they got ANC during 

their last pregnancy 

Sources of ANC for the last pregnancy (Multiple Response) Number Percent 

Nurse/ANM 353 50.5 

Doctor 251 35.9 

HA/AHW 222 31.8 

MCHW 112 16.0 

FCHV 73 10.4 

VHW 39 5.6 

FPAN/CMA/ Marie Stopes/ nursing home) 17 2.4 

TTBA/TBA 4 0.5 

Other (a person from medical shop) 4 0.6 

Total (n) 699 - 

It is recommended that a woman has to receive antenatal services four times during her 

pregnancy. Therefore, all the RDW were asked about the number of times they had received 

ANC during their last pregnancy. Data presented in Figure 6.1 indicate that more than three 

quarters (77.6%) of the RDW had received ANC at least one followed by 70% at least twice and 

60% received at least thrice during their last pregnancy. Overall, only 45% of the RDW had 

received ANC at least four times from any health providers, and 44.7% received from a trained 

health provider indicating the need for informing community about the need of receiving 

antenatal care at least four times during pregnancy. 

Figure 6.1 Percent of RDW by number of times they received pregnancy check ups during 


Percent 

100 

80 

60 

40 

20 

0 

22.3 

None 

77.6 

At least one 

time 

70.1 

At least two 

times 

60.3 

At least three 

times 

45.1 

At least four 

times 

n=900 

Table 6.9 further shows differentials on utilization of pregnancy check ups at least four times by 

the RDW during their last pregnancy according to their selected background characteristics. 

Those RDW who are younger, have less than 2 living children, literate, and belonged to Brahmin 

or Chhetri castes are significantly more likely to receive ANC at least four times than their 

respective counterparts. Likewise, significantly a higher percentage of the RDW exposed to 

media and belonged to the highest SES index are more likely to receive ANC four times or more 

compared to their respective counterparts. 

48

Table 6.9 Percent of RDW who received pregnancy check ups at least four times during their last 

pregnancy by selected background characteristics 


Age RDW (in years) * 

15-19 46.3 107 

20-24 51.5 367 

25-29 46.2 262 

30-34 34.4 96 

35-49 19.1 68 

Literacy * 



Ethnicity * 



Tharu 25.5 149 

Dalit 33.3 114 



Other 44.1 59 


None 18.0 111 


TV only 32.4 71 



ns 





months of pregnancy (Table 6.10). The mean number of months pregnant at the time of first 

ANC visit was 3.9 with the standard deviation of 1.6. 

Table 6.10 Percent distribution of RDW by timing of receiving first antenatal services during 


Number of months pregnant while receiving first antenatal care for 

the last pregnancy 


2 138 19.7 

3 195 27.9 

4 151 21.6 

5 107 15.3 

6 + 107 15.3 


Mean (SD) 3.9 (1.6) 

Total 699 100.0 

Those RDW who reported receiving ANC during their last pregnancy were also asked about the 

types of services that they received at least once during pregnancy check ups. The basic services 

that should be provided in a standard-quality ANC visit were read out by the interviewers. The 

great majority (94.3%) of the RDW said their abdomen was examined followed by 90% received 

TT vaccines and 87% received iron tablets during their visit for ANC (Table 6.11). The other 

types of services received by over three-quarters of them were measurement of their blood 

pressure and weight, and one-third received de-worming tablets and over 40% said that their 

urine and blood was examined during ANC visit. Of the 699 RDW who received ANC, 58% 

reported receiving at least 6 of the above mentioned quality antenatal services. In total, 44.9% of 

the 900 RDW had received acceptable quality ANC during last pregnancy, where acceptable 

quality is defined as having received at least 6 of the key ANC services listed in Table 6.11. 

Table 6.11 Percent distribution of RDW by types of ANC received during their last pregnancy 

(n=699) 

Type of ANC received during last pregnancy (at least once) Yes No DK 

Was your abdomen examined 94.3 5.7 - 

Did you receive iron tablets 87.3 12.7 - 

Did you receive deworming tablets 34.9 64.5 0.6 

Did you receive TT vaccination 89.8 10.2 - 

Was your weight measured 75.4 24.5 0.1 

Was your height measured 22.0 77.7 0.3 

Was your blood pressure measured 86.3 13.7 - 

Did you give a urine sample 46.8 53.1 0.1 

Did you give a blood sample 42.8 57.1 0.1 

Received at least 6 of the above services 57.8 42.2 - 

More than 80% of the 699 RDW said that they were accompanied by some one at least one time 

during their antenatal visit, and nearly one-fifth were not accompanied by anybody (Table 6.12). 

Nearly half of the RDW were accompanied by their husbands followed by friends or neighbor 

50

(23.3%), and other family members (19.5%). Those RDW who were accompanied by their inlaws 

constituted only 9%. Overall, 51.7% out of 900 RDW were accompanied by family 

members a least one time during their ANC visit. 

Table 6.12 Percent distribution of RDW by persons accompanied at least once while visiting 

health facility or health personnel for ANC (among RDW who made at least one ANC visit) 

Persons accompanied at least once during ANC visit (Multiple 

Response) 


Husband 339 48.5 

Friend / neighbor 163 23.3 

Other family member 136 19.5 

Mother-in-law 59 8.4 

Mother 26 3.7 

Father-in-law 3 0.4 

Nobody (went alone) 135 19.3 

FCHV/TBA 4 0.5 

Total (n) 699 - 

Family members accompanying RDW during ANC visit 

Table 6.13 shows percent distribution of husbands and MIL accompanying their wives/DIL at 

least once while going for ANC during their wives/DIL’s last pregnancy. More than half (53.4%) 

of the husbands as against only 22% MIL said they accompanied their wives/DIL at least once 

indicating the minimal involvement of MIL in accompanying their DIL during pregnancy check 

ups. 

Table 6.13 Percent distribution of husbands and MIL who accompanied their wives/DIL at least 

one time for ANC during their last pregnancy 

Description Husband Mother-in-law 


Whether accompanied your wife / DIL at 

least one time to her ANC 

Yes 156 53.4 88 22.0 

No 136 46.6 206 78.0 

Total 292 100.0 264 100.0 

Reasons for not accompanying wife / DIL 

during ANC visit 

Others accompanied her 34 25.0 104 50.5 

No need 30 22.1 57 27.7 

Too busy 41 30.1 25 12.1 

Too far 2 1.5 3 1.5 

Other± 10 7.4 11 5.3 

She did not visit for ANC 19 14.0 6 2.9 

Total 136 100.0 206 100.0 

± Other includes: health post is in proximity, I had no good relationship with her during her pregnancy, I had health problem, 

did not know about it, not a practice, she did not ask me, shameful, not at home. 

51

Those husbands (n=136) and MIL (n=206) who did not accompany their wives/DIL during last 

pregnancy were asked about the reasons for not doing so. Over half of the MIL and about a 

quarter of the husbands did not accompany because some one was in the family to accompany 

their wives/DIL. Likewise, about 30% of the husbands and 12% MIL said that they were too 

busy at that time. Quite a sizeable percentage of the respondents (27.7% of MIL and 22.1% 

husbands) did not think it necessary to accompany their wives/DIL while visiting for ANC 

(Table 6.13). 

Those RDW receiving antenatal care during their last pregnancy were further asked about the 

places or persons that they visited for their most recent antenatal care. The results are presented 

in Table 6.14. Over one-third of the RDW reported visiting HP or SHP for receiving antenatal 

care followed by 23% to PHCC and 21% to private clinic or nursing home. More than one in 

every 10 women reported visiting hospital. Quite a small percentage of the women reported 

visiting PHC ORC to receive antenatal services. 

Table 6.14 Percent distribution of RDW by places they visited for their most recent antenatal 

care 

Source of antenatal care for your most recent antenatal care visit Number Percent 

PHCC 163 23.3 

Private clinic/nursing home 148 21.2 

Sub-health post 140 20.0 

Health post 97 13.9 


PHC/OR clinic 30 4.3 

Immunization clinic/ immunization program 14 2.0 

FCHV 7 1.0 

Pharmacy 5 0.7 

Other § 10 1.4 

Total 699 100.0 

§ Other includes: FPAN clinic, Marie Stopes clinic, experienced person, medical shop, MCHW, camp. 

Consultation with FCHVs during last pregnancy 

The RDW were also asked whether they met the FCHV for seeking advice or services during 

their last pregnancy. In response, nearly a quarter (24.0%) of the 900 RDW said they met the 

FCHVs. Among those who reported meeting the FCHVs during their last pregnancy, about 57% 

met them for 2-3 times, 20% met only once and about a quarter met for 4 times or more. On an 

average they met the FCHVs for 2.7 times (Table 6.15). 

52

Table 6.15 Percent distribution of RDW meeting the FCHVs during their last pregnancy 


Whether met the FCHV for services or advice during last 

pregnancy 

Yes 216 24.0 

No 684 76.0 

Total 900 100.0 

Number of times met the FCHV during last pregnancy outside of 

the mothers group to receive services or advice 

1 43 19.9 

2 64 29.6 

3 60 27.8 

4 28 13.0 

5 + 21 9.7 

Mean (SD) 2.7 (1.5) 

Total 216 100.0 

Table 6.16 presents data on percentage of RDW that met FCHVs for services or advice during 

their last pregnancy prior to their most recent delivery by their selected background 

characteristics. A higher percentage of literate women, those belonging to other terai castes and 

those with low parity reported visiting FCHVs for services or advice during their last pregnancy. 

However, no significant association was observed in consulting FCHVs for services or advice 

across the age group of RDW, media exposure, access to health facility and their SES index. 

53

Table 6.16 Percent distribution of RDW who met FCHV for services or advice during their last 

pregnancy prior to their most recent delivery by selected background characteristics 


Age RDW (in years) 

ns 

15-19 26.2 107 

20-24 24.5 367 

25-29 26.7 262 

30-34 21.9 96 

35-49 10.3 68 

Literacy * 



Ethnicity * 



Tharu 17.4 149 

Dalit 27.2 114 



Other 33.9 59 

Exposure to radio/TV 

ns 

None 21.6 111 


TV only 21.1 71 



ns 





Figure 6.2 Percent distribution of husbands, MIL and FIL who met the FCHVs for information 

or advice when their wife/DIL’s was pregnant last time 

100 

80 

Percent 

60 

40 

20 

0 

11.6 12.5 

Husbands MIL FIL 

4.3 

n= 292 husbands, 264 MIL and 190 FIL 

The RDW were also enquired if the FCHVs discussed about specific plans for the delivery 

during their pregnancy. The possible responses were read out by the interviewers to the 

respondents. Data presented in Figure 6.3 indicate that the FCHVs in the study areas had 

discussed with quite a small proportion of the RDW about the specific plans for delivery. For 

instance, only about 16% of the RDW said that the FCHV discussed with them about identifying 

or using a skilled birth attendant followed by 13% on source of emergency obstetric care and 

about 10% each on finances for delivery care and emergency transport for delivery. Of the 216 

RDW who met FCHVs during their last pregnancy, 46.8% reported that they were counseled by 

FCHVs in at least 3 out of 5 key birth preparedness topics listed in Figure 6.3 during their last 

pregnancy. 

Figure 6.3 Percent of RDW reporting that FCHVs discussed specific plans for delivery during 


Identif y person to accompany mother in emergency 

About source of Emergency Obstetric Care 

Finances f or deliv ery care 

Emergency transport f or deliv ery 

Identif y ing/using a skilled birth attendant 

8.8 

12.7 

10.1 

9.8 

15.8 

0 20 40 60 80 100 

Percent 

n=900 

All the RDW were asked about types of advices related to pregnancy, delivery and postpartum 

they received from FCHVs during their last pregnancy. The types of advices expected to be 

received by a woman from the FCHVs during pregnancy were read out by the interviewers to the 

respondents during interview. There were 23 different topics read out by the interviewers during 

55

interview. Data presented in Table 6.17 indicate that the proportion of RDW who reported 

receiving advice from FCHVs on different topics ranged from a minimum of 4% to the 

maximum of 23%. Comparatively a higher percentage of the RDW had received advices on the 

topics related to the pregnancy while smaller percentages had received advices on the topics 

related to the postpartum care. 

Table 6.17 Percent distribution of RDW who received advice from FCHVs on various topics 

related to pregnancy, delivery and postpartum care during their last pregnancy (n=900) 

Receiving advice from FCHV on the following topics during last pregnancy Percent 

Pregnancy-related 

Seek ANC 4 times from health worker 19.4 

Take rest and avoid heavy work 20.2 

Proper, balanced diet 19.8 

Tetanus toxoid vaccination 22.6 

Obtain iron and deworming tablets 22.7 

Danger signs for pregnant woman 16.9 

Delivery-related 

Using a skilled birth attendant 15.6 

Use Clean Home Delivery Kit 10.3 

Deliver in clean, light surface/room 10.7 

Danger signs during delivery 11.0 

Financial preparation for your delivery 9.1 

Identifying emergency transport options 7.3 

Arranging for blood in case of emergency 5.1 

Post-delivery and newborn care-related 

Make at least 3 PNC visits 8.3 

Mother should take Vitamin A after delivery 14.0 

Danger signs for postpartum woman 10.4 

Wrap the newborn in a clean and dry cloth 8.7 

Do not bathe the newborn within 24 hours 4.0 

Keep the newborn’s cord dry and clean (do not apply anything) 6.4 

Breastfeed the newborn within 1 hour after birth 10.3 

Continue exclusive breastfeeding 9.3 

Danger signs in newborn 10.0 

Other 

Use family planning following delivery 9.8 

The husbands and MIL of the RDW were also asked about the types of advices they received 

from FCHVs during their wife’s/DIL’s last pregnancy. Compared to the RDW quite a small 

proportion of the husbands and MIL reported receiving advices on various topics related to 

pregnancy, delivery and postpartum period (Table 6.18). The above information indicates the 

less interaction between the FCHVs and the husbands and MIL of the pregnant women in the 

community. 

56

Table 6.18 Percent distribution of husbands and MIL who received advice from FCHVs on 

various topics related to pregnancy, delivery and postpartum care during their wife’s/ DIL’s last 

pregnancy 

Receiving advice from FCHV on the following topics during your 

wife’s / DIL’s last pregnancy 

Pregnancy-related 

Husband 

(n=292) 

Mother-in-law 

(n=264) 

Wife / DIL should seek ANC 9.9 10.6 

Danger signs for pregnant woman 6.8 10.2 

Financial preparation for your delivery 3.4 4.5 

Identifying emergency transport options 1.7 3.1 

Arranging for blood in case of emergency 2.4 1.9 

Delivery-related 

Using a skilled birth attendant 8.6 8.7 

Danger signs during delivery 6.5 9.5 

Post-delivery-related 

Wife / DIL should make at least 3 PNC visits 3.4 4.5 

Danger signs for postpartum woman 4.4 5.7 

Do not bathe the newborn within 24 hrs. 2.0 3.0 

Keep the newborn’s cord dry and clean (do not apply anything) 2.0 4.5 

About source of Emergency Obstetric Care 5.1 6.1 

Danger signs in newborn 4.8 4.9 

Other 

Use family planning following delivery 5.1 5.7 

Those RDW (n=216) who met FCHVs during their last pregnancy were also asked whether they 

were counseled individually or in the group by the FCHVs on maternal and child health issues 

using a flip chart. In response, only about 26.4% of the 216 RDW said that they were counseled 

by FCHVs using flip chart indicating the less practice of using flip chart by the FCHVs during 

counseling (Table not shown). 

Types of counseling received during ANC visit 

All 699 RDW who had received antenatal care during their last pregnancy were also asked about 

the type of counseling services that they had received from the health providers. The specific 

type of counseling that has to be provided by the health providers to their clients were read out 

by the interviewers at the time of interview. The survey results indicate that the majority of the 

RDW had received counseling on TT vaccines followed by about 44% on danger signs that 

could appear during pregnancy (Table 6.19). Counseling on the need of using a skilled birth 

attendant followed by breastfeeding to newborn immediately after birth was mentioned 

respectively by 38% and 32% of the respondents. Counseling on financial preparation for 

delivery, wrapping the newborn, family planning, arrangement of transport and blood for 

emergency was received by a relatively lower (

Table 6.19 Percent distribution of RDW by type of counseling received from health care 

providers any time during their last pregnancy 

Types of counseling received from health workers 

during last pregnancy 

Yes No DK Number 

Financial preparation for your delivery 23.6 76.3 0.1 699 

Breastfeeding immediately after birth 31.9 67.8 0.3 699 

Danger signs during pregnancy 43.9 56.1 - 699 

Tetanus toxoid vaccination 80.0 19.9 0.1 699 

Wrapping the newborn 28.9 71.0 0.1 699 

Using a skilled birth attendant 37.6 62.4 - 699 

Family planning 20.3 79.7 - 699 

Identifying emergency transport options 17.5 82.5 - 699 

Arranging for blood in case of emergency 15.5 84.5 - 699 

Receiving TT vaccines 

TT vaccination rates during most recent pregnancy (based on recall) 

Overall 73% of the 900 RDW reported that they had received TT vaccines during their last 

pregnancy. About 62% of them had received at least two doses of TT vaccines during their last 

pregnancy. Table 6.20 presents the data on percentage of RDW by number of TT vaccines that 

they received during their last pregnancy by their selected background characteristics. 

Significant variation on receiving TT vaccines according to the age, literacy status, ethnicity, 

exposure to media, access to health facility, exposure to media and SES of the RDW was 

observed. A higher proportion of younger women compared to the elder ones reported receiving 

TT vaccines. Similarly, literate women are significantly more likely to receive TT vaccines than 

the illiterates. By ethnicity, Tharu and Muslim women are less likely to take TT vaccines than 

the women of other castes. Significant difference on the use of TT vaccines was also observed 

according to the respondents’ exposure to media, distance to the health facility, number of living 

children and SES of women. 

58

Table 6.20 Percent distribution of RDW by number of TT vaccines taken (based on recall) during 

last pregnancy by selected background characteristics 

Background characteristics None 1 dose 2 dose 3 + DK Number 


15-19 20.6 10.3 50.5 18.7 - 107 

20-24 21.3 12.8 48.5 17.2 0.3 367 

25-29 26.7 9.2 48.9 14.9 0.4 262 

30-34 38.5 7.3 34.4 19.8 - 96 

35-49 54.4 10.3 26.5 8.8 - 68 

Literacy * 

Illiterate 48.2 10.9 28.8 11.7 0.5 386 

Literate 11.3 10.5 58.4 19.8 - 514 

Ethnicity * 

Brahmin/Chhetri 7.3 13.9 57.5 21.2 - 273 

Tibeto-Burman 22.9 10.0 48.6 18.6 - 140 

Tharu 45.6 9.4 33.6 10.7 0.7 149 

Dalit 33.3 7.0 43.0 16.7 - 114 

Muslim 49.2 10.8 26.2 12.3 1.5 65 

Other terai origin 40.0 4.0 44.0 12.0 - 100 

Other 23.7 18.6 44.1 13.6 - 59 


None 56.8 9.9 22.5 9.9 0.9 111 

Radio only 45.0 6.7 34.2 14.2 - 120 

TV only 31.0 11.3 43.7 14.1 - 71 

Both radio and TV 17.6 11.5 52.5 18.2 0.2 598 

Travel time to the nearest health 

facility * 

Less than 30 minutes 22.9 9.7 47.1 19.8 0.4 454 

30 minutes or more 31.2 11.7 44.3 12.8 - 445 

Do not know 100.0 - - - - 1 


Card-based TT vaccination rates 

All 699 RDW who had received antenatal services during their last pregnancy were asked to 

show their antenatal card. Of the 699 RDW, only one-fifth (n=140) claimed that they had such 

card with them, however, only 13% (n=91) were able to show their card to the field team (Table 

not shown). Based on the record maintained in antenatal card for these 91 women, 65% of the 

women had received TT vaccines two times followed by 19% three times and the rest (16.5%) 

had received only once (Table not shown). Thus, the percentage of RDW who received at least 

two doses of TT vaccines during last pregnancy (based on vaccines recorded on antenatal cards) 

stands at 8.4%. 

Lifetime TT vaccination rates (based on recall) 

All the RDW (n=900) included in the study were also asked about the number of TT vaccines 

they received during their lifetime. More than half of the women had received 5 times or more, 

21% for 3-4 times and 15% for 1-2 times during their life time. Slightly more than one in every 

10 women reported that they had never received TT vaccines (Table 6.21). Nearly three-quarters 

(72.6%) of the 900 RDW reported receiving at least three doses of TT vaccines at any time in the 

past. 

Table 6.21 Percent distribution of RDW by number of times they received TT vaccines during 

their life time 

Number of times TT vaccines taken in the lifetime Number Percent 

None 97 10.8 

1-2 times 133 14.8 

3-4 times 187 20.7 

5 times or more 466 51.8 


Mean (SD) 4.8 (3.2) 

Total 900 100.0 

Receiving iron/folic acid and deworming tablets 

Overall, 68.1% of the 900 RDW reported that they received iron/folic acid tablets during their 

last pregnancy. Similarly, a quarter (25.4%) out of 900 RDW had taken deworming tablets 

during their last pregnancy. Table 6.22 shows differentials on the use of iron/folic acid as well as 

deworming tablets by the RDW according to their selected background characteristics. The use 

of iron/folic acid tablets by the younger women (15-24 years) was higher than for other age 

categories while in case of deworming tablets the figure was higher among the women aged 20- 

29 years. Literate women are more likely to use iron/folic acid and deworming tablets compared 

to the illiterates. Data stratified by ethnicity suggest that a higher proportion of the RDW that 

belonged to Brahmin or Chhetri castes as compared to the RDW of other castes reported of 

taking them during their last pregnancy; and the observed difference was statistically significant. 

Exposure to media including their SES was also strongly associated with the use of the iron/folic 

acid and deworming tablets. A higher proportion of the women with low parity reported of using 

both the iron/folic acid and deworming tablets compared to the women of high parity. No 

significant difference was observed on the use of the iron/folic acid and deworming tablets and 

60

the distance to the health facility from the residence of the RDW. 

Table 6.22 Percent distribution of RDW who used iron/folic acid tablets and deworming tablets 

during their last pregnancy by selected background characteristics 

Background characteristics Iron/folic Deworming Number 

Age of RDW (in years) * * 

15-19 78.5 23.4 107 

20-24 71.9 30.0 367 

25-29 68.3 26.0 262 

30-34 57.3 17.7 96 

35-49 45.6 13.2 68 

Literacy * * 


Literate 84.0 32.1 514 

Ethnicity * * 



Tharu 53.0 20.8 149 

Dalit 64.9 26.3 114 

Muslim 36.9 9.2 65 


Other 76.3 25.4 59 

Exposure to radio/TV * * 

None 44.1 10.8 111 

Radio only 50.8 23.3 120 

TV only 60.6 22.5 71 

Both radio and TV 76.9 28.9 598 

Travel time to the nearest health facility ns ns 

Less than 30 minutes 70.3 24.9 454 

30 minutes or more 66.1 26.1 445 

Do not know - - 1 

Number of living children * * 

119 days. Similarly, 15% of the RDW said they took iron/folic acid tablets for 30-89 days. On 

average, among RDW who had taken iron/folic acid tablets, each RDW had taken iron/folic acid 

tablets for 100 days during their last pregnancy (Table 6.23). 

Table 6.23 Percent distribution of RDW by number of days taking and source of supply of 

iron/folic acid tablets, among RDW who took iron/folic tablets during most recent pregnancy 


Number of days taken iron/folic tablets during the whole 

pregnancy 

< 30 days 42 6.9 

30-59 days 91 14.8 

60-89 days 88 14.4 

90-119 days 103 16.8 

120 + 279 45.5 


Mean (SD) 99.6 (55.8) 

Total 613 100.0 

Sources of supply of the iron/folic acid tablets (Multiple 

Response) 

FCHV 183 29.9 


PHCC 145 23.7 


Private clinic/nursing home 89 14.5 


Pharmacy 47 7.7 

PHC/OR clinic 43 7.0 

Other § 17 2.8 

Total 613 - 

§ Other includes: FPAN, Marie Stopes, immunization center. 

With regard to the source of supply of iron/folic acid tablets, among RDW who had taken 

iron/folic acid tablets, nearly three in every 10 RDW reported that they obtained them from 

FCHVs followed by about 24% each from sub-health post and PHCC (Table 6.23). The other 

sources mentioned were health post (16.5%), private clinic or nursing home (14.5%), hospital 

(10.6%) pharmacy (7.7%) and PHC ORC (7.0%). More than 71% out of 216 RDW who reported 

meeting FCHV during their last pregnancy (refer to Table 6.15) said that they obtained iron/folic 

acid tablets from FCHVs while about 29% said they did not receive such tablets from FCHVs 

even after meeting them. 

6.4 Knowledge and attitudes towards delivery services and birth preparedness 

In order to assess their level of knowledge, all the RDW who had given live birth in the past 12 

months, as well as their husbands and MIL, were asked about the things or materials that need to 

be maintained clean during delivery. Nearly three-quarters of the RDW and MIL and more than 

two-thirds of the husbands were aware about the need of maintaining surface clean. Likewise, 

nearly 75% of the MIL followed by 69% RDW and 57% husbands said that mothers’ cloths 

should be kept clean during childbirth (Table 6.24). More than half of the RDW and MIL and 

62

nearly half of the husbands opined that the blade to cut the umbilical cord needs to be kept clean. 

Relatively a smaller proportion of the respondents of all three categories were aware of the need 

of keeping nails, hands, and perineum clean indicating the need of creating awareness to the 

community about these aspects. Overall, nearly half (49.4%) of the RDW have correct 

knowledge of at least three things (among those listed in Table 6.24) that need to be kept clean 

during childbirth. 

Table 6.24 Percent distribution of RDW, husbands and MIL by their opinion regarding the things 

that need to be kept clean during childbirth 

Opinion regarding the things that need to be kept clean 

during childbirth (Multiple Response) 

RDW Husband MIL 

Surface 73.5 67.8 75.0 

Mother’s clothes 68.8 57.2 74.6 

Blade 53.7 47.9 53.8 

Thread 37.6 31.8 40.2 

Perineum 28.1 16.1 22.0 

Clean hands 18.0 13.4 14.4 

Cloth for newborn 12.6 8.9 9.8 

Clean nails 6.0 4.1 6.8 

Other± 6.5 6.5 5.7 

Do not know 5.4 11.6 2.3 

Total (n) 889 292 264 

± Other includes: plastic sheet, cleanliness of home surroundings, hot water, mother’s body, utensils, bamboo stick, tub, rough 

with enough light, coin, soap, scissor, bedding for child. 

Attitudes of family members of RDW towards birth preparedness 

Questions related to the perception of husbands and MIL of the RDW on birth preparedness were 

asked during the study. The results are presented in Table 6.25. Almost all the husbands and 

MIL agreed that “it is safer for women to deliver with the assistance of a doctor, nurse or 

midwife than with a TBA or a relative” and “any woman can develop a serious health problem 

related to pregnancy or childbirth”. Likewise, nearly 9 in every 10 husbands and more than 8 in 

every 10 MIL agreed on the statement “after a normal delivery, a woman needs a health check 

up”. Over 85% of the husbands and MIL agreed that a woman and her newborn baby could 

leave the house for medical care before the nwaran. The majority of the husbands (88.0%) and 

MIL (76.1%) disagreed on the statement “matters related to childbirth are mostly women’s 

domain; men are not supposed to be very involved”. In summary, for all of the statements noted 

above, the majority of respondents stated attitudes that support the goals of the CB-MNC. 

However, there were two statements for which respondents did not demonstrate the desired 

attitude. For the statements “a woman should plan ahead of time where she will deliver her baby 

and who she will get there” and “a woman should plan ahead of time what she will do if she has 

a serious health problem related to pregnancy or childbirth”, more than 60% of the husbands 

and nearly 60% MIL were not supportive of the statements. 

63

Table 6.25 Percent distribution of husbands and MIL regarding their attitude towards different 

aspects of birth preparedness 

Statement Husband (n=292) Mother-in-law (n=264) 

It is safer for women to deliver with the assistance of a 

doctor, nurse, or midwife than with a TBA or a 

relative. 

64 

Agree 

Disagree 

DK Agree Disagree 

DK 

98.3 1.7 - 97.7 1.9 0.4 

Any woman can develop a serious health problem 

related to pregnancy or childbirth 98.3 1.4 0.3 98.1 1.9 

After a normal delivery, a woman needs a check-up 88.7 9.6 1.7 83.7 12.9 3.4 

Matters related to childbirth are mostly women’s 

domain. Men are not supposed to be very involved 12.0 88.0 - 22.3 76.1 1.5 

It is okay for a woman and her newborn baby to leave 

the house for medical care before the nwaran (i.e., 

naming and purification ceremony) 

86.0 13.4 0.7 85.2 13.6 1.1 

A woman should plan ahead of time where she will 

deliver her baby and how she will get there 38.0 61.3 0.7 43.2 55.3 1.5 

A woman should plan ahead of time what she will do if 

she has a serious health problem related to pregnancy 

or childbirth 

36.3 63.7 - 39.4 59.1 1.5 

Table 6.26 presents data on perception of FIL on different aspects of pregnancy and delivery. 

The responses of the fathers-in-law were also more or less similar to those of husbands and 

mothers-in-law as almost all the FIL agreed on the statements that “it is safer for women to 

deliver with the assistance of a doctor, nurse, or midwife than with a TBA or a relative”, and 

“any woman can develop a serious health problem related to pregnancy or childbirth”. 

Likewise, more than 8 in every 10 fathers-in-law also agreed on the statements that “after a 

normal delivery, a woman needs a check-up” and “it is okay for a woman and her newborn baby 

to leave the house for medical care before the nwaran”. 

Table 6.26 Percent distribution of FIL by their perception on different aspects of pregnancy and 

delivery services (n=190) 

Statement Agree Disagree DK 

It is safer for women to deliver with the assistance of a doctor, nurse, or 

midwife than with a TBA or a relative 98.4 1.6 - 

Any woman can develop a serious health problem related to pregnancy 

or childbirth 98.4 1.1 0.5 

After a normal delivery, a woman needs a check-up 83.7 13.2 3.2 

Matters related to childbirth are mostly women’s domain. Men are not 

supposed to be very involved. 23.2 76.8 - 

It is okay for a woman and her newborn baby to leave the house for 

medical care before the nwaran (i.e., naming and purification ceremony) 88.4 11.1 0.5 

A woman should plan ahead of time where she will deliver her baby and 

how she will get there 45.8 53.7 0.5 

A woman should plan ahead of time what she will do if she has a serious 

health problem related to pregnancy or childbirth 39.5 60.0 0.5 

-

6.5 Support from family members during pregnancy 

Discussion on planning for the last delivery 

Information about the care and support received by the RDW from their family members during 

the last pregnancy was collected from all the RDW, their husbands and MIL. Discussions 

between husbands and wives with respect to planning for delivery was relatively high as 71% of 

the RDW said that they discussed planning for their delivery with their husband at the time of 

their last pregnancy. Likewise, about 60% of the husbands and 64% of the mothers-in-law said 

that they had discussed about preparing for the birth of their wives/DIL with their friends, 

families, neighbors, or other acquaintances (Figure 6.4). 

Figure 6.4 Percent distribution of RDW who discussed with their husbands for planning of their 

last delivery, and husbands and MIL who discussed with other about planning for their 

wives/DIL’s delivery 

Percent 

100 

80 

60 

40 

20 

0 

70.9 

59.6 64.0 

RDW Husbands MIL 

n= 900 RDW, 292 husbands and 264 MIL 

Consumption of food during pregnancy 

It is necessary to provide adequate amount of food to the pregnant women for improving their 

nutritional status as well as the birth weight of their babies. In this respect, all the RDW were 

asked about the amount of food they consumed during their last pregnancy. On the question, 

when you were pregnant did you eat less than usual, about the same amount as usual or more 

than usual amount of food? more than one-third of the RDW said they consumed less than usual 

amount and another one quarter consumed same amount of food as usual. Nearly 39% of the 

RDW, however, reported to have consumed more than usual amount of food during their last 

pregnancy (Figure 6.5). The above findings indicate the need for imparting knowledge to the 

community about the importance of consuming more amount of food by the women during 

pregnancy. 

65

Figure 6.5 Percent distribution of RDW by amount of food they consumed during their last 

pregnancy 

100 

80 

Percent 

60 

40 

20 

0 

35.9 

38.9 

25.1 

0.1 

Less than usual Same as usual More than as usual Do not know 

n=900 

Care and support from family members 

In addition to the amount of the food the RDW consumed during their last pregnancy, they were 

also asked about the extent of support they received from their family members. The husbands 

and MIL of the RDW were also enquired about the extent of care and support they provided to 

their wives/DIL. Data presented in Table 6.27 shows modest variation on the responses given by 

three types of respondents. About 64% of the RDW reported that they received more than usual 

support followed by 34% received same as usual and about 2% said that they received less than 

usual support. The great majority of the husbands (75.0%) and MIL (83.0%) claimed that they 

provided more care and support to their wives/DIL than usual. 

Table 6.27 Percent distribution of RDW receiving care and support from their husbands and family 

members during last pregnancy as responded by RDW, their husbands and MIL 

Description RDW Husband MIL 

Amount of care and support received/provided by the 

family members during last pregnancy 

Less than usual 2.2 0.7 0.8 

Same as usual 34.0 22.9 15.9 

More than usual 63.8 75.0 83.0 

Do not know - 1.4 0.4 

Total (n) 900 292 264 

Types of care/support received/provided (among 

respondents who stated “more than usual” above) 

(Multiple Response) 

Advised for more rest 82.4 74.0 75.3 

Given more nutritious food to eat 76.7 77.6 74.0 

Reduced heavy load 82.2 72.1 73.1 

Given more food to eat 59.8 61.1 64.4 

Advised/accompanied for physical check-up 31.4 34.2 21.0 

Other 0.5 - 0.5 

Total (n) 574 219 219 

66

Of the RDW who reported of receiving more than usual support during their last pregnancy 

(n=574), over 8 in every 10 said that their family members advised them to take more rest and to 

reduce heavy load. More than three quarters of the RDW also said they were given more 

nutritious foods and another 60% said they were given more food to eat. The responses given by 

the husbands and MIL were consistent with those responses given by the RDW (Table 6.27). 

RDW who responded that they received more than usual care and support during their last 

pregnancy were asked “who provided care and support during their last pregnancy in the 

family”. The majority (78.7%) of the RDW said they received support form their husbands 

followed by 48% received care and support from their MIL. About a quarter each of the RDW 

reported that they received support from their FIL and sisters-in-law as well (Table 6.28). 

Table 6.28 Percent distribution of RDW mentioning the persons in the family providing care and 

support during their last pregnancy 

Persons provided above-mentioned care/supports (Multiple 

Response) 




Sister-in-law 152 26.5 


Other family members± 41 7.1 

Mother 36 6.3 

Daughter 29 5.1 

Son 13 2.3 

Other (neighbors/ household helper) 2 0.3 

Total (n) 574 - 

± Other family members include: cousin sister, father, sister-in-law, brother, daughter-in-law, grandmother, niece. 

Decision making in identifying birth attendant and health facility 

Information about the members in the family making decision on the person to attend delivery 

was collected form all the four types of respondents. On the question “who was the main person 

who decided the person who would attend your delivery or your wife’s/DIL’s most recent 

delivery” the majority of the responding husbands said that they themselves made decision on it. 

Likewise, more than one-third of the RDW also reported that their husbands had made decision 

on it. In contrary, a higher proportion of the responding MIL and FIL claimed that they had 

made decision to attend a person during delivery. When further asked about the main person in 

the family who decided where your or your wife’s or DIL’s most recent delivery would take 

place, the responses given by all four types of the respondents was similar to that of the decision 

making on the person to attend delivery (Table 6.29). The responses obtained from all the four 

types of respondents indicate that mostly the husbands, MIL and FIL get involved in making 

decision about the person to attend delivery as well as the place for delivery. 

67

Table 6.29 Percent distribution of RDW, husbands, MIL and FIL reporting the person in the 

family who decided the person who would attend their or their wife’s/DIL’s most recent delivery 


(n=889) (n=292) (n=264) (n=190) 

Main person who decided who would attend 

your/your wife or DIL most recent delivery 

Mother-in-law 13.7 12.3 40.9 23.7 

Father-in-law 7.1 8.2 24.2 44.7 

Husband 34.1 70.5 27.3 21.1 

Mother / father 4.8 2.7 2.7 4.7 

Other relative/neighbor 2.0 1.4 1.1 1.1 

Self 18.8 - - - 

Self and husband together 16.8 - - - 

None 2.6 - - 4.2 

Do not know 0.1 0.7 1.5 0.5 

Wife or DIL herself - 4.1 2.3 - 

Main person who decided where your or your 

wife’s / DIL’s most recent delivery would take 

place 

Father-in-law 6.6 8.2 22.0 44.7 

Mother-in-law 13.2 12.3 41.3 23.7 

Husband 37.7 72.9 29.9 21.1 

Mother / father 4.6 1.7 2.7 4.7 

Other relative/other 1.1 0.3 1.1 3.3 

Self 22.8 - - - 

Self and husband together 13.8 - - - 

None 0.1 - - - 

Wife or DIL herself - 4.1 3.0 2.1 

Do not know - 0.3 - 0.5 

6.6 Danger signs during delivery 

The responding RDW, their husbands, MIL and FIL were asked about danger signs related to 

delivery. The responses obtained from different type of respondents are discussed in this section. 

Knowledge about danger sings during delivery 

In order to assess their knowledge, all types of respondents were asked to mention the danger 

signs or symptoms during labor that call for immediate care. In response, more than 85% of the 

respondents with a slightly higher proportion of husbands considered labor longer than 8 hours 

as a danger sign during labor indicating the need to seek immediate care (Table 6.30). Excessive 

bleeding before or after delivery as the danger sign or symptom was mentioned by more than 

60% of the RDW and MIL and over half of the husbands and FIL. Likewise, over half of the 

RDW and MIL and about 40% of the husbands and FIL considered appearance of baby’s leg 

first as the danger sign or symptoms during labor. Over 40% of the RDW, MIL and FIL and 

about 30% of the husbands also considered appearance of baby’s hand first as the danger sign or 

symptoms. A few percentages of the respondents considered appearance of umbilical cord first 

68

and convulsion as the danger sings/symptoms during labor indicating the need to seek immediate 

care. The survey results reveal that over half (52.4%) of the RDW were able to mention at least 

three danger signs that may occur during delivery. The overall results indicate that still a higher 

proportion of the people in the study areas are not well aware about different kinds of danger 

signs during labor, which require immediate care from the health facility or health personnel. 

Table 6.30 Percent distribution of RDW, husbands, MIL and FIL mentioning the signs/symptoms 

during labor which need immediate care 

Types of the signs/symptoms during labor 

indicating the need to seek immediate care 



Labor longer than 8 hours 86.2 89.0 85.6 87.4 

Excessive bleeding before or after delivery 65.9 57.9 60.6 54.7 

Appearance of baby’s leg first 50.3 37.7 50.4 42.6 

Appearance of baby’s hand first 44.1 29.5 47.3 41.6 

Appearance of umbilical cord first 11.1 9.9 11.7 8.4 

Convulsion 9.4 8.9 6.4 6.3 

Severe lower abdominal pain 0.9 2.4 1.5 2.1 

Abnormal position of fetus/ fetus in tilted 

1.9 2.7 1.9 2.1 

position 

Excessive vaginal discharge 2.8 1.0 1.9 0.5 

Other± 6.3 5.0 7.2 3.6 

Do not know 1.5 2.7 1.9 2.6 

Total (n) 889 292 264 190 

± Other includes: dizziness, urinating problem, waist pain, severe weakness, retention of placenta, swelling in body, headache, 

placenta coiled to baby, lose stool, constipation, labor pain for more than 2 hours, back pain, swelling in hands and feet, no 

movement of fetus or fetal death, excessive vomiting, fever. 

Further enquiries were also made to all the husbands, MIL and FIL of the RDW to give their 

opinion on if the above-mentioned problems could kill a woman. In response, all the MIL and 

almost all the husbands (99.3%) and FIL (96.3%) opined that such problems could kill a woman. 

Two out of 292 husbands and 4 out of 190 FIL were uncertain about it (Table not shown). 

Opinion of the RDW, their husbands, MIL and FIL regarding the extent of dangers if a woman 

has labor for longer than 8 hours or experiences excessive bleeding during or after delivery or if 

the baby does not come out head first during delivery was collected in the study. The great 

majority (94%-99%) of the respondents of all four types considered the above problems as 

dangerous or very dangerous. Nearly 95% of the RDW reported that labor longer than 8 hours is 

dangerous or very dangerous to the women during labor. Similarly, over 97% of the RDW also 

considered the breached delivery as dangerous or very dangerous to the women during labor. 

Only a few (less than 3%) of the respondents did not consider the above three problems 

dangerous (Table 6.31). 

69

Table 6.31 Percent distribution of RDW, husbands, MIL and FIL by their opinion on extent of 

danger of various signs and symptoms that may appear during delivery 


(n=889 1 ) (n=292) (n=264) (n=190) 

In your opinion, how dangerous is it to a 

woman in labor when the labor is longer than 8 

hours? 

Not dangerous 2.8 0.7 1.5 0.5 

Somewhat dangerous 2.5 1.7 3.0 0.5 

Dangerous 11.0 9.6 15.5 13.7 

Very dangerous 83.5 87.3 79.5 83.7 

Do not know 0.2 0.7 0.4 1.6 


woman when the baby does not come out headfirst 

during delivery? 

Not dangerous 1.3 0.7 1.9 1.1 

Somewhat dangerous 0.8 1.7 3.0 - 

Dangerous 8.3 8.6 12.1 7.9 


Do not know 0.8 3.1 0.4 4.7 


woman when she experiences excessive 

bleeding during or after delivery? 

Not dangerous 0.7 - 0.8 0.5 

Somewhat dangerous 1.1 1.0 1.5 1.6 

Dangerous 7.1 6.5 9.8 6.8 


Do not know 0.6 0.7 - 0.5 

Experiencing danger signs 

All the RDW (n=889) who had given live births in the past one year were asked if they had 

experienced any of the danger signs listed in Table 6.30 above during their last pregnancy. Each 

of the possible responses was read out by the interviewer during the interview. The results are 

presented in Table 6.32. Nearly a quarter of the RDW had experienced prolonged labor followed 

by 13% had problems of excessive bleeding and 7% experienced convulsion. About 2% of the 

RDW said baby’s hand, leg or cord came out first during delivery. About one-third (33.6%) of 

the RDW reported to have experienced at least one of the above four signs during the delivery of 

their last child. 

1 This question was asked to RDW who had a live birth (n = 889). 

70

Table 6.32 Percent distribution of RDW experiencing problems during the delivery of their last 

child (n=889) 

Whether experienced any of the any of the following problems at 

anytime during last delivery 

Yes 

No 

So much bleeding that it wet your clothes and you feared it was life 

threatening 13.2 86.8 

Convulsions 7.0 93.0 

Prolonged labor (>8 hours) 24.6 75.4 

The baby’s hand, leg or cord came out first 1.8 98.2 

At least one of the above problems 33.6 66.4 

Of the 889 RDW who were questioned, 299 reported experiencing at least one of the abovementioned 

problems during their last delivery. Among these 299 women, nearly 84% reported to 

have taken any kind of measures for the management of their problems while about 16% did not 

do anything (Table 6.33). Over a quarter of the RDW visited hospital and another one-fifth 

attended a private clinic or nursing homes for the management of the problems. Nearly one-fifth 

of the RDW consulted the relatives, neighbors and friends, and another 13% consulted with the 

health workers. Less than 10% of the RDW also said they sought services from PHCC/HP/SHP. 

Overall, 53.8% of RDW who experienced a danger sign during delivery sought care from a 

health facility for management of their problems. 

Table 6.33 Percent distribution of RDW by places of visit or persons consulted for the 

management of problems appeared during delivery 

Places visited or persons consulted for the problems appeared during Number 

last delivery (Multiple Response) 

71 

Percent 





PHCC /HP/ SHP 25 8.4 

Consulted a TBA 15 5.0 






Consulted MCHW 1 0.3 


Other § 7 2.3 

Total (n) 299 - 

§ Other includes: Medical shop person visited home/ experienced person. 

Those 299 RDW were also asked whether they were referred or advised to go to a health facility 

by a health worker for seeking services, and about 29.8% or n= 89 of them responded positively, 

while the rest (70.2%) were not referred or advised by the health worker (Table not shown). Of 

the 89 RDW advised to visit health facility by health workers only 63 (70.8%) reported visiting

of health facilities upon referral or advice from the health worker (Table not shown). Of these 63 

women about 70% visited hospital followed by 25% to private clinic or nursing home. Only one 

each of the RDW had visited health post, subhealth post or pharmacy (Table not shown). 

The 889 RDW who had given live births over the past one year were also enquired if they 

delivered their list child by caesarean section or if instruments were used during the delivery. 

The results are presented in Figure 6.6. More than 5 in every 100 children were found to be 

delivered by caesarean section and another 8 in every 100 children had instrumental delivery. 

This finding implies that more than 13% of the deliveries that occurred among the RDW were 

associated with some sort of the complications. 

Figure 6.6 Percent distribution of RDW whose last delivery was caesarean section or had an 

instrumental delivery 

100 

80 

Percent 

60 

40 

20 

0 

5.4 7.9 

Caesarean section 

Instrumental delivery 

n=889 

The vast majority (97.1%) of the RDW said that their last baby was born with head first while 

only 1% said that other parts of the body was out first. About 2% of the RDW could not recall 

about it (Table not shown). 

Postpartum hemorrhage 

Women whose birth is attended by a skilled birth attendant (SBA) are often given Oxytocin 

injection immediately after delivery in order to prevent postpartum hemorrhage. Regarding this, 

all the RDW who did not deliver via caesarean section (n=841) were asked if a health worker 

gave an injection in their thigh or buttocks right after the baby was born. Data presented in 

Figure 6.7 reveal that nearly a quarter (23.4%) of them were given such injection to prevent from 

them from postpartum hemorrhage. About three quarters of these RDW said they were not given 

such injection and another 2% were ignorant about it. The above findings call for the need of 

making provision of appropriate medicines through grassroots level health providers that can 

help to prevent women from experiencing postpartum hemorrhage. 

72

Figure 6.7 Percent distribution of RDW who were given an injection after the birth of their 

youngest child in order to prevent them from postpartum hemorrhage among RDW who had 

live birth and did not have caesarean section 

Percent 

100 

80 

60 

40 

20 

0 

74.9 

23.4 

1.7 

Given Not given Do not know 

n=841 

Those RDW who had delivered their last child without caesarean section and the MIL of the 

RDW were asked about the amount of bleeding they (or their DIL) have had immediately 

following the birth of the last child. Almost the same proportion of the RDW (64.6%) and MIL 

(65.5%) reported that they or their DIL had normal amount of bleeding. However, more than 

one-third (34.5%) of the RDW compared to only 13% of the MIL reported that they had more 

than normal amount of bleeding. More than one-fifth of the MIL was not aware about the 

amount of bleeding that their DIL have had (Table 6.34). When further asked about the number 

of cloths used to absorb blood in 24 hours following delivery, about a quarter of the RDW and 

their MIL said that they had used two pieces or fewer clothes. While nearly three-quarters 

(74.2%) of the RDW compared to only 46% of the MIL said that they had used more than two 

pieces of clothes. Quite a substantial percentage (32.2%) of the MIL, however, were ignorant of 

the number of clothes used by their DIL to absorb blood during last delivery. 

Table 6.34 Percent distribution of RDW and the MIL reporting that they (their DIL) had 

bleeding immediately following the birth of their last child and number of clothes used to absorb 

blood during the first 24 hours after delivery 

Description RDW MIL 


Amount of bleeding following the birth of the 

last baby 

More than normal 290 34.5 33 12.5 

Normal 543 64.6 173 65.5 

Do not know 8 1.0 58 22.0 

Total 841 100.0 264 100.0 

Number of cloths used to absorb the blood 

during the first 24 hours after baby was born 

Two pieces or less 202 24.0 59 22.3 

More than two pieces 624 74.2 120 45.5 

Do not know 15 1.8 85 32.2 

Total 841 100.0 264 100.0 

73

Side effects of Misoprostol 

Those RDW (n=841) whose most recent delivery was a live birth and was not a caesarean 

section were asked whether they experienced specific symptoms during the 6 hours following 

delivery. These symptoms are known side effects of the drug Misoprostol that is being 

distributed in Banke district as part of a field trial to reduce post-partum hemorrhage. Jhapa 

district is serving as a control area for certain aspects of the Banke Misoprostol field trial. The 

possible symptoms were read aloud to the RDW by the interviewers and then they were asked if 

they had experienced such problems immediately after giving birth to their last child. The results 

are presented in Table 6.35. Over a quarter (27.6%) of the RDW said they felt faint or dizzy and 

7% actually became faint or lost consciousness. A little over one-fifth (20.7%) had experienced 

shivering for an average duration of 3.9 hours. Likewise, about 8% had problems of nausea, 

lasting for 2.8 hours on an average. Nearly one in every 10 RDW had experienced fever for an 

average duration of 15 hours. A few (5.0%) of the RDW also said they had experienced a watery 

stool, for 4.3 times in average, immediately after giving birth. 

Table 6.35 Percent distribution of RDW who experienced any of the problems in the first 6 hours 

following the delivery of their last child (n=841) 

Types of problems experienced in the first 6 hours following delivery Yes No/ DK 

Did you feel faint or dizzy? 27.6 72.4 

Did you actually faint or lose consciousness? 7.1 92.9 

Did you experience shivering? 20.7 79.3 

Did you experience nausea? 7.6 92.4 

Did you experience fever? 8.9 91.1 

Did you have a watery stool? 5.0 95.0 

6.7 Knowledge about sources of delivery services 

Respondents’ knowledge about the availability of and accessibility to the health facilities and the 

trained health providers in their areas was also assessed. When asked to mention the training 

background of the trained health providers that they knew who would attend a delivery in their 

homes, relatively a higher proportion (26.4%-29.8%) of the respondents of all four types 

mentioned AHW or CMA followed by ANM (12.1%-16.4%) respectively (Table 6.36). Only 3% 

of RDW named an MCHW, a finding that confirms the low utility of this cadre in providing 

skilled attendance for home deliveries. The practice of making home visits by the doctor or staff 

nurse in the study areas was found to be a quite low as less than 3% of the respondents of all four 

categories reported that doctor and staff nurse would attend a delivery in their homes. Overall, 

23.4% of respondents identified a skilled birth attendant (doctor, nurse, ANM or MCHW) who 

would attend a home delivery. The practice of attending delivery at home by the medical 

shopkeeper or other experienced person was also found to be common as reported by about 10% 

of the respondents of all four types. 

74

Table 6.36 Percent distribution of RDW, husbands, MIL and FIL by knowledge about the 

trained health provider who would attend a delivery in their homes 

Know the types of trained health providers in the 

areas who would attend a delivery in your home 


AHW/ CMA 26.4 29.8 29.5 27.9 

Trained TBA 13.6 11.6 9.8 13.2 

ANM 16.4 14.4 15.9 12.1 

FCHV 4.6 7.2 4.5 5.8 

MCHW 2.8 4.5 3.4 3.7 

Untrained TBA 8.8 9.6 6.4 3.7 

Doctor 1.6 - 3.0 3.2 

HA 1.3 1.4 1.5 3.2 

Staff Nurse 2.6 2.4 2.7 2.1 

VHW 3.5 2.4 2.7 2.1 

Medical shopkeeper/ experienced person 9.1 9.2 10.6 10.0 

Other§ 1.0 1.4 0.4 1.1 

We are unfamiliar with other since we have 

recently migrated to this place/ no familiar to any 

one/ no one helped me 

8.2 6.2 9.5 12.1 

Total (n) 889 292 264 190 

§ Other includes: other health workers, neighbor, relatives, peon of PHC, FPAN clinic. 

All the RDW, husbands, MIL and FIL were also asked to mention the health facility where they 

(their wives or DIL) could go to deliver the child. The most frequently cited sources for seeking 

delivery services mentioned by all four types of the respondents were hospital (23.2%-31.6%), 

PHCC (22.3%-25.1%), subhealth post (17.8%-18.8%), private clinic or nursing home (12.6%- 

18.2%) and health post (11.1%-12.8%). Overall, 98.5% of RDW named a health facility where 

they could go for their delivery. A higher proportion of FIL compared to the respondents of other 

categories said that they could go to hospital for seeking delivery services whereas those 

mentioning PHCC for seeking services was slightly higher among RDW and lower among MIL 

(Table 6.37). 

Table 6.37 Percent distribution of RDW, husbands, MIL and FIL by their knowledge about the 

health facility where they or their wives/DIL could go to deliver the child 

Knowledge about the places or a health facility in 

the community where you/your wife or DIL could 

go to deliver the child 


Hospital 23.2 27.1 26.9 31.6 

PHCC 25.1 24.0 22.3 23.7 


Private clinic/ nursing home 18.2 17.8 17.0 12.6 

Health post 12.8 11.3 13.3 11.1 

Other§ 1.9 2.1 1.2 1.6 

Do not know - - 0.8 1.1 

Total (n) 889 292 264 190 

§ Other includes: CMA of medical shop, medical shopkeeper, ANM of medical shop, experienced person, FPAN clinic. 

75

On the question regarding the places where they could go for emergency services in case of 

problems during delivery at home, more than half (52.2%-58.4%) of the respondents mentioned 

hospital followed by over 20% said private clinic or nursing home (Table 6.38). About one in 

every 10 respondents of all four types also said they could go to PHCC for services. Less than 

one percent of the respondents could not mention any places for seeking emergency services. 

Almost all (98.8%) of the RDW who had given live birth in the past 12 months (n=889) were 

able to identify a health facility in their community where they could go in case they have an 

emergency while delivering at home. The above information indicate that people in the study 

areas are well aware about the places where they could go for emergency services in case of 

problems during delivery at home. 

Table 6.38 Percent distribution of RDW, husbands, MIL and FIL by their knowledge about the 

health facility where they or their wives/DIL could go to deliver the child in case of problems 

during delivery at home 

Knowledge about the places or a health facility in the 

community where you/your wife or DIL could go to 

receive emergency services if you have a problem 

during delivery at home 


Hospital 52.2 53.1 56.4 58.4 


PHCC 12.3 11.6 9.1 10.0 


Health post 4.2 2.7 4.2 3.7 

PHC OR clinic 0.1 0.3 - 0.5 

CMA of medical shop/ medical shopkeeper/ ANM of 

medical shop/ experienced person 1.0 1.7 0.4 1.6 

Do not know 0.2 - 0.8 1.1 

Total (n) 889 292 264 190 

Information about the accessibility to the emergency services in the study areas was also sought 

from the RDW included in the study. On the question how long does it take to travel to the 

sources in case of emergency during delivery at home, over half of the RDW said that they have 

to spend one hour or more to reach the health facility. Slightly more than one fifth had access to 

the health services within a distance of less than half an hour and another 23% were within a 

distance of 30-59 minutes (Figure 6.8). On an average, they had to travel more than one hour (63 

minutes) to reach the health facility. 

Figure 6.8 Percent distribution of RDW by distance to the health facility where they could go 

for emergency services associated with delivery 

100 

Percent 

80 

60 

40 

20 

0 

50.1 

20.9 23.4 

5.6 

Less than 30 minutes 30-59 minutes 60 minutes or more Do not know 

n=889 

76

6.8 Utilization of delivery services 

Information regarding the utilization of the delivery services by the RDW during their last 

delivery was also sought from RDW themselves, their husbands, MIL and FIL. The results are 

discussed in this section. Data presented in Table 6.39 indicate that about 43% of deliveries were 

assisted by the trained health workers (doctor, nurse, ANM, HA, AHW or MCHW), 36.6% of 

the deliveries were assisted by skilled birth attendant (doctor, nurse, ANM or MCHW) and 17% 

by TBA. More than one-third (35.7%) of the deliveries were assisted by family members, 

relatives or friends. Further analysis by the selected background characteristics of the RDW 

reveal that a higher proportion of literate RDW had received assistance from trained health 

workers as compared to the illiterate ones. Brahmins or Chhetri are more likely to seek 

assistance from the trained health workers during delivery while Tharus, Dalit and Muslim are 

less likely to receive such assistance from them. Likewise, a higher proportion of the RDW who 

had exposure to both the radio and TV, who had less than 2 living children and those who 

belonged to the highest SES had received assistance from the trained health workers than their 

respective counterparts. No association on the use of delivery services was found across the age 

group of the RDW and distance to the health facility. 

77

Table 6.39 Percent distribution of RDW by persons assisting during delivery of their youngest child by 


Background characteristics Doctor 

Nurse/ 

ANM 

HA/ 

AHW 

None 

MCHW VHW FCHV TBA Family 

members 

and other 

Age of RDW (years) ns 

15-19 24.5 13.2 7.5 - - 3.8 15.1 34.9 0.9 106 

20-24 30.5 9.9 6.6 - 0.5 1.4 15.1 35.4 0.5 364 

25-29 25.2 9.3 6.2 0.4 1.2 3.5 18.2 34.9 1.2 258 

30-34 20.4 7.5 7.5 - 1.1 1.1 23.7 37.6 1.1 93 

35-49 26.5 4.4 8.8 - - 1.5 13.2 38.2 7.4 68 

Literacy * 

Illiterate 13.8 4.8 7.7 - 1.1 2.1 20.9 46.8 2.9 378 

Literate 36.6 12.9 6.3 0.2 0.4 2.3 13.7 27.4 0.2 511 

Ethnicity * 

Brahmin/Chhetri 45.8 15.1 7.0 0.4 - 2.6 5.5 23.6 - 271 

Tibeto-Burman 32.1 10.0 4.3 - - 1.4 17.9 33.6 0.7 140 

Tharu 16.9 4.7 7.4 - 1.4 5.4 20.3 41.9 2.0 148 

Dalit 14.3 6.3 5.4 - - 0.9 20.5 50.0 2.7 112 

Muslim 3.2 4.8 4.8 - - - 23.8 60.3 3.2 63 

Other terai origin 13.5 6.3 11.5 - 4.2 2.1 35.4 27.1 - 96 

Other 23.7 10.2 8.5 - - - 11.9 40.7 5.1 59 


None 7.3 2.7 10.9 - 0.9 0.9 21.8 51.8 3.6 110 

Radio only 15.3 8.5 5.1 - 0.8 2.5 22.9 41.5 3.4 118 

TV only 25.4 1.4 5.6 - 1.4 2.8 16.9 45.1 1.4 71 

Both radio and TV 33.1 11.9 6.6 0.2 0.5 2.4 14.6 30.3 0.5 590 

Travel time to the 

nearest health facility ns 

Less than 30 minutes 27.6 10.9 7.3 0.2 0.7 1.6 15.4 34.5 1.8 449 

30 minutes or more 26.2 8.0 6.4 - 0.7 3.0 18.2 36.7 0.9 439 

Do not know - - - - - - - 100.0 - 1 

Number of living 

children * 

and 33% mentioned the friends or neighbors. Nearly a quarter of the RDW said that their 

mothers-in-law were present during delivery and another one-fifth mentioned fathers-in-law as 

well (Table 6.40). 

Table 6.40 Percent distribution of RDW reporting the persons who were present outside the 

room during the delivery of last birth 

Persons present at the delivery outside the room where the delivery 

took place (Multiple Response) 



Other relatives or family members 437 49.2 

Friends/Neighbors 290 32.6 



Mother 100 11.2 

Father 68 7.6 

Trained TBA 4 0.4 

Untrained TBA 6 0.7 

FCHV 6 0.7 

Other (MCHW/ peon of PHC/ medical shop keeper/ AHW) 3 0.3 

Nobody 39 4.4 


Total (n) 889 - 

Similar question was also put forward to the husbands, MIL and FIL of the RDW that if they 

were present at their wives/DIL recent delivery, either inside or outside the room where the 

delivery took place. In response, more than 90% of the husbands followed by 69% of the MIL 

and 61% of the FIL said they were present at that time (Figure 6.9). Compared to the responses 

of the RDW, the proportion of husbands, MIL and FIL claiming to be present during delivery 

was much higher (See Table 6.40). 

Figure 6.9 Percent distribution of husbands, MIL and FIL who were present at their 

wives/DIL’s most recent delivery 

Percent 

100 

80 

60 

40 

20 

0 

90.1 

68.6 

60.5 

Husbands Mothers-in-law Fathers-in-law 

n= 292 husbands, 264 MIL and 190 FIL 

On the question where did they deliver their last child, over one-third (34.6%) of the RDW 

reported to have delivered their last child at the health facility mostly at the hospital (17.7%) and 

private clinic or nursing home (14.7%). A few had delivered their last child at PHCC, health post 

and subhealth post. Significantly a higher proportion of the RDW that belonged to the younger 

age cohort reported delivering their last child at the health facility compared to those of elder age 

79

cohorts (Table 6.41). By literacy status, nearly half of the literate RDW compared to only 18% 

illiterate ones delivered at the health facility. Significantly a higher proportion of the Brahmin 

and Chhetri women had delivered their last child at the health facility while those delivering at 

the health facility was significantly lower among the Tharu, Dalit and Muslim women indicating 

the need of encouraging the people of these castes to deliver at the health facilities for the good 

health of both the mother and newborn. Those RDW who had exposure to both the radio and TV, 

who had less than 2 living children and those belonging to the highest SES reported delivering 

their last child at the health facility compared to their respective counterparts; and the observed 

differences were statistically significant. 

Table 6.41 Percent distribution of RDW by place of delivery of their last child by their selected 

background characteristics 

Background characteristics Health facility Home or other Number 


15-19 37.7 62.3 106 

20-24 39.6 60.4 364 

25-29 32.6 67.4 258 

30-34 23.7 76.3 93 

35-49 26.5 73.5 68 

Literacy * 


Literate 47.2 52.8 511 

Ethnicity * 



Tharu 21.6 78.4 148 

Dalit 19.6 80.4 112 

Muslim 7.9 92.1 63 


Other 33.9 66.1 59 


None 10.9 89.1 110 

Radio only 19.5 80.5 118 

TV only 25.4 74.6 71 



Those RDW (n=308) whose recent delivery took place at the health facility were further asked 

whether their last delivery at the health facility was as per the pre-plan or they decided to go to 

the health facility due to the problems occurring during labor or delivery. Data presented in 

Figure 6.10 reveals that nearly 40% of the institutional deliveries were as per the preplan and the 

rest (60.1%) of the delivery took place at the health facility only after the problems seen during 

labor or delivery. Among RDW who had a live birth, 20.8% of them gave birth at a health 

facility due to an obstetric emergency after planning to delivery at home. The survey results 

indicate that people in the community mostly go to the health facility for delivery services only 

when some sort of danger signs or complications are seen. 

Figure 6.10 Percent distribution of RDW whose last delivery taken place at the health facility 

was as per pre-plan or only due to the problems during pregnancy or labor 

100 

Percent 

80 

60 

40 

20 

39.9 

60.1 

0 

Planned to go during pregnancy 

Started to deliver at home 

n=308 

All types of respondents (RDW, husbands, MIL and FIL) that reported not delivering their or 

their DIL’s last child at the health facility were further asked about the reasons for not using the 

health facility. The results are presented in Table 6.42. More than 80% of the RDW and 

husbands, and about three-quarters of the MIL and FIL said they did not think it to be necessary 

to deliver the child at the health facility. The other reasons mentioned by a small proportion of 

the respondents were: costs too much (6.2%-13.1%), health facility too far (2.8%-5.2%), and 

facility not open (2.2%-4.1%). About 8% of the respondents reported that they called health 

workers at home to assist during delivery. 

81

Table 6.42 Percent distribution of RDW, husbands, MIL and FIL by reasons for not delivering 

their last child or grandchild at the health facility 

Reasons for not delivering the last child in a RDW Husband MIL FIL 

health facility (Multiple Response) 

Cost too much 13.1 6.2 9.7 7.8 

Called health worker at home (MCHW, health worker, 

AANM, doctor, trained TBA, person from medical 7.2 6.2 8.3 7.8 

shop, AHW, etc) 

Too far / no transportation 3.6 5.2 2.8 4.9 

Facility not open 2.2 4.1 3.5 2.9 

Do not trust facility / poor quality service 1.0 0.5 - 1.0 

Not customary 6.0 2.1 5.6 1.0 

Husband / family did not allow 1.7 - - - 

Could not go since it was night time/ transport strike/ 

child got birth on the way to/ delivery took place at 3.1 2.6 1.4 1.9 

home before going to hospital/Late arrival of 

ambulance/ curfew was imposed 

Other± 1.5 1.5 1.4 4.9 

Not necessary 81.2 84.0 78.5 73.8 

Do not know because she was in her parents house - 0.5 3.5 6.8 

Total (n) 581 194 144 103 

± Other includes: ANM assured that the child in womb is in good condition, delivery took place before due date, given birth 

within 2 hour of labor pain, it is shameful, did not like to go, afraid of, delivery took place at medical shop. 

The knowledge of each type of respondents regarding the persons that need to be present at birth 

to help deliver the baby safely was also collected in the present study. Classification of responses 

by type of respondents indicate that a higher proportion (74.6%-85.3%) of all types stated that a 

doctor should be present at the time of delivery followed by over half (54.1%-64.2%) mentioned 

staff nurse and more than 10% considered the need of ANM’s presence for the safe delivery of a 

baby. There were only a few (

Table 6.43 Percent distribution of RDW, husbands, MIL and FIL by knowledge regarding 

persons to be present at birth to help deliver the baby safely 

Knowledge regarding the persons who should be 

present at birth to help deliver the baby safely 



Doctor 73.0 79.8 74.6 85.3 

Staff Nurse 55.7 54.1 53.8 64.2 

Family members (mother-in-law/ sister/ husband/ 

mother) 11.2 24.0 31.1 27.4 

Relative/friend 39.1 30.1 32.2 20.0 

Trained TBA 17.0 23.3 18.2 12.1 

ANM 17.2 16.8 13.6 10.5 

FCHV 7.9 9.6 5.7 7.4 

Untrained TBA 5.8 5.1 6.8 6.3 

AHW/ CMA 6.9 7.5 6.1 4.2 

MCHW 2.5 3.1 1.9 1.6 

HA 0.8 1.7 1.5 1.1 

Traditional healers 0.6 1.4 1.1 0.5 

VHW - 1.0 - - 

Other± 0.1 - 0.4 - 

Do not know because I did not face any problem 0.1 0.7 1.5 1.1 

Total (n) 889 292 264 190 

± Other includes: neighbor, medical shopkeeper, experienced person. 

Figure 6.11 shows the distribution of respondents who considered the importance of attending 

delivery by the trained health workers such as doctor, nurses, midwives or MCHW and their 

actual utilization of services from such health personnel during their or theirs wife’s/DIL’s 

recent delivery. The survey results indicate that only a small proportion of the recent delivery 

was attended by the trained health workers. For instance, of the 867 RDW who stated that it is 

important for their delivery to be attended by a trained health worker, only 37.5% had actually 

received these services during delivery. Likewise, only about 47% of the MIL and FIL and 35% 

of the husbands reported that their wives/DIL were attended by the health workers during last 

delivery. This finding clearly indicate the need of changing behavior of the community people 

through various programs with respect to the need of seeking assistance from the trained health 

workers during delivery. 

Figure 6.11 Percent distribution of respondents who considered it to be important for the delivery to be 

attended by trained health personnel and actual use status of these services during the recent delivery 

Percent 

100 

80 

60 

40 

20 

0 

62.5 64.6 

47.3 52.7 47.8 52.2 

37.5 35.4 


Attended by trained HW 

Not attended by trained HW 

n= 867 RDW, 291 Husband, 258 MIL and 186 FIL 

83

Those respondents who stated that it was “very important” or “somewhat important” for the 

delivery to be attended by trained health workers such as doctors, nurses, midwives or MCHWs 

but not using their services during their/their wife’s or DIL’s recent delivery were again asked 

about the reasons for not doing so. The majority (69.1%-74.5%) of the respondents of all four 

categories gave the reason that they did not think it necessary because no serious problems were 

seen at that time (Table 6.44). The percentage of respondents giving this response was much 

higher among RDW (74.5%) than other three categories of the respondents. About one in every 

10 respondents said that they sought assistance from other types of the health workers. A few 

(3.7%-6.8%) of them cited the financial reason for not seeking assistance from the trained health 

workers. 

Table 6.44 Percent distribution of RDW, husbands, MIL and FIL by reasons for not seeking 

assistance from the trained health workers during last delivery 

Reasons for not using any trained health workers RDW Husband MIL FIL 

to attend delivery despite stating the importance 

of attending by health workers 

I didn’t have a problem and therefore it was not 

necessary 74.5 70.7 72.1 69.1 

Another type of health worker attended 10.9 12.8 13.2 11.3 

Will cost too much 6.8 4.8 3.7 4.1 

Do not know who to ask 0.4 1.1 - 1.0 

No service available nearby 2.6 5.3 0.7 1.0 

No practice in the community 0.4 - - - 

Family members do not allow 0.7 0.5 - - 

ANM visited my home/ experienced person 

assisted during delivery 0.9 - 0.7 - 

Could not call upon since it was night 

time/transport strike or curfew was imposed/ 

2.4 2.7 1.5 3.1 

delivery took place on the way to health facility or 

before going to hospital 

Other± 0.2 - 0.7 1.0 

She was in her parents home/delivered baby in her 

parents home - 0.5 3.7 8.2 

Do not know 0.2 1.6 3.7 1.0 

Total (n) 542 188 136 97 

± Other includes: not a practice, first delivery was normal, delivery took place before due date, religious taboos, shameful. 

6.9 Behavior change communication 

Pregnant women in Nepal participate in making the decision regarding who will attend their 

delivery through a complex, multi-faceted process that is influenced by a variety of factors. 

Although there are environmental factors related to the decision regarding who will attend a birth 

such as resources or access, other factors centered on the individual such as social support or 

perception of risk that are classically associated with behavior change communication (BCC) 

may also play a role in the decision-making process. These factors are crucial components of 

some models 2 that attempt to describe the process(es) that result in people changing their 

2 Compendium of Indicators for Evaluating Reproductive Health Programs, pp. 117. MEASURE Evaluation 

84

ehavior or deciding to utilize a service. The CB-MNC baseline survey therefore contained 

questions that attempted to measure several factors that were felt to be relevant to the program 

context – exposure to messages, knowledge, attitude, social support, self-efficacy, intent to act, 

behavior, and advocacy – as they relate to the use of trained birth attendant. Most of the 

questions were structured using a Likert scale for the responses. Questions were worded both 

negatively as well as positively in order to guard against positive response bias. The results 

presented below represent a baseline set of measurements that can be used to guide planning as 

well as serve as the basis for baseline-post comparisons following the endline CB-MNC survey. 

The principal limitations of this investigation should be briefly noted. Each factor has been 

measured through a single question; while this approach may produce a reasonably accurate 

result for an indicator of utilization, it may not be as accurate a measure of a concept such as 

self-efficacy. As noted above, many of the questions were based on a Likert scale, a construct 

that may have been difficult for rural Nepalese respondents to understand. 

Exposure 

In order to assess the exposure of the respondents to BCC materials related to delivery services, 

all the RDW, husbands and MIL were asked if they had seen, heard or read anything about the 

need of attendance of a trained health worker during delivery on the radio or TV or in the 

newspaper or any other means in the past 3 months. In response, nearly half (49.0%) of the 

husbands (49.0%) followed by 42% of RDW and 37% MIL affirmed that they had seen, heard or 

read about it (Figure 6.12). 

Figure 6.12 Percent distribution of RDW, husbands and MIL who had seen, heard or read 

anything about the need of attendance of a trained health worker during delivery on the radio 

or TV or in the newspaper or anywhere else in the past 3 months 

100 

80 

Percent 

60 

40 

42.3 

49.0 

36.7 

20 

0 

RDW Husband MIL 

n= 900 RDW, 292 husbands and 264 MIL 

Source of exposure 

Those respondents reporting to have seen, heard or read about the need of attendance of a trained 

health workers during delivery over the past 3 months were further asked about the places or 

persons from which they got such information. The results are presented in two categories – one 

Manual Series No. 6. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel 

Hill. August 2002. 

85

“unaided or spontaneous response” in which case the respondents mentioned different sources 

listed in the questionnaire without assistance from the interviewer; and the other one “aided or 

after probing response” where the interviewer had to probe or read out each of the sources listed 

in the questionnaire that the respondents did not mention spontaneously. The results are 

presented in Table 6.45. Radio and TV was reported as the major sources of information for the 

majority of the respondents of all three types. By respondent type, a higher proportion of the 

husbands compared to the RDW and MIL said they received information about it from the radio 

while those mentioning TV was higher among the MIL than other types of the respondents. The 

third major source of information about the need of attendance of health workers during delivery 

was reported to be the health workers. The fourth and fifth important sources of information on 

these aspects were found to be the FCHVs and TBAs. More than one-fifth of the respondents 

also said they got messages about it from community groups. The contribution of printed IEC 

materials in disseminating information on these aspects was found to be quite low as only quite a 

small proportion of the respondents said that they got information about it from poster, 

pamphlets, leaflets and FCHV flip charts. 

Table 6.45 Percent distribution of RDW, husbands, and MIL reporting source from where they 

got information or messages on attendance of a trained health workers during delivery 

Sources from where you RDW (n=381) Husband (n=143) MIL (n=97) 

saw or heard a message 

on attendance of a trained 

health worker during 

delivery 

Unaide 

d yes 

Aided 

yes 

Total 

yes 

Unaide 

d yes 

Aided 

yes 

Total 

yes 

Unaide 

d yes 

Aided 

yes 

Total 

yes 

FCHV flip chart 1.0 6.6 7.6 - 7.0 7.0 - 9.3 9.3 

From FCHV 18.4 13.4 31.8 5.6 15.4 21.0 13.4 27.8 41.2 

From TBA 2.6 15.0 17.6 2.1 16.8 18.9 6.2 15.5 21.7 

From a health worker at 

the health facility 19.2 28.6 47.8 17.5 30.8 48.3 13.4 25.8 39.2 

Community groups 9.2 15.5 24.7 13.3 17.5 30.8 5.2 15.5 20.7 

Posters, pamphlets, 

leaflets 4.5 15.5 20.0 9.1 23.8 32.9 2.1 8.2 10.3 

Newspaper 9.7 14.2 23.9 20.3 18.9 39.2 1.0 8.2 9.2 

Radio 75.1 6.3 81.4 82.5 9.1 91.6 72.2 13.4 85.6 

TV 63.0 9.2 72.2 57.3 16.1 73.4 70.1 10.3 80.4 

Villagers/ friends/ family 

members/ neighbors 7.6 - 7.6 5.6 - 5.6 4.1 - 4.1 

Informal exposure 

All the RDW, husbands and MIL included in the study were asked if any of their friends, family 

members or other acquaintances had spoken with them informally during the past two months 

about attendance of a trained health worker during delivery. In response, about 32% each of the 

RDW and MIL and 28% husbands reported discussing about it with others during the past two 

months (Table not shown). The FIL of the RDW were also asked if thy had conversations about 

preparing for the birth with friends, families, neighbors or other acquaintances while their DIL 

was pregnant. Nearly half (48.4%) of the FIL said “yes” (Table not shown). Overall, about 

49.2% of the RDW had formal (electronic or print media) or informal (family members, friends, 

neighbors, etc) exposure to message regarding need of attendance of a trained health worker in 

86

the past three months. 

Knowledge 

The knowledge of respondents regarding who should be present to ensure a safe delivery has 

been reported above in Table 6.43. 

Attitude 

The great majority of the respondents of all categories opined that it is very important that 

delivery is attended by a trained health worker such as a doctor or nurse, midwife or MCHW 

(Table 6.46). For instance, 97.5% of the RDW, 99.6% husbands, 97.7% MIL and 97.9% FIL 

stated that it is important or very important to have their birth attended by a trained health 

worker. 

Table 6.46 Percent distribution of RDW, husbands, MIL and FIL by their opinion regarding the 

need of attending delivery by trained health workers and the reasons for it 


Opinion on the importance of attending own 

delivery by doctor, nurses, midwives or 

MCHWs 

Very important 86.3 93.8 87.1 87.9 

Somewhat important 11.2 5.8 10.6 10.0 

Not important 1.5 - 1.5 0.5 

Do not know 1.0 0.3 0.8 1.6 

Total (n) 889+ 292 264 190 

Reasons for being importance of attending 

delivery by these health personnel (among 

respondents who feel it is very or somewhat 

important; multiple responses allowed) 


For the safety of mother 68.4 67.7 69.0 64.0 

For the safety of child 63.0 59.1 62.8 53.8 

To manage complications easily 30.3 33.7 29.1 32.3 

To examine the condition of mother and child 27.9 29.2 26.0 28.5 

In case of serious problem with the delivery 29.4 25.1 27.1 26.9 

In order to have a normal delivery 27.7 23.0 26.0 26.3 

To confirm the position of the fetus 13.7 9.6 15.1 17.7 

For infection free delivery 13.0 12.0 13.2 13.4 

To identify danger signs 11.1 11.0 10.9 13.4 

Other± 0.3 0.3 -- 1.1 

Do not know 0.7 0.3 1.9 0.5 

Total (n) 867 291 258 186 

+ This question was asked only those RDW who had given live birth in the past 12 months. 

± Other includes: medicines available for both the mother and newborn, give immunization. 

Those RDW, husbands, MIL and FIL who considered it to be “important” or “very important” 

for attending delivery by a trained health worker were also asked to give reasons as to why they 

think so. Safety of mother and child were the main reasons given by more than half to the two- 

87

thirds of the respondents of different categories. Over a quarter of the respondents also opined 

that it is important that delivery is attended by a health worker to manage serious problems or 

complications easily, to examine the condition of mother and for normal delivery. 

Social network support, self-efficacy, and intention to utilize 

A series of questions related to the perception of the respondents with regards to social network 

support, self-efficacy, and intention to utilize in the context of utilization of a trained health 

worker during delivery were asked to all types of respondents. More than three-quarters (77.1%) 

of the RDW disagreed with the following statement: “people who attended my most recent 

delivery do not feel it is necessary to have a trained health worker present at a delivery”. On the 

statement related to ability to ensure the presence of trained health workers during delivery (i.e., 

self-efficacy), RDW were evenly divided: about half of the respondents agreed with the 

statement (“If I have another child, I will not be able to ensure that a trained health worker is 

present at my delivery” (Table 6.47). Forty-five percent of RDW declared that a trained health 

worker would attend their next delivery by agreeing with the statement “If I have another 

delivery, I will ensure that a trained health worker is present at my delivery”. 

Table 6.47 Percent distribution of RDW with regards to social network support, self-efficacy and 

intent to utilize trained health worker at delivery (n=900) 

Statement 

Agree 

Strongly 

disagree 

Disagree 

Strongly 

agree 

People who attended my most recent delivery do not feel it 

necessary to have a trained health worker present at a delivery 28.6 48.6 19.9 3.0 

If I have another child, I will not be able to ensure that a trained 

health worker is present at my delivery 13.1 37.8 33.0 16.1 

If I have another delivery, I will ensure that a trained health 

worker is present at my delivery 19.8 35.1 34.6 10.6 

Advocacy 

RDW were also asked whether they had ever encouraged their friends or family member to 

arrange a trained health worker to be present at their delivery. In response nearly half (48.4%) of 

them said that they had encouraged their friends or relatives to arrange a trained health worker to 

be present during delivery and almost the same percentage had neither encouraged nor 

discouraged while 4% said that they discouraged their friends or family members to arrange a 

trained health worker to be present at their delivery (Figure 6.13). 

88

Figure 6.13 Percent distribution of RDW who have ever encouraged to their friends or family 

members to arrange for a trained health workers for their delivery 

Neither encouraged 

nor discouraged 

47.9% 

Encouraged 

48.4% 

Discourage d 

3.7% 

n=900 

Summary of BCC factors 

Table 6.48 presents a summary of results regarding the various BCC factors as they relate to the 

utilization of a trained health worker at delivery. 

Table 6.48 Percentage of respondents whose most recent delivery was live birth with positive 

factors in relation to utilization of a trained health worker at delivery 

Factor 

Indicator Definition 

Indicator 

Value (n=889) 

Exposure: 

formal 

Exposure: 

formal or 

informal 

Knowledge 

Attitude 

(positive) 

Social network 

support 

Self-efficacy 

Intent to act 

Behavior 

Advocacy 

Percentage of respondents reporting formal exposure to message 

regarding need for trained health worker at delivery in 2 months 

prior to survey 

Percentage of respondents reporting formal or informal exposure 

to message regarding need for trained health worker at delivery in 

2 months prior to survey 

89 

42.4 

49.4 

Percentage of respondents with correct knowledge regarding need 

for trained health worker at delivery 84.9 

Percentage of RDW who state that it is important or very 

important to have their delivery attended by a trained health 

worker 

97.5 

Percentage of respondents who perceive support for need for 

trained health worker at delivery in their social network 77.2 

Percentage of respondents who feel they are able to ensure that an 

trained health worker is present during delivery 51.0 

Percentage of respondents who state that an trained health worker 

will be present during their next delivery 45.0 

Percentage of respondents who had a trained health worker present 

during their last delivery among RDW with live birth 36.6 

Percentage of respondents who have advocated regarding need for 

a trained health worker at delivery to others 48.5 

Note: For the comparison purposes, the denominator used for the calculation of the above indicators are among 

RDW whose most delivery was live birth.

Conclusions that can be drawn from the data presented in the table above include the following: 

♦ 

♦ 

♦ 

♦ 

♦ 

Exposure to messages is at a moderate level. 

There is a gradually declining continuum in the percentage of respondents who report 

positive factors from attitude (98 percent) to behavior (37 percent), suggesting that gains in 

the desired behavior may be achieved by program inputs that focus on addressing multiple 

factors in the table above. This is in contrast to a similar study 3 that was recently conducted 

in Kailali district in which it was found that while correct knowledge of the desired newborn 

behaviors were low, the levels of most of the “mid-process” factors (i.e., attitude, social 

network support, self-efficacy, perception of risk, intent to act) were at approximately the 

same (higher) levels for most individuals – levels that are, for the most part, higher than 

levels of desired behavior. That finding, coupled with the low knowledge levels of 

respondents, suggested to programmers in Kailali that increasing knowledge alone may have 

resulted in the improvement of levels of the desired behaviors. 

While levels of correct knowledge, desired attitude, and perception of social support 

regarding the use of a trained health worker at birth are quite high, there follows a notable 

“drop-off” to self-efficacy and intent to act, suggesting that pregnant women and their 

families need to be shown how to ensure that a trained health worker attends their delivery 

and they need to commit (i.e., “intend”) to doing so before the delivery. 

The level of intent to act is higher than the level of behavior, suggesting potential for positive 

improvement in the use of trained health workers at birth. 

Almost half of all respondents reported having advocated the use of a trained health worker 

at delivery — a higher percentage than reported intent to use or utilization itself. Advocacy is 

the final step in the BCC model and it is to be expected that its practice will lag behind other 

factors. The practice of advocacy may also be affected by ethnic and caste distinctions as 

well as expectations regarding who should and should not give advice. Developing and 

promoting the practice of advocacy should be made a priority, especially given recent 

findings that communication within community networks played an important role in 

reduction of mortality in Makwanpur 4 and the need to work towards sustainability in the CB- 

MNC. 

Additional analyses will be conducted in the near future that will explore associations between 

the various factors reported in the table above and the attendance of a trained health worker at 

delivery. 

3 Strengthening Essential Newborn Care Practices: Results from a Program to Advance Home-Based Care of 

Newborns Through Behavior Change Communication in Kailali District, Nepal. Ministry of Health and Population, 

Government of Nepal, and Save the Children Nepal, 2005. 

4 Manandhar DS et al. (2004). Effect of a participatory intervention with women’s groups on birth outcomes in 

Nepal: cluster-randomized controlled trial. Lancet. 364: 970-979. 

90

Chapter 7 

Postpartum, Immediate Newborn and Newborn Care 

A series of questions related to knowledge, attitude and practice on postpartum services 

including newborn care was asked to the recently delivered women (RDW), their husbands, 

mothers-in-law (MIL) and fathers-in-law (FIL). Likewise, information related to knowledge 

about postpartum hemorrhage, family support during postpartum period, immediate newborn 

care and newborn care during first month was also collected from all the four types of 

respondents included in the present study. This chapter presents the results related to the above 

aspects. Results for key CB-MNC Core Indicators related to these topics are included in the 

table below. 

CB-MNC Core Indicators for postpartum, immediate newborn and newborn care 


Estimates 

(n) 

Exposure to messages 

9.1 Percentage of RDW who report exposure to the message that “a mother and 

newborn should have their health checked by a trained health worker within 3 889 21.9 

days after birth” among RDW with live birth. 

14.1 Percentage of RDW who received information about bleeding after childbirth 

during their last pregnancy. 900 53.9 

14.2 Percentage of RDW who received information about a drug that can reduce 

bleeding after childbirth during their last pregnancy. 900 16.0 

Knowledge 

3.3 Percentage of RDW who know at least three maternal danger signs during 

postnatal period among RDW with live birth 889 39.6 

3.4 Percentage of RDW who know at least three newborn danger signs among 

RDW with live birth 889 26.3 

9.2 Percentage of RDW who know that postnatal checkups for mother and 

newborn should take place within 1 day (24 hours) after birth among RDW 889 2.9 

with live birth. 

14.5 Percentage of RDW who know that excessive bleeding during or after 

delivery is dangerous or very dangerous to the woman in labor among RDW 


889 97.6 

Commodities 

4.8 Percentage of RDW who received Vitamin A capsule within six weeks of 

delivery among RDW who delivered 2-11 months prior to the survey 765 36.3 

Utilization 

6.8 Percentage of RDW who received post-partum care within 3 days of delivery 

from a trained provider among RDW who delivered 2-11 months prior to the 

survey 

6.11 Percentage of RDW whose infant received newborn care within 1 day after 

delivery from a trained provider among RDW with live birth whose infant 

lived at least two months. 

Essential newborn care 

8.3 Percentage of RDW whose newborns’ cord was cut with a clean / new 

instrument OR a clean birth kit was used among RDW with live birth who 

delivered at home 

91 

765 43.5 

876 40.2 

581 89.5 

8.6 Percentage of RDW who report that their baby was dried before the placenta 

was delivered among RDW with live birth 889 50.2 

8.7 Percentage of RDW who report that their baby was wrapped in cloth before 

the placenta was delivered among RDW with live birth 889 51.6


Estimates 

(n) 

8.5 Percentage of newborns that have nothing applied on cord stump. among 


8.8 Percentage of RDW who report that their baby was not bathed during first 24 

hours after birth among RDW with live birth 889 17.4 

8.9 Percentage of RDW who breastfed their infant within one hour of birth 


8.10 Percentage of RDW who gave colostrum to their newborn child among RDW 

with live birth 889 79.0 

8.12 Percentage of infants aged less than six months at the time of the survey who 

are being exclusively breastfed 432 54.2 

Management of health emergencies 

12.7 Percentage of RDW who report experiencing a danger sign during the 

postpartum period following their most recent delivery among RDW with live 889 30.3 

birth. 

12.8 Percentage of RDW who sought care at health facility after experiencing a 

danger sign during the postpartum period following their most recent delivery 269 28.6 

(among RDW with live birth who report experiencing a danger sign). 

12.11 Percentage of RDW who report that their infant experienced a danger sign 

during the neonatal period following their most recent delivery among RDW 876 21.9 

with a live birth whose infant lived at least two months. 

12.12 Percentage of RDW who sought care at health facility for their infant after 

s/he experienced a danger sign during the neonatal period (among infants who 

lived at least two months and who experienced a danger sign). 

192 48.4 

7.1 Postpartum services from health workers or health facility 

Meeting with FCHV for postpartum care 

RDW (n=765) who were more than 2 months post-delivery at the time of the survey were asked 

about the number of times they met with FCHV during 6 weeks following their recent delivery 

outside the mothers’ group meeting to receive services or advice. In response, the majority 

(87.8%; or n=672) of the RDW said they did not see FCHVs within 6 weeks following the 

delivery while only 12.2% (n=93) reported of seeing them during that period (Figure 7.1). 

Among those RDW who met their FCHV, most had met the FCHV either once or twice (Table 

not shown). About 40% of the RDW had met the FCHV within 1-2 weeks of delivery, about a 

quarter within 3-4 weeks of delivery and over a quarter met them more than one month following 

the delivery (Table not shown). Among RDW with more than two months of post-delivery and 

who know their FCHVs (n= 602), on average, each RDW met their FCHVs 0.2 times during the 

6 weeks following their most recent delivery. Among RDW who met the FCHVs on average 

they first contacted FCHVs in 15.9 days following delivery. 

92

Figure 7.1 Percent distribution of RDW who met with FCHV during the 6 weeks following 

their recent delivery outside the mothers’ group to receive services or advice, among RDW 

who were more than 2 months post-delivery 

Met FCHV 

12.2% 

n=765 

Not met FCHV 

87.8% 

Those RDW (n=93) who delivered 2-11 months prior to survey and who reported meeting the 

FCHVs for services or advice within 6 weeks following their recent delivery were further asked 

about types of services or advice they received from the FCHVs. The possible answers were read 

out by the interviewers to the respondents during interview. The results are presented in Table 

7.1. The majority of the RDW reported that they received vitamin A (71.0%) and iron tablets 

(59.1%) from their FCHVs. About two-thirds (67.7%) received advice on breastfeeding or infant 

care. The provision of other types of information and services such as diagnosing or treating 

newborn’s respiratory infection or diarrhea, checking newborn to see any other health problems, 

advising and providing help for birth registration, providing FP supplies and assessing the 

mother for delivery-related problem were reported by less than half of the respondents. 

Table 7.1 Percent distribution of RDW by types of services, help or advice received from FCHV 

during 6 weeks following their last delivery, among RDW who were more than 2 months postdelivery 

and who reported meeting the FCHVs for services or advice within 6 weeks following 

their recent delivery (n=93) 

Types of services, help or advice received from FCHV Yes No DK 

Diagnose or treat newborn’s respiratory infection or diarrhea 41.9 58.1 - 

Check to see if your newborn had any other health problem 34.4 65.6 - 

Provide vitamin A for mother 71.0 29.0 - 

Provide iron tablets for mother 59.1 39.8 1.1 

Check to see if the mother had a delivery- related problem (e.g. 

infection) 24.7 75.3 - 

Make referral to health service provider 24.7 74.2 1.1 

Advice on breastfeeding or infant care 67.7 32.3 - 

Advice or help with birth registration 39.8 60.2 - 

Family planning supplies 30.1 68.8 1.1 

RDW (n=93) who delivered 2-11 months prior to survey and who reported meeting the FCHVs 

for services or advice within 6 weeks following their recent delivery were also asked (with 

prompting of individual items) if they received any advice from their FCHV during 6 weeks 

following their last delivery. Over 7 in every 10 RDW reported receiving advice on taking rest, 

not doing heavy work, maintaining a balanced diet, breastfeeding, and taking iron tablets. Over 6 

93

in every 10 RDW also said that they got advice on danger signs in newborn and another 53% on 

danger signs that may appear to mother during postpartum period. More than half (52.7%) of the 

RDW had also received advice on family planning from their FCHVs (Table 7.2). 

Table 7.2 Percent distribution of RDW received advices on various aspects related to postpartum 

services in the 6 weeks following their last delivery from FCHV, among RDW who were more 

than 2 months post-delivery and who reported meeting the FCHVs for services or advice within 6 

weeks following their recent delivery (n=93) 

Advice on the following topics received from your FCHV Yes No DK 

Take rest 71.0 28.0 1.1 

Avoid heavy work 74.2 24.7 1.1 

Diet 78.5 20.4 1.1 

Breastfeeding counseling 71.0 28.0 1.1 

Postpartum danger signs for mother 52.7 45.2 2.2 

Danger signs for newborn 60.2 39.8 - 

Iron tablets 71.0 29.0 - 

Family planning 52.7 45.2 2.2 

In order to examine the extent of participation of RDW in mothers’ group meetings to know 

about various information and services related to postpartum issues, all the RDW (n=765) who 

were more than 2 months of post-delivery were asked if they had participated in the mothers’ 

group meeting during 6 weeks following their recent delivery. The results indicate that only 

1.3% of the 765 RDW reported to have attended the mothers’ group meetings indicating low 

participation of the women during their postpartum period (Table not shown). The above 

findings suggest that efforts are needed to encourage women to participate in the mothers’ group 

meetings. 

Postpartum services from health workers, FCHV or TBA 

Among RDW (n=765) who were more than 2 months of post-delivery were further asked 

whether a health professional, FCHV or a traditional birth attendant checked their health 1) 

during the first three days and 2) between 4 days and 6 weeks after the child birth. In response, 

over half (53.1%) of them said that they were checked by one or more of these health care 

providers within 3 days following the birth. However, only 44% were checked within 3 days of 

birth by the trained health providers such as doctor, nurse, ANM, HA, AHW and MCHW 

(Figure 7.2). Likewise, 14% of the RDW said they received a check up from the health workers 

or FCHV or TBA between 4 days to 6 weeks after birth. Those receiving check ups from the 

trained health workers during this time period constituted about 11%. Overall, 46% of the 765 

RDW who were more than 2 months post-delivery at the time of the survey said they received 

check-up services within 6 weeks of delivery of their last child from a trained health worker. 

94

Figure 7.2 Percent distribution of RDW who were checked by trained health worker, FCHV 

or traditional birth attendant on their health during the first three days and 4 days to 6 weeks 

after birth, among RDW who were more than 2 months post-delivery 

Percent 

100 

80 

60 

40 

20 

0 

53.1 

55.9 

43.5 

45.9 

13.5 11.4 

Health professional, FCHV or TBA 

Trained health worker 

Within 3 days 4 days to 6 w eeks Within 6 w eeks 

n=765 

Table 7.3 further shows data on persons that had checked the RDW during the first three days 

and 4 days to 6 weeks following the delivery of their last child. Respondents were asked to name 

all personnel who examined them during these time periods. More than 31% of the women were 

checked by either nurse or ANM and another 26% by doctor within 3 days of childbirth. 

Similarly, about 8% of the women said they were checked by HA or AHW during that period. 

Among those women who received a check-up between 4 days and 6 weeks following their 

delivery, about 6% each said that they were checked by doctor, and nurse or ANM. 

Table 7.3 Percent distribution of RDW by person who checked their health during the first three 

days and 4 days to 6 weeks after birth, among RDW who were more than 2 months post-delivery 

Persons checked on your health during the first three days Within 3 days 4 days to 6 weeks 

after birth (Multiple Response) 

Doctor 26.1 6.3 

Nurse/ANM 31.5 6.7 

HA/AHW 7.7 3.5 

MCHW 0.3 0.4 

VHW 1.2 0.9 

FCHV 2.1 0.9 

TTBA 2.7 0.3 

TBA 1.3 0.1 

Other± 3.2 0.7 

None 46.9 86.5 

Total (n) 765 765 

± Other includes: CMA, peon of PHC, other health worker, experienced person, medical shopkeeper. 

Among those women (n=103) who reported getting check up services (either first or follow up 

visits) between 4 days and 6 weeks following the birth of their last child, nearly half (44.7%) 

visited only once and 20% visited twice, and the rest (34.9%) had visited 3 times or more to 

these health workers to seek services (Table not shown). More than one-third (35.0%) of the 

women visited hospitals, 17% to private clinic, 13% to health post or subhealth post and 10% to 

PHCC. Six out of 103 women also reported visiting PHC ORC to seek services. More than a 

quarter of the women said that their health check ups were done at home. 

95

Table 7.4 further shows differentials on the utilization of postpartum services from the trained 

health workers (doctor, nurse, ANM, HA, AHW and MCHW) by the RDW (among RDW who 

were more than 2 months post-delivery) at any time within six weeks of their delivery by 

selected background characteristics. No significant difference was observed on the use of 

postpartum care by the women across age groups and different measures of distance to the health 

facility from their place of residence. However, significant association between the use of such 

services and literacy status, ethnicity, media exposure, parity and SES of the women was 

observed. For instance, a higher proportion of literate RDW, RDW who belonged to Brahmin or 

Chhetri castes, RDW who had exposure to media, RDW who had less than 2 living children and 

RDW who belonged to highest SES were found to be receiving postpartum care from a trained 

health provider within six weeks of their delivery than their respective counterparts (Table 7.4). 

Almost all the RDW (96.7%) who delivered their last child at a health facility and about 86% of 

those who had delivered at home with the assistance of SBA compared to only 15% of those who 

delivered at home without the assistance from a SBA reported receiving postpartum services 

from the trained health workers. 

96

Table 7.4 Percent distribution of RDW who had received postpartum care within six weeks of 

delivery from a trained provider by their selected background characteristics, among RDW who 

were more than 2 months post-delivery 



ns 

15-19 45.2 93 

20-24 50.3 310 

25-29 45.0 231 

30-34 39.5 81 

35-49 34.0 50 

Literacy * 



Ethnicity * 



Tharu 31.0 129 

Dalit 29.0 100 



Other 47.2 53 


None 25.0 92 


TV only 35.5 62 



ns 




Places visited for postpartum services 

Those RDW (n=765) who were more than 2 months post-delivery were again asked if they did 

visit a health facility or PHC/ORC approximately 6 weeks after the birth for check up or to have 

their child vaccinated. The majority (83.3%) of the 765 RDW had visited for check ups or for 

their child’s vaccination while 12% (n=92) had not visited the facility. Less than 5% of the RDW 

said that they did not go but somebody else took their infant (Figure 7.3). Those RDW (n=92) 

who did not visit the health facility gave the following reasons for not visiting the health facility 

or PHC ORC (Table not shown): 

• Did not know I should get check up (47.3%) 

• Did not think it necessary (41.8%) 

• Did not know whom to ask (7.7%) 

• No service available nearby (6.6%) 

The other reasons given by less than 4% of the respondents were no such practice in their 

community, family members did not allow, costs too much, felt unsafe to go, was at maternal 

home, transport strike, inability to go due to sickness, and too busy to visit health facility. 

Figure 7.3 Percent distribution of RDW visiting a health facility or PHC ORC 6 weeks after 

their most recent delivery for check up or to have their child vaccinated, among RDW who 

were more than 2 months post-delivery 

Not visited 

12.0% 

Only child taken 

4.7% 

n=765 

Visited 

83.3% 

The RDW (n=637) who were more than two months post-delivery at the time of the survey and 

had visited a health facility for check ups were further asked about the places that they visited. 

Data presented in Table 7.5 indicate that nearly two-fifths had visited the immunization center or 

clinic followed by a quarter to the subhealth post. More than 10% each of the RDW also said 

they visited outreach clinic or PHCC. 

98

Table 7.5 Percent distribution of RDW by type of health facility they visited within 6 weeks of 

their most recent delivery for their health check ups or for child immunization, among RDW who 

were more than 2 months post-delivery and who visited a health facility for check ups 

Types of health facility visited Number Percent 

Immunization center/ immunization clinic 247 38.8 

SHP 164 25.7 

Outreach clinic 82 12.9 

PHC 67 10.5 

HP 35 5.5 


Private clinic 9 1.4 

NGO clinic 9 1.4 

FPAN clinic 1 0.2 

Other± 2 0.3 

Total 637 100.0 

± Other includes: called doctor at home, medical shopkeeper, CMA, FCHV. 

Those RDW (n=637) who visited the health facility around 6 weeks following their most recent 

delivery were also prompted about types of services they received from the health service 

providers during their visit. Data presented in Table 7.6 reveal that, among these 637 

respondents, the majority (81.8%) of the RDW had received counseling on immunization from 

the health workers while the other types of services were found to have been received by quite a 

small proportion of the respondents. Slightly over one in every 7 respondents reported receiving 

counseling on breastfeeding and one in every 10 received advice on newborn care and on family 

planning. Activities such as examination of abdomen, internal examination and asking question 

to client on the status of bleeding or abdominal pain was done only to quite an insignificant 

percentage of the RDW. The above findings clearly indicate the poor quality of postnatal check 

ups in Jhapa district. Hence, it is necessary to inform the health workers about basic activities 

services that they have to provide to the clients during their postpartum visit. 

Table 7.6 Percent distribution of RDW reporting about types of services or activities conducted 

by the health workers during their postnatal check ups, among RDW who were more than 2 

months post-delivery and who visited a health facility for check ups (n=637) 

Types of activities ere conducted by the health worker during Yes 

No 

postnatal checkup 

Examination of abdomen 4.7 95.3 

Internal examination 2.7 97.3 

Asked if you had excessive bleeding / severe abdominal pain 6.4 93.6 

Counseled you about family planning 9.7 90.3 

Counseled you about breastfeeding 15.4 84.6 

Counseled you about immunization 81.8 18.2 

Provided advice on newborn care 11.5 88.5 

Check up of the newborn during the visit for postpartum services 

RDW (n=765) who were more than 2 months post-delivery at the time of the survey were asked 

if they had taken their youngest child to the health facility within 6 weeks following the birth of 

their last child. In response, 86.6% (n=662) out of the 765 RDW said that they took the child 

with them. 

99

Those 662 RDW who took their child with them at the health facility at that time were again 

asked (by prompting) about type of activities done by the health worker during their baby’s 

check ups. In response, almost all the RDW said that the name of their baby was entered in the 

health facility register (97.9%) and was given vaccination (97.9%). Relatively a smaller 

proportion of the RDW said that their baby was weighed and that this information was recorded 

in the health facility register (39.3%), that health workers asked questions about baby’s feeding 

habits (19.0%), that the baby received physical examination (13.1%) and that health workers 

encouraged the respondents to register baby’s birth (10.4%; Table 7.7). These findings indicate 

the low quality of neonatal health examinations in health facilities in Jhapa district. 

Table 7.7 Percent distribution of RDW reporting about types of services or activities conducted 

by the health workers during their postnatal check ups, among RDW who were more than 2 

months post-delivery and who visited a health facility with their child for postnatal check ups 

(n=662) 

Types of activities conducted by the health worker during baby’s Yes No DK 

checkup 

Baby’s name entered in health post register 97.9 2.1 - 

Health worker asked questions about baby’s feeding habits 19.0 81.0 - 

Baby was weighed and weight was recorded in register or other 

document 39.3 60.6 0.2 

Baby was given vaccination 97.9 2.1 - 

Baby received physical examination 13.1 86.9 - 

Health worker encouraged you to register baby’s birth 10.4 89.6 - 

Use of iron/folic tablets and vitamin A capsules during postpartum period 

All the RDW who had given live birth over the past one year were also asked about the number 

of days they took iron/folic acid tablets following their most recent delivery. Over 70% of them 

reported not to have taken iron/folic acid tablets at all and 29% reported receiving them. Sixteen 

percent of the RDW took iron/folic tablets for 1-2 months, 9% for less than one month and 2.5% 

received such tablets for 2 months or more (Table 7.8). Among the RDW (n=755) who were 

more than two months post-delivery at the time of the survey and who knew how long they had 

taken iron/folic acid tablets, on average, each RDW took iron/folic acid tablets for 9.2 days. 

Among those who were more than two months post-delivery at the time of the survey who took 

iron/folic acid tablets (n=212), on average, each RDW took them for 33 days. 

Table 7.8 Percent distribution of RDW receiving iron/folic acid tablets following their most 

recent delivery 

Number of days taken iron or folic tablets during most recent delivery Number Percent 

Not taken at all 630 70.9 

Those RDW (n=889) who had given live birth over the last one year period were shown the 

vitamin A capsule and then asked if they had taken vitamin A tablets in the first 42 days 

following their most recent delivery. The proportion of RDW (n=765) who were more than two 

months post-delivery at the time of the survey who had taken a vitamin A capsule during the first 

42 days constituted only 36.3% indicating the need of giving information and education to the 

community about the importance of RDW taking a Vitamin A capsule during postpartum period. 

Differentials on the use of vitamin A capsules by the women in their first 42 days following 

recent delivery by selected background characteristics indicated that younger and literate women 

are more likely to receive vitamin A capsules than the elder and illiterate women (Table 7.9). 

Ethnicity wise data indicate that Brahmin or Chhetri are more likely to use vitamin A capsules 

while Muslim are less likely to consume them. Likewise, differential on taking of vitamin A 

capsules was also observed according to the media exposure of the women as more than 40% of 

the RDW with exposure to both radio and TV as against only 17% without exposure to the media 

had taken vitamin A capsules. Distance to the health facility has no strong influence on the use of 

vitamin A capsules among the women. However, women with low parity and those who 

belonged to the highest socio-economic status reported receiving vitamin A capsules than their 

respective counterparts. Over half (53.3%) of the RDW who delivered their last child at a health 

facility compared to only 36% who delivered at home with the assistance of SBA and 27% who 

delivered at home without SBA assistance reported receiving vitamin A capsules in the first 42 

days after delivery. 

101

Table 7.9 Percent distribution of RDW who took a Vitamin A capsules in the first 42 days after 

delivery by selected background characteristics, among those who delivered 2-11 months prior to 

the survey 



15-19 40.9 93 

20-24 38.7 310 

25-29 37.7 231 

30-34 30.9 81 

35-49 16.0 50 

Literacy * 



Ethnicity * 



Tharu 25.6 129 

Dalit 36.0 100 



Other 37.7 53 


None 17.4 92 


TV only 30.6 62 



ns 





Receiving counseling on specific maternal danger signs or issues 

All RDW who had a live birth (n=889) were asked whether they were counseled by health 

worker, FCHV or TBA on specific maternal danger signs or issues following their delivery. The 

possible answers were read out by the interviewer to them during interview. Data presented in 

Figure 7.4 indicate that only a small proportion of the RDW were counseled on various types of 

maternal danger signs or issues by the health workers. For instance, slightly over a quarter had 

received counseling on excessive bleeding and severe lower abdominal pain and slightly over 

one-fifth on high fever, severe headache and breast problems. Only less than one-fifth of the 

RDW reported receiving counseling on convulsions and service sources from the health 

providers. One core indicator that was developed to measure the quality of counseling was 

percentage of RDW receiving post-natal care from a trained provider within six weeks of 

delivery who were counseled in at least two maternal danger signs or issues. The value of this 

indicator was found to be 46%. 

Figure 7.4 Percent distribution of RDW who received specific counseling on maternal danger 

signs or issues from health workers, FCHV or TBA following their delivery 

Percent 

100 

80 

60 

40 

20 

0 

29.7 27.3 

Excessive 

bleeding 

Severe lower 

abdominal 

pain 

22.7 22.3 22.0 20.2 17.5 15.6 

High fever 

Severe 

headache 

Smelly 

discharge 

Breast 

problems 

Convulsions Where to go 

for services 

n=889 

Exposure to messages and knowledge regarding timing of first check-up after delivery 

In order to examine the knowledge regarding the timing of first check ups for the mothers and 

newborn, all the four types of respondents were asked “Within how many days after birth should 

mothers and newborns have their health checked by a health worker?”. Data presented in Table 

7.10 indicate that only 3% of RDW knew that the checkup should take place within one day of 

birth while 8% of RDW answered that it should take place within the first week post-delivery. 

About half of the RDW, MIL and FIL and about 38% of the husbands responded “do not know”. 

A higher proportion of the respondents (28.2%-35.3%) opined that a mother and her newborn 

should have health check ups in 15-42 days following the birth. Similarly, a sizeable percentage 

of the respondents (13.7%-25.0%) also opined that they should get health check ups within 2 

weeks after delivery. 

103

Table 7.10 Percent distribution of RDW, husbands, MIL and FIL by opinion regarding the 

timing of first check ups by mothers and newborn from the health workers 

Opinion regarding the timing of receiving health RDW Husband MIL FIL 

checked for the first time after delivery by 

mothers and newborns (in days) 

One day 2.9 6.2 2.7 2.1 

2-6 days 4.6 6.5 3.4 6.3 

7-14 days 6.9 12.3 7.6 9.5 

15-29 days 12.0 12.3 14.8 13.2 

30-42 days 16.2 20.9 20.5 15.3 

43 days+ 5.6 3.4 2.3 2.6 

Do not know 51.7 38.4 48.9 51.1 

Total (n) 889 292 264 190 

All the four types of respondents included in the study were also enquired if they had heard the 

message “mothers and newborns should have their health checked by a health worker with 24 

hours after birth” from any sources in the past. The majority, with a higher proportion of RDW 

than the other three categories, of the respondents reported not to have hard the above message at 

all. About 35% of the husbands followed by 27% FIL, 25% MIL and 22% RDW reported to 

have heard the messages. Those who reported having heard of the messages said that they heard 

about it from radio, TV, health workers, FCHVs and friends (Table 7.11). 

Table 7.11 Percent distribution of RDW, husbands, MIL and FIL who had heard the messages 

“mothers and newborns should have their health checked by a health worker with 24 hours after 

birth” 

Heard the message: “Mothers and newborns RDW Husband MIL FIL 

should have their health checked by a health 

worker with 24 hours after birth” 

Have heard the message 21.9 34.9 24.6 26.8 

Source of exposure (Multiple Response) 

Radio 11.6 20.9 9.8 16.8 

TV 7.2 9.2 5.3 7.9 

From health worker 7.9 10.6 10.2 7.4 

From friends 5.7 7.5 8.3 7.4 

From FCHV 4.2 4.1 2.7 1.6 

Other± 1.7 2.1 0.8 2.1 

Total (n) 889 292 264 190 

± Other includes: TBA, husband, sister-in-law, book, mother, father, poster, adult literacy class, newspaper or magazine. 

7.2 Danger signs during postpartum period 

Discussion on the aspects related to the knowledge of respondents on the danger signs during 

postpartum and problems experienced by the RDW during postpartum period is held in this 

section. 

Knowledge about danger signs during postpartum period 

All the respondents of four categories were asked to name the symptoms of the mother that call 

for the need to her to seek immediate health care during the six weeks following delivery. 

104

Overall, over 90% of the RDW and MIL and nearly 90% of the husbands and FIL were able to 

mention at least one type of danger sign that may appear during postpartum period (Table 7.12). 

The majority (66.8%-78.4%) of the respondents of all four types named excessive bleeding as a 

symptom that needs immediate health care while lower percentages named high fever (48.3%- 

51.1%) and pain in lower abdomen or smelly vaginal discharge (35.8%-50.8%). Relatively a 

small proportion of the respondents of all types named symptoms such as severe headache and 

convulsion and fit. Overall, only 40% of RDW were able to correctly name three or more danger 

signs that may appear during postnatal period. 

Table 7.12 Percent distribution of RDW, husbands, MIL and FIL by knowledge of symptoms of 

the mother indicating the need for her to seek immediate health care during the 6 weeks after 

delivery 

Types of the symptoms of the mother indicating the RDW Husband MIL FIL 

need for her to seek immediate health care during the 

six weeks after delivery (Multiple Response) 

High fever 49.3 48.3 51.1 48.9 

Pain in lower abdomen or smelling vaginal discharge 50.8 39.0 50.4 35.8 

Excessive bleeding 75.1 69.9 78.4 66.8 

Severe headache 27.2 26.4 21.2 23.7 

Convulsion and fit 16.1 17.1 14.4 11.1 

Swelling in hands and feet/ pain in hands and leg 2.4 1.0 0.4 2.6 

Dizziness 2.9 1.4 0.4 1.6 

Severe weakness 2.4 5.1 3.0 3.7 

Others± 5.3 8.2 10.6 7.5 

Do not know 7.3 10.3 6.4 11.6 

Total (n) 889 292 264 190 

± Other includes: blurred vision, waist pain, less appetite, urinary problem, white vaginal discharge, high blood pressure, back 

pain, cold and cough, infection in uterus, diarrhea, jaundice, swelling in body, uterus prolapsed, retention of placenta, vomiting 

or nausea, infection in breast. 

Problems during postpartum period 

All the RDW (n=889) who had delivered live birth in the past one year were asked if they had 

experienced any problems during the six weeks following their most recent delivery. Four 

possible problems associated with the postpartum period such as excessive bleeding, high fever, 

severe lower abdominal pain and convulsions were read out by the interviewers to all 

respondents who were then asked if they had experienced such problems. The results are 

presented in Figure 7.5. About 3 in every 10 RDW said that they had experienced one or more of 

these problems during the postpartum period. Slightly a higher proportion (16.2%) had problems 

with severe lower abdominal pain followed by 15% with excessive bleeding and 13% with high 

fever. About 6% of the RDW had problems with convulsions. 

105

Figure 7.5 Percent distribution of RDW who had experienced problems during 6 weeks 

following their most recent delivery 

Percent 

100 

80 

60 

40 

20 

0 

14.6 12.8 16.2 

Excessive 

bleeding 

High fever 

Severe lower 

abdominal pain 

5.5 

Convulsions 

30.3 

At least one 

n= 889 

Those RDW (n=269) who had experienced one or more of the above-mentioned problems during 

6 weeks following their most recent birth were asked about the persons they consulted or places 

they visited for the management of such problems. Findings indicate that the practice of visiting 

health facility or consulting the health personnel for the management of complications among the 

women in the study districts was quite low as only about 10% of the RDW said they visited a 

hospital and another 10% said that they visited a PHCC/HP/SHP. Overall, 29% of 269 RDW 

sought care at a health facility after experiencing a health problem during the postpartum period. 

More than one-fifth of the RDW said that they bought medicines from the pharmacy without 

consulting health personnel and about 9% adopted traditional treatment at home. More than a 

quarter (26.8%) of the RDW did not consult any one nor visited any facility for the management 

of complications. 

Table 7.13 Percent distribution of persons consulted or places visited by RDW when they had 

serious health problems within 6 weeks after their most recent birth 

Places visited or persons consulted for the problems experienced Number Percent 

within 6 weeks after the most recent birth (Multiple Response) 











Consulted a TBA 3 1.1 

Other± 1 0.4 


Total (n) 269 - 

± Other includes: a person holding Diploma in pharmacy. 

Those RDW (n=269) who experienced a danger sign in the six weeks following their most recent 

delivery were also asked if a health worker referred or advised them to go to a health facility for 

treatment. Only 22% of the 269 RDW said they were referred or advised to go health facility by 

a health worker (Table not shown). Only 45% of the 60 RDW who were referred actually visited 

106

a health facility to seek services following their referral. Most of the referred RDW visited a 

hospital, PHCC or sub-health post (Table not shown). 

7.3 Family support during postpartum period 

Information on the support received by the RDW during postpartum period was collected from 

all four types of respondents. On the question whether they consumed less food than usual, about 

the same amount as usual, or more than usual during the first 6 weeks after their most recent 

delivery, nearly three-quarters (73.8%) of the RDW whose most recent delivery was a live birth 

said they consumed more than usual. Eighteen percent of RDW reported that they ate the same 

amount as usual and the rest (8.7%) consumed less than usual amount (Figure 7.6). 

Figure 7.6 Percent distribution of RDW by amount of food they consumed during the first 6 

months after their most recent delivery 

100 

80 

73.8 

Percent 

60 

40 

20 

8.7 

17.5 

0 

Less than usual Same as usual More than usual 

n=889 

With respect to the care and support received from the family members during the first 6 weeks 

after their delivery, the great majority (85.8%) of the RDW reported receiving more care and 

support than usual while only less than 2% mentioned that they received less than usual. The 

responses of the husbands and MIL was also consistent with the responses of RDW as nearly 

88% of the husbands and 94% MIL said that they provided more support than usual to their 

wives/DIL during postpartum period (Table 7.14). RDW primarily reported receiving four types 

of support from family members including their husbands and MIL, which were a) receiving 

more nutritious food (87.5%-91.1%), b) advising for more rest (82.0%-88.6%), c) reducing 

heavy load (66.8%-73.9%), and d) giving more food to eat (69.1%-71.3%). Support related to 

advising or accompanying the RDW by their family members for health check ups was found to 

be less common as only about one in every 10 respondents of all three categories reported 

receiving or providing such support during postpartum period. 

107

Table 7.14 Percent distribution of RDW by amount and type of support received from the family 

members during their first six weeks following the delivery of the last child 

Description RDW Husband MIL 

Amount of support received from family members or 

provided to the wife/DIL 

Less than usual 1.7 - - 

Same as usual 12.5 11.0 5.3 

More than as usual 85.8 87.7 93.6 

Do not know - 1.4 1.1 

Total (n) 889 292 264 

Types of care/support received from family members or 

provided to wife/DIL (Multiple Response) 

Given more food to eat 71.3 69.1 69.6 

Given more nutritious food to eat 87.5 87.9 91.1 

Advised for more rest 88.6 82.0 87.9 

Reduced heavy load 73.9 67.2 66.8 

Advised/accompanied for check-up 8.1 10.5 7.3 

Other - 1.2 0.8 

Total (n) 763 256 247 

The RDW (n=763) who reported receiving more support from their family members than usual 

during their 6 weeks of postpartum period were further asked to mention the persons that 

provided the above-discussed support to them. Data presented in Table 7.15 indicate that RDW 

had received such supports mostly from their husbands (74.8%) followed by their MIL (48.6%) 

and sisters-in-law (26.6%). Nearly one-fifth of the RDW also reported receiving support from 

their FIL as well. 

Table 7.15 Percent distribution of RDW by persons who provided support during their 

postpartum period of the last birth among RDW who reported receiving more support 

from their family members than usual during their 6 weeks of postpartum period 

Persons provide care/supports provided following the delivery of the Number Percent 

last child (Multiple Response) 



Sister-in-law 203 26.6 


Mother 80 10.5 

Other family member± 63 8.3 

Daughter 52 6.8 

Son 18 2.4 

Other (neighbor/ household helper) 3 0.4 

Total (n) 763 - 

± Other family members includes: daughter-in-law father sister niece, brother, grandfather, brother-in-law. 

All the respondents were asked if they knew the places or sources where one could go for health 

services in case of danger signs during the 6 weeks following the delivery. In response, all the 

RDW and husbands and almost all the MIL and FIL were able to give at least one such sources. 

A higher proportion of the respondents of all categories reported that such services could be 

available from the hospital (27.0%-44.7%) followed by PHCC (22.6%-27.3%) and subhealth 

108

post (19.9%-23.6%). The other sources mentioned by about one-fifth or less of the respondents 

were private clinics or nursing home and health post. 


availability of services for the management of danger signs that may appear during six weeks 

following the delivery 

Source of services for the danger signs that may RDW Husband MIL FIL 

appear during the six weeks after the delivery 


Hospital 27.0 32.5 38.3 44.7 

PHCC 27.3 26.4 22.7 22.6 

Health post 17.9 14.4 15.9 14.7 


PHC/OR clinic 0.7 - - - 


ANM or CMA or shopkeeper from medical shop 2.7 1.7 1.5 2.1 

Other± 0.4 0.3 - - 

Do not know - - 0.4 1.1 

Total (n) 889 292 264 190 

± Other includes: MCHW, traditional healers, person working in the medical field in the village, FPAN clinic, Marie Stops 

clinic. 

7.4 Knowledge about postpartum hemorrhage 

Postpartum hemorrhage (PPH) is considered to be the leading cause of maternal death in Nepal. 

The NFHP is conducting a “delivery-system field trial” to demonstrate the feasibility of 

distributing Misoprostol (a drug that prevents PPH) through FCHVs in Banke district. Issues 

related to PPH and Misoprostol are thus explored in some depth in this survey. Jhapa district 

serves as a non-equivalent control district for some aspects of the study. 

In order to assess the knowledge of respondents regarding postpartum hemorrhage all the four 

types of respondents were asked several questions related to bleeding after childbirth. This 

section presents findings on these aspects. All four types of respondents were asked if they 

received any information about bleeding after childbirth during their or their wives/DIL’s last 

pregnancy. In response, about half of the respondents, with a higher proportion of the RDW 

(53.9%) than other respondent groups, responded affirmatively indicating that quite a higher 

proportion of the respondents have not been exposed to information about PPH (Figure 7.7). 

Therefore, it is necessary to provide information about the need of prevention and timely 

treatment of bleeding after childbirth. 

109

Figure 7.7 Percent distribution of RDW, husbands, MIL and FIL who had been exposed to 

information about bleeding after childbirth during their or their wives/DIL’s last pregnancy 

100 

Percent 

80 

60 

40 

53.9 

46.9 48.5 44.2 

20 

0 



Slightly less than half (40.5%-47.0%) of the respondents of all four types reported to have heard 

that bleeding after childbirth could cause maternal death. Comparatively a higher percentage of 

RDW (47.0%) than other three types of respondents reported receiving information that bleeding 

after childbirth could cause death. Likewise about one-third of the RDW, husbands and MIL and 

23% of the FIL had heard about the need for going to health facility promptly in case of bleeding 

after childbirth. Over one in every 10 of the respondents of all four types had also heard about 

the need of getting help from the health workers in case of bleeding after childbirth (Table 7.17). 

The respondents who received information about PPH were also asked about the sources from 

which they got information about the bleeding after childbirth. Radio was reported as the main 

sources of information for the majority of the respondents followed by informal sources such as 

neighbor, family, friends and relatives. Across the four respondent groups, from over three to 

nearly five in every 10 respondents also said they knew about it from TV. The proportion of 

respondents who got information about it from health workers, FCHV and health facility was 

relatively low. Likewise, quite an insignificant percentage of the respondents mentioned print 

BCC materials such as pamphlet/flyer or poster from which they got information about bleeding 

after childbirth. The above findings indicate the need for encouraging health personnel to inform 

people about the bleeding after childbirth, and also to effectively utilize the BCC materials to 

impart knowledge about it to the community people. 

110

Table 7.17 Percent distribution of RDW, husbands, MIL and FIL by type of information they 

heard about bleeding after child birth and their sources 


Type of information received about bleeding 

after childbirth (Multiple Response) 

Can cause death 47.0 42.5 45.1 40.5 

Go to health facility promptly 34.3 32.9 30.7 23.2 

Get help from health worker 15.8 14.8 12.1 11.1 

Causes weakness 1.9 1.4 1.1 0.5 

Other± 0.9 0.3 0.4 - 

None 46.1 53.1 51.5 55.8 

Total (n) 900 292 264 190 

Source of information about bleeding after 

childbirth among respondents who received 

information about PPH (Multiple Response) 

Radio 54.0 65.0 54.7 61.9 

Neighbor/family/friend/ relative 62.1 48.9 61.7 58.3 

Television 31.3 38.7 44.5 36.9 

Health worker 20.6 24.8 18.0 11.9 

FCHV 16.9 11.7 12.5 9.5 

Health facility 8.5 6.6 5.5 6.0 

Women’s group 1.0 0.7 0.8 3.6 

Pamphlet/flyer/poster 2.0 10.9 2.4 2.4 

I myself aware of the problem 0.8 - 0.8 2.4 

Other§ 4.1 3.6 1.6 3.6 

Total (n) 485 137 128 84 

± Other includes: unconsciousness, possibility of fetus death, blurred vision, should take medicines to control bleeding, should 

consult traditional healers, cause anemia. 

§ Other includes: training, newspaper, magazine, street drama, books, TBA, UNICEF, adult literacy class, mother’s group, 

MCHW, experienced person, radio listening group. 

All the respondents were also asked if they or their wives/DIL received any information about a 

medicine that could be taken to reduce bleeding after childbirth during their or their wife’s/DIL’s 

last pregnancy. Data presented in Figure 7.8 reveal that only a small proportion (15 to 19%) of 

the respondents of all four types had received information about the medicine. Overall, 16% of 

the RDW reported receiving information about a drug that could reduce bleeding after childbirth 

during their last pregnancy. 

Figure 7.8 Percent distribution of RDW, husbands, MIL and FIL who received information 

about the medicine that can be taken to reduce bleeding after childbirth during their or their 

wives/DIL’s last pregnancy 

100 

80 

Percent 

60 

40 

20 

16.0 15.8 18.9 

14.7 

0 



111

7.5 Immediate newborn care 

Information regarding knowledge, attitude and practices of the respondents with regard to 

newborn care was collected in the present study. Information related to materials used for cord 

cutting, use of clean delivery kits, timing of the newborn’s first bath, initiation of breathing and 

crying immediately after birth, initiation of breastfeeding including colostrums feeding, and 

drying and wrapping the newborn were collected from the RDW included in the study. Questions 

that seek to measure knowledge of respondents for issues such as timing of the newborn’s first 

bath, and initiation of breastfeeding was also sought from the husbands, MIL and FIL. This 

section thus presents findings on these issues. 

Cord cutting and use of clean delivery kits 

Current international recommendations call for the cord to be cut with a new or sterilized blade 

and for nothing to be subsequently applied to the cord. Of the 900 RDW included in the study, 

889 had given live birth in the past one year period. On the question whether the cord of their 

newborn was cut before the placenta was delivered, slightly over a quarter (26.1%) of the RDW 

said that the cord was cut before the placenta was delivered. About 63% said that the cord was 

cut after delivering the placenta, and about 11% said they did not know about it (Figure 7.9). A 

higher percentage (41.9%) of the RDW who delivered their last child at a health facility 

compared to those who delivered at home with the assistance of SBA (30.8%) or without the 

assistance of SBA (17.1%) reported that the cord was cut before the placenta was delivered 

(Table not shown). 

Figure 7.9 Percent distribution of RDW reporting the time when the cord of their last child 

was cut 

Percent 

26.1 

62.8 

11.1 

100 

80 

60 

40 

20 

0 

Cutting before the placenta 

delivered 

Cutting after the placenta 

delivered 

Do not know 

n=889 

Those RDW (n=889) who had given a live birth in the past one year from the survey date were 

asked about the use of clean delivery kits or clean/new instrument to cut the cord of their child. 

The survey results reveal that 32.3% had used clean delivery kits (CDK). About 10% of the 

women said that the cord was cut by scissor, bamboo stick or unboiled used blade (Table not 

shown. Given the assumption that a clean or new instrument is used to cut the cord for births that 

take place in facilities, the indicator of primary interest is the percentage of RDW delivering at 

home whose newborns’ cord was cut with a clean / new instrument OR a clean birth kit was 

used. The value of this indicator is 89.5%. 

Table 7.18 presents data on differentials on the use of clean delivery kits or other clean 

instruments to cut the cord of the newborn by the selected background characteristics of the 

112

RDW. No significant difference was observed on the use of clean delivery kits or clean 

instruments to cut the cord of the newborn according to the age group of the RDW. However, 

literate respondents are more likely to use “clean delivery kits or other clean instruments”. 

Ethnicity wise data indicate that a higher proportion of the Brahmin or Chhetri had used “clean 

delivery kits or other clean instrument” than the respondents of other ethnic groups. 

Table 7.18 Percent distribution of RDW who used a clean delivery kit or newborn’s cord was cut 

with a clean or new instrument during last delivery by selected background characteristics 

Background characteristics Use of CDK Use of CDK or 

clean instruments 

Number of 

respondents 

Age of RDW (in years) ns ns 

15-19 35.8 95.3 106 

20-24 33.5 93.4 364 

25-29 31.4 93.0 258 

30-34 33.3 91.4 93 

35-49 22.1 91.2 68 

Literacy * * 


Literate 42.7 95.9 511 

Ethnicity * * 



Tharu 23.0 88.5 148 

Dalit 26.8 91.1 112 

Muslim 11.1 87.3 63 


Other 27.1 96.6 59 

Exposure to radio/TV * * 

None 10.0 83.6 110 

Radio only 22.0 89.8 118 

TV only 29.6 87.3 71 


Travel time to the nearest health 

* * 

facility 

Less than 30 minutes 37.0 93.3 449 

30 minutes or more 27.6 93.2 439 

Do not know - - 1 

Number of living children * ns 

Women who had exposure to media, residing near to the health facility, had less than two living 

children and are belonged to the highest SES are more likely use “clean delivery kits or other 

clean instrument” than their respective counterparts. Likewise, the use of “clean delivery kits or 

other clean instrument” was significantly much higher among women who had exposure to 

media, living nearer from the health facility and belonged to the highest SES (Table 7.18). 

Those RDW (n=602) who had not used clean delivery kits during the delivery of their last child 

were asked about the materials used to tie the cord. It is assumed that RDW who deliver in health 

facilities have the cord tied with a new or sterilized string or thread. Among RDW who delivered 

a live newborn at home (n=581), 95% said that a CHDK, “new thread”, or “boiled string or 

thread” was used to tie the cord. Less than 1% of the women also said they used other materials 

such as plastic gripper, gripper (chimti) or ordinary thread and the same percentage (

Table 7.19 Percent distribution of RDW who applied anything on the stump after the baby’s cord 

was cut by their selected background characteristics 



ns 

15-19 25.5 106 

20-24 27.2 364 

25-29 31.0 258 

30-34 32.3 93 

35-49 30.9 68 

Literacy * 



Ethnicity * 



Tharu 38.5 148 

Dalit 33.0 112 



Other 22.0 59 


None 43.6 110 


TV only 25.4 71 



ns 





that they applied on the stump of the cord were turmeric powder (2.2%), sindoor (1.7%) and 

animal dung (1.5%). The above findings clearly indicate the common practice of applying 

various types of unhygienic substances on the stump of the cord of the newborn in the study 

areas, which could lead to the risk of infection. Therefore, it is necessary to educate people about 

risk of applying substances on the stump to the newborn. 

Table 7.20 Percent distribution of RDW by types of substances applied to the cord stump of the 

newborn 

Substances applied on the cord stump (Multiple Response) Number Percent 

Oil 97 10.9 

Ash 65 7.3 

Ointment/powder 55 6.2 

Turmeric/turmeric powder 20 2.2 

Sindoor 15 1.7 

Animal dung 13 1.5 

Liquid medicine/ yellow colored liquid/ red colored liquid 6 0.7 

Dettol (antiseptic solution) 4 0.5 

Other± 10 1.1 


None 527 59.2 

Can not remember 105 11.8 

Total (n) 889 - 

± Other includes: spider, herbal fluid, Cibazol powder, onion fried in oil, spirit, clay from cook stove (Chulako Mato), 

breastmilk, hing and jwano. 

Drying, wrapping and bathing the newborn 

Current international recommendations call for the newborn to be dried and wrapped 

immediately after birth, before the placenta is delivered. Information regarding the current 

practice of drying, wrapping and bathing the newborn in the study areas was collected from all 

the RDW who had delivered live birth in the past one year. Slightly over half of the RDW 

reported that they dried (50.2%) and wrapped in cloth (51.6%) their newborn before the placenta 

was delivered. Over four in every 10 RDW said that their child was not dried before the placenta 

was delivered, and almost the same percentage also said that the child was not wrapped before 

the placenta was delivered (Figure 7.10). By place of delivery, significantly a higher percentage 

of RDW who delivered at a health facility (64.6%) compared to those who delivered at home 

with the assistance from SBA (53.8%) or without assistance from SBA (42.0%) said that their 

baby was dried before the placenta was delivered. Likewise, about 64% of the RDW who 

delivered at health facility followed by 62% who delivered at home with SBA assistance and 

44% without SBA assistance reported that the child was wrapped before the placenta was 

delivered (Table not shown). 

116

Figure 7.10 Percent distribution of RDW who dried and wrapped their newborn before the 

placenta was delivered 

Percent 

100 

80 

60 

40 

20 

0 

50.2 51.6 

43.3 42.2 

6.5 6.2 

Yes No Do not know 

Dried before placenta w as delivered 

Wrapped in cloth before the placenta w as delivered 

n=889 

The RDW were also asked regarding where their newborn was placed before the placenta was 

delivered. Data presented in Figure 7.11 reveal that about 45% of newborns were placed on the 

floor while 23% were placed on the cot. Likewise, 11% of the RDW reported that they 

themselves held the child and another 15% said that the newborn was held by someone else. 

Figure 7.11 Percent distribution of RDW regarding the placement of their newborn 

before the placenta was delivered 

100 

80 

Percent 

60 

40 

20 

0 

45.0 

23.3 

On the floor On the cot With the 

mother 

11.4 15.1 

With som eone 

else 

0.3 

Other 

4.9 

Do not know 

n=889 

Current international recommendations call for the first bathing of the newborn to be delayed and 

take place no sooner than 24 hours following delivery. In order to assess the knowledge of 

respondents regarding the timing of first bath to the newborn, all four types of respondents were 

asked a question “please tell me when should a newborn child be bathed after the birth? Over 

half of the respondents of all types reported that a newborn should be given bath immediately 

after the birth, those giving this response was slightly higher among MIL than other types of 

respondents. More than a quarter of the respondents mentioned “within 24 hours” and about 10% 

(with a slightly lower percentage of FIL) correctly mentioned after 24 hours after birth (Table 

7.21). The above findings, thus, suggest for educating community to give bath to the newborn 

only after 24 hours following the birth. 

117

Table 7.21 Percent distribution of RDW, husbands, MIL and FIL reporting the timing of bathing 

the newborn after the birth 

Timing of first bathing the newborn after the birth RDW Husband MIL FIL 

Immediately after the birth 50.6 50.7 58.0 54.7 

Within 24 hours after birth 32.1 27.7 32.6 27.9 

After 24 hours after birth 10.0 11.3 8.0 6.8 

Other± - 0.3 0.4 0.5 

Do not know 7.3 9.9 1.1 10.0 

Total (n) 900 292 264 190 

± Other includes: immediately after the placenta is out, after half an hour, after one hour, should not be bathed, after umbilical 

cord was cut. 

The RDW were also enquired about when their most recently delivered child was first bathed 

following the birth. The majority of the children were given bath within one hour after the birth 

(44.8%) or between 2-24 hours of birth (32.7%). Only about 17% of the children were given bath 

for the first time more than 24 hours following the birth. It should be noted that this figure is 

higher than that of their reported knowledge as depicted in Table 7.21 (Figure 7.11). By place of 

delivery, significantly a higher percentage of RDW who delivered at a health facility (37.0%) 

compared to those who delivered at home with the assistance from SBA (23.1%) or without 

assistance from SBA (6.3%) said that their child was given bath for the first time more than 24 

hours following the birth (Table not shown). 

Figure 7.12 Percent distribution of RDW by time when they first bathed their youngest child 

Percent 

100 

80 

60 

40 

20 

0 

44.8 

32.7 

17.4 

5.1 

Within 1 hour 2-24 hours After 24 hours Do not know 

n=889 

Crying of the baby after birth 

More than 86% of the RDW said that their last child cried immediately after the birth while 

about one in every 10 babies did not cry after the birth. About 9% of the newborn required some 

sort of help for breathing or crying shortly after the birth. Nearly a quarter each of the RDW said 

they made the baby cry by patting the baby and rubbing on their feet (Table 7.22). Other 

methods used by some of the respondents to make their baby cry included the following: holding 

the baby upside down, mouth-to-mouth resuscitation, rubbing the feet, putting water inside 

mouth, and drying the baby. 

118

Table 7.22 Percent distribution of RDW reporting that their babies cried immediately after birth 

and help needed for breathing or crying the child after birth 


Whether the baby cried immediately after birth 

Yes 767 86.3 

No 100 11.2 


Total 889 100.0 

Whether the baby need any help for breathing or crying shortly 

after birth 

Yes 81 9.1 

No 780 87.7 


Total 889 100.0 

Action taken to help the baby cry or breath at the time of birth 

Rubbed back 18 22.2 

Patting the baby 20 24.7 

Held the baby upside down 9 11.1 

Mouth to mouth resuscitation 6 7.4 

Rubbed the feet 5 6.2 

Sprinkled water/ put water inside mouth/ sprinkled gold dipped 

water (Sunpani) 5 6.2 

Dried the baby 4 4.9 

Squeeze the cord 3 3.7 

Heated the cord 2 2.5 

Other± 5 6.2 

Do not remember 4 4.9 

Total 81 100.0 

± Other includes: placed finger inside the mouth, placed warm cloth on child’s face, trumpeted eating plate (Thaal Bajayeko), 

rubbed on thigh. 

Initiation of breastfeeding 

Current international recommendations call for the newborn to be breastfed immediately after 

birth, at the latest within one hour of delivery. Knowledge of respondents about the timing of 

introducing the breast milk to the newborn was therefore sought during the study. The 

respondents of all types gave different opinion on this aspect. The highest percentage of the 

respondents of all types opined that a child should be breast fed for the first time after bathing, 

those giving this response ranged from 36% to 50%. Likewise, a sizeable proportion of the 

respondents (23.9%-34.9%) correctly mentioned that a child should be breast fed immediately 

after the birth. Overall, 31.7% of the RDW correctly mentioned that a child should be breastfed 

immediately after the birth. Over one in every 10 respondents of all types thought that 

breastfeeding should only be initiated 24 hours post-delivery (Table 7.23). 

119

Table 7.23 Percent distribution of knowledge of RDW, husbands, MIL and FIL regarding the 

correct timing of initiating the breast milk for the first time to the newborn 

Knowledge regarding the correct timing of initiating RDW Husband MIL FIL 

breast milk to the newborn for the first time after the birth 

Immediately after the birth 31.7 34.9 23.9 28.4 

After the placenta is out 5.3 3.4 5.3 8.9 

After bathing the new born 41.6 36.3 50.4 35.8 

After 24 hours after birth 12.3 13.4 16.7 12.6 

Other± 3.6 3.1 3.4 6.3 

Do not know 5.6 7.9 0.4 7.9 

Total (n) 900 292 264 190 

± Other includes: within half an hour, after 2 hours, within one hour, after 3 days, within 24 hours, after 6 hours, within 3 hours, 

after one hour. 

In order to examine the exposure of the respondents on messages related to timing of 

breastfeeding to the newborn, all four types of respondents were asked if they had heard the 

message “A newborn should be breastfed within one hour after birth”. Overall, 47% of the MIL 

followed by 43% RDW, 40% husbands and 38% of the FIL reported that they had heard about it. 

About one-fifth of all respondents reported hearing such a message from radio and more than 

10% each from TV and health workers. A sizeable proportion (8.6%-18.6%) of the respondents 

had also heard about it from their friends. Slightly a higher proportion of the RDW (7.9%) 

compared to other types of respondents (

if they were currently breastfeeding to their youngest child. Almost all (except 2 RDW) reported 

that they were currently breastfeeding their youngest child (Table not shown). 

Figure 7.13 Percent distribution of RDW by initiation of breastfeeding to their last child 

Do not know/not 

breastfed 

1.4% 

During the first 

hour 

33.1% 

More than 1 hour 

65.5% 

n=889 

All the RDW who had given a live birth in the past one year and whose youngest child was still 

alive were asked about the types of liquid and solid foods they gave to the child in the day and 

night preceding the survey day. About 20 liquid and solid food items listed in the questionnaire 

were read out by the interviewer to the respondents. Table 7.25 shows the types of liquid and 

solid foods given to the child by age group of “below 6 months” and “6-11 months”. Nearly twofifths 

of the children below 6 months and 90% aged 6-11 months were given plain water and 

over a quarter of the children below 6 months and more than three-fifths between 6-11 months 

were given animal milk during the specified time period. Nearly half of the children 6-11 months 

old and about 4% below 6 months of age were given daal soup. With respect to the solid food, 

nearly one-fifth of the children below 6 months were given lito. In case of children 6-11 months 

of age about 58% of the RDW said they provided bhat followed by 40% reported feeding 

biscuits and 36% mentioned Jaulo. The exclusive breast-feeding rate for children under 6 months 

— defined as having given nothing other than breast milk to the infant in the 24 hours prior to 

the survey — was estimated at 54%, which is slightly lower than that of the NFHP core program 

districts of 59.9% (NFHP/VaRG 2005). 

121

Table 7.25 Percent distribution of RDW by types of foods given to their children below one year 

of age in the day or night preceding the survey date 

Type of liquid or solid food items given 0-5 months 6-11 months Number 

Plain water 38.4 90.4 64.5 

Honey 3.0 6.9 5.0 

Non-breast (animal) milk 27.1 63.5 45.4 

Infant formula 1.6 1.6 1.6 

Fruit juice 3.2 19.0 11.2 

Daal 3.7 46.1 25.0 

Yogurt or mohi 0.5 8.5 4.5 

Tea 0.7 11.5 6.1 

Ghee 3.5 19.3 11.4 

Other liquids (beans soup/horlicks/ glucose water/ 

vegetable soup) 0.7 1.1 0.9 

Jaulo 6.9 35.6 21.3 

Lito 18.3 23.6 21.0 

Biscuits 7.9 40.1 24.1 

Noodles 0.5 6.2 3.3 

Fruits 3.2 23.2 13.2 

Vegetables 2.3 27.1 14.7 

Bread 0.5 6.2 3.3 

Rice 4.2 57.6 31.0 

Meat, fish or eggs 0.9 9.6 5.3 

Other solids (beans/ peas/ corn/ cerelec/ sweets) 1.2 0.7 0.9 

Exclusive breastfeeding 54.2 4.6 29.3 

Total (n) 432 436 868 

Table 7.26 further shows exclusive breastfeeding rates by month for children aged 0-5 months. 

Table 7.26 Percent distribution of RDW who breastfed their infant exclusively at zero to five 

months by infant’s age 

Age of infant (in month) Number Percent 

0 55 96.4 

1 63 77.8 

2 84 58.3 

3 57 54.4 

4 76 39.5 

5 97 22.7 

Total 432 54.2 

7.6 Newborn care during first month 

Information regarding newborn care during first month was collected mostly from the recently 

delivered women (RDW) included in the study. Aspects covered in this section include the 

knowledge of all the four types of respondents about danger sings of the infant within 7 days 

after birth, newborn health check ups, problems experienced by the newborn and adoption of 

treatment measures. 

122

Knowledge about danger signs and symptoms among the new born 

All the respondents of four types were asked to mention the symptoms of the infant within 7 

days after the birth indicating the need to seek immediate health care. More than 90% of the 

respondents of all four categories were able to mention at least one such symptom. The majority 

of the respondents named poor sucking or feeding (59.6%-67.4%) as a danger sign, followed by 

fast or difficult breathing (35.3%-49.2%) and feeling cold or too hot (25.3%-38.4%) 

respectively. Comparatively, a higher proportion of the MIL was aware of the above symptoms 

than the respondents of other categories. The other symptoms such as pustules on skin (one large 

or more than 10 small ones), severe umbilical infection (redness of skin around the cord) or foul 

smelling discharge or bleeding from the cord stump, considered as the dangers to the newborn, 

were mentioned by relatively a small percentages of the respondents of all types (Table 7.27). 

Overall, 26% of the 889 RDW were able to correctly name three or more newborn danger signs. 

Further analysis reveal that overall, 26% of the 889 RDW who had given live birth in the last 12 

months were able to correctly name three or more newborn danger signs (Table not shown). 


symptoms among the infant within 7 days after delivery indicating the need to seek immediate 

health care 

Types of symptoms of the infant within 7 days after RDW Husband MIL FIL 

delivery indicating the need to seek immediate health care 


Poor sucking or feeding 59.6 59.9 67.4 65.8 

Fast or difficult breathing 49.1 46.2 49.2 35.3 

Feels cold or too hot 38.4 31.2 36.0 25.3 

Fever 22.7 19.9 15.5 16.8 

Pustules on skin 1 large or more than 10 small ones 18.0 15.8 19.3 15.8 

Frequently crying 5.8 12.7 7.6 11.1 

Cough/pneumonia 7.0 8.2 8.7 7.9 

Diarrhea/vomiting 6.4 6.2 8.0 5.8 

Severe umbilical infection redness of skin around the 

cord/ foul smelling discharge OR bleeding from the cord 8.7 5.5 8.7 4.7 

Difficult to wake/lethargic/unconscious 2.7 3.1 7.6 3.7 

Jaundice 6.7 5.1 6.4 2.6 

Not passing stool or urine/ urinary problem 3.7 3.1 3.4 2.6 

Other± 4.6 3.8 0.4 6.3 

Do not know 8.8 8.9 7.2 10.0 

Total (n) 900 292 264 190 

± Other includes: headache, rashes or infection in tongue, nasal discharge, reddish eye, TB, typhoid, not able to cry, dry nose 

and mouth, ear infection, swelling in body, weakness, TT, stomach pain. 

Respondents were asked where they could go or with whom they could seek health services if 

their newborn experienced any of the above discussed danger signs. In response, the higher 

proportion of the respondents of all four categories mentioned hospital (25.2%-37.4%) and 

private clinic or nursing home (20.0%-34.4%) for seeking health services. Likewise more than 

one-fifth of the respondents mentioned PHCC and subhealth post and one in every seven 

mentioned the health post as facilities where they could go for services (Table 7.28). 

123

Table 7.28 Percent distribution of RDW, husbands, MIL and FIL by knowledge about source of 

health services if a child has danger signs 

Knowledge about the sources for health services if RDW Husband MIL FIL 

newborn child has danger signs (Multiple Response) 

Hospital 25.2 29.5 34.8 37.4 

PHCC 23.3 25.3 20.5 24.7 

Health post 17.4 15.8 15.5 14.2 



PHC/OR clinic 0.7 - 0.4 - 

Doctor 0.6 - - - 

Nurse/ANM 1.2 - - - 

HA/AHW 2.9 - - - 

MCHW 0.1 - - - 

FCHV 0.2 - - - 

TTBA - 0.3 - - 

Other§ 3.5 3.7 1.9 2.6 

Do not know - - 0.4 1.1 

Total (n) 900 292 264 190 

§ Other includes: traditional healers, medical shopkeeper, experienced person, FPAN clinic, immunization center. 

Check ups of newborn health 

All RDW (n=876) whose child(ren) born in their most recent delivery was either still alive or 

who died at an age of 2 months or greater were asked whether a health professional, FCHV or a 

traditional birth attendant had checked the health of their newborn. Over half (53.4%) of the 

RDW said that their newborn was checked by any of the health care providers (trained or 

untrained) within one month following the birth. Among the 53% of newborns reported to have 

been checked by the health care providers, 48% were checked for the first time within 3 days, 

and the remaining 5% were checked for the first time within 4 days to 4 weeks following the 

birth (Figure 7.14). 

Figure 7.14 Percent distribution of RDW when newborns were checked for the first time by 

the health care providers within 4 weeks following the birth 

None 

46.6% 

Within 3 days 

48.5% 

n=876 

In 4 days to 4 w eeks 

4.9% 

Table 7.29 shows data on which health care providers were consulted for first-time newborn 

check-ups (within 3 days or in 4 days to 4 weeks). The highest percentage (27.4%) of the 

respondents took their child to nurse or ANM for check ups followed by doctor (23.1%) and HA 

or AHW (6.8%). Likewise, about one percent each of the respondents reported consulting doctor, 

124

nurse or ANM and HA or AHW during their first visit when their child was in 4 days to 4 weeks 

old. 

Table 7.29 Percent distribution of RDW by persons consulted for the first time for the check up of 

their child within 3 days and between 4 days to 4 weeks following the birth, among RDW whose 

child(ren) born in their most recent delivery was either still alive or who died at an age of 2 

months or greater 

Persons who checked on the newborn’s health In 3 days In 4 days to 4 weeks 

during the first three days after birth (Multiple Number Percent Number Percent 

Response) 

Doctor 202 23.1 9 1.0 

Nurse/ANM 240 27.4 9 1.0 

HA/AHW 60 6.8 15 1.7 

MCHW 2 0.2 3 0.3 

VHW 10 1.1 4 0.5 

FCHV 9 1.0 6 0.7 

TTBA 23 2.6 - - 

TBA 7 0.8 - - 

CMA/medical shopkeeper/ experienced health 

worker 22 2.5 2 0.2 

Other (friends/ relative/ traditional healers) 1 0.1 1 0.1 

Do not know / Do not remember - - 1 0.1 

None 451 51.5 833 95.1 

Total (n) 876 - 876 - 

Among RDW with live birth whose infant lived at least two months, 40.2% of newborns 

received care within one day after delivery from a trained provider (i.e., doctor, nurse, ANM, 

HA. AHW, MCHW), while 40.9% received care within three days of delivery from a trained 

provider. Overall, 45.4% of the RDW (n=757) who delivered more than 2 months prior to the 

survey reported that their newborns received care within four weeks of delivery from a trained 

provider. Table 7.30 further presents differentials on the percentage of newborns (still alive or 

born alive but died at age of 2 months or greater) who received newborn care within four weeks 

of birth from a trained provider (such as doctor, nurse, ANM, HA, AHW or MCHW) by the 

selected background characteristics of the RDW. No significant differences were noticed on the 

use of newborn care according to the age of the RDW. Significantly a higher proportion of the 

literate RDW and those who belonged to Brahmin or Chhetri castes reported receiving newborn 

care from the trained health provider than their respective counterparts. The proportion of the 

RDW who received care for their newborn from the trained providers was much lower among 

Tharu, Dalit and Muslims. The proportion of RDW who had received newborn care was 

significantly much higher among those who had exposure to the radio and TV, who had less than 

2 living children, and who belonged to the highest SES than those with no exposure to TV, had 

two or more living children and belonged to the lowest SES. The great majority (94.1%) of the 

RDW who delivered their last child at a health facility followed by 77% of those who had 

delivered at home with the assistance of SBA and 16% of those who delivered at home without 

the assistance from a SBA reported receiving newborn care from trained health providers. 

125

Table 7.30 Percent distribution of RDW whose infant received newborn care within four weeks 

of delivery from a trained health provider by their selected background characteristics, among 

those who delivered 2-11 months prior to the survey 



ns 

15-19 47.3 93 

20-24 48.9 305 

25-29 43.7 229 

30-34 40.0 80 

35-49 38.0 50 

Literacy * 



Ethnicity * 



Tharu 28.6 126 

Dalit 29.3 99 



Other 52.8 53 


None 26.1 92 


TV only 33.3 60 



ns 





Receiving Vitamin A Capsules 

In order to prevent children from Vitamin A deficiency HMG/Nepal has been distributing 

vitamin A capsules to children between 6-59 months two times (in the months of Baisakh and 

Kartik) every year throughout the country. In order to examine the coverage of Vitamin A 

capsule distribution, all the RDW whose child born during their most recent delivery was 6 

months or above age at the time of the last National Vitamin A Day were asked if their child 

received a Vitamin A capsule distributed in Baisakh 2062 (April 15 – May 15, 2005). Of the 272 

children 6 months or above at the time of the last National Vitamin A Day, 93.3% had received 

vitamin A capsule distributed during that time while 6% had not received such capsule (Figure 

7.15). 

Figure 7.15 Percent distribution of children aged 6-11 months receiving vitamin A capsules 

during Baisakh 2062 distribution 

No 

6.3% 

Do not know 

0.4% 

n=272 

Yes 

93.3% 

Counseling on newborn issues 

Those RDW (n=757) who were more than two months of post delivery and whose child born 

during their most recent delivery was still alive or survived until 2 months post-birth were asked 

about types of counseling provided by the health worker, FCHV or TBA on the newborn issues 

either prior to or following her delivery. The specific types of newborn issues were read out by 

the interviewers to the respondents and asked if they were given counseling on these issues. 

More than half (54.0%) of the RDW had received counseling on immunization followed by 

about half each had received counseling on breastfeeding (47.6%) and keeping newborn warm 

(46.5%). Less than two-fifths of the RDW reported receiving counseling on newborn danger 

signs, cord care and special care of small baby. Overall, 53.1% of RDW who delivered more 

than 2 months prior to the survey were counseled by a health worker, FCHV or TBA in at least 

two newborn issues either prior to or following their deliveries. The above findings reveal that 

quite a high percentage of the RDW have not received counseling on newborn issues from the 

health workers or health care providers working in their areas. Hence, it is necessary to give 

proper counseling on these issues to the women for the good health of the newborn. 

127

Table 7.31 Percent distribution of RDW receiving counseling on newborn issues from health 

worker, FCHV or TBA, among those who delivered 2-11 months prior to the survey (n=757) 

Whether a health worker, FCHV or TBA counsel you at any time on Yes No DK 

the following newborn issues prior to or following your delivery 

Keeping the baby warm 46.5 53.4 0.1 

Breastfeeding 47.6 52.3 0.1 

Newborn Danger signs (e.g. fast breathing, poor feeding, less 

weight, fever, cord infection, etc.) 39.2 60.5 0.3 

Cord care 35.5 64.3 0.1 

Special care of small baby 38.7 60.9 0.4 

Immunization 54.0 45.8 0.1 

Neonatal complications and treatment 

Those RDW (n=876) whose child born during their most recent delivery was still alive or 

survived until 2 months post-birth were asked about health problems their child may have 

encountered in the first four weeks following delivery. A set of fourteen complications that may 

occur to the neonates were read out by the interviewers to the respondents who in turn informed 

interviewers if their newborns had experienced the complications. Data presented in Table 7.32 

reveal that fever was the most commonly pronounced complication to the neonates (13.5%) 

followed by trouble in breathing (8.4%), fast breathing (7.6%) and feeding problems (7.0%). 

Chest indrawing and persistent vomiting was mentioned by about 4% each of the respondents. 

More than one-fifth (21.9%) of the children were reported to have suffered from at least one type 

of health problems in the first four weeks following the delivery. Eight out of 876 RDW (0.9%) 

also said that their child suffered from hypothermia. Among these 8 RDW, 5 (62.5%) said that 

they provided care to their child through skin-to-skin contact (Table not shown). 

Table 7.32 Percent distribution of RDW whose infant had experienced complications in the first 

four weeks following the delivery (n=876) 

Types of the health problems experienced by the newborn at Yes 

No 

anytime in the first four weeks following delivery 

Fever 13.5 86.5 

Feeding problem 7.0 93.0 

Trouble breathing 8.4 91.6 

Fast breathing 7.6 92.4 

Chest-in-drawing 4.3 95.7 

Drowsy 2.1 97.9 

Abdominal tenderness 2.2 97.8 

Convulsions 0.7 99.3 

Persistent vomiting 4.3 95.7 

Unconscious 0.5 99.5 

Red/discharging eye 2.6 97.4 

Skin pustules 2.6 97.4 

Skin around cord red 3.1 96.9 

Felt cold 0.9 99.1 

At least one of the above 21.9 78.1 

128

Of the 192 RDW whose newborn experienced complications during the first 4 weeks after birth, 

about 81% said that they had consulted a health facility or health provider for the management of 

complications while 19% did not consult any one. The highest percentage (26.0%) of RDW had 

taken their child to a private clinic or nursing home followed by 19% who took their child to 

PHCC, HP or SHP for consultation. About one in every 10 RDW also said they consulted a 

traditional healer (dhami / jhankri) or other health workers (Table 7.33). Overall, 48.4% of all 

respondents sought care at a health facility for their infant after s/he experienced a danger sign 

during the neonatal period. 

Table 7.33 Percent distribution of RDW by person consulted or places visited for the treatment of 

complications occurred to their last child within four weeks after birth 

Places visited or persons consulted for the problems of the newborn Number Percent 












Consulted MCHW 1 0.5 

Other± 2 1.0 


Total (n) 192 - 

± Other includes: medical shop, gaon ghar clinic, experienced person, person holding diploma in pharmacy from India. 

The 155 RDW who reported seeking care during the illness of their newborn were further asked 

about the timing of seeking services or consultation for the first time. Data presented in Table 

7.34 reveal that nearly half (47.1%) of the RDW had taken their child for consultation on the 

same day of the illness followed by 28% sought medical help on the second day. About 16% 

sought medical help on the third day and another 8% on the fourth or more days. On average, 

respondents delayed 2.1 days following the onset of illness before seeking care for their sick 

newborns. In response to the question “how many days old was your child when you took 

him/her for consultation due to complications?”, nearly two-fifths of the respondents said their 

child was of less than 15 days old and another 31% said that s/he was 15-21 days old. Likewise, 

about 29% of the RDW said their child was between 22-30 days old (Table 7.34). 

129

Table 7.34 Percent distribution of RDW by time that they sought medical help when their child 

had complications within four weeks after birth and age of the child at that time 


How long was your child sick before you sought medical help for 

the first time? (days) 

One day 73 47.1 

Two days 43 27.7 

Three days 24 15.5 

Four or more days 13 8.4 

Not taken for check-up 1 0.6 


Total 155 100.0 

Age of the child at that time (in days) 

0-7 32 20.6 

8-14 28 18.1 

15-21 48 31.0 

22-30 45 29.0 


Mean (SD) 16.2 (9.1) 

Total 155 100.0 

When these 155 respondents were asked for what specific health problem did they seek medical 

help for their child at that time, the highest percentage (38.7%) of the RDW said that their child 

had fever followed by 13% mentioned trouble breathing (Table 7.35). The other problems 

mentioned were: persistent vomiting, skin around cord red, skin pustules, fast breathing and 

feeding problems. When asked what made them decide to seek medical help, the majority 

(69.0%) of the RDW said that their child was very ill followed by 22% said the child showed 

danger sign at that time. Some RDW also said they took the child for medical help because some 

one advised or referred for care (Table not shown). 

The RDW were also enquired about the places where they took their child first for consultation 

for the above mentioned health problems. Data presented in Table 7.35 reveal that the highest 

percentage (32.9%) of the RDW had first taken their child for medical check up to AHW or 

CMA followed by 23% to doctor and 16% to traditional healers. Nearly one in every 10 RDW 

first took their child to the medical shop for treatment. Overall, among neonates who were 

provided care of any type after s/he experienced a danger sign, 64.5% were taken first to a 

trained health worker. 

130

Table 7.35 Percent distribution of RDW who first sought medical help according to the health 

problems to their newborn 


Type of health problem the newborn had at that time 

Fever 60 38.7 

Trouble breathing 20 12.9 

Persistent vomiting 12 7.7 

Skin around cord red 12 7.7 

Skin pustules 11 7.1 

Fast breathing 11 7.1 

Feeding problem 9 5.8 

Chest-in-drawing 5 3.2 

Drowsy 3 1.9 

Abdominal tenderness 3 1.9 

Red/discharging eye 3 1.9 

Convulsions 1 0.6 

Other (cold or cough/ pneumonia) 5 3.2 

Total 155 100.0 

Persons consulted for the first time for health problem 

AHW/CMA 51 32.9 

Doctor 35 22.6 

Traditional healer 24 15.5 

Medical shop 14 9.0 

Nurse 6 3.9 

ANM 5 3.2 

Private practitioner 5 3.2 

HA 2 1.3 

Family member 2 1.3 

MCHW 1 0.6 

VHW 1 0.6 

FCHV 1 0.6 


Other± 1 0.6 

Not taken for check up/ given medicine at home 6 3.9 

Total 155 100.0 

± Other includes: person holding diploma in pharmacy from India, not taken to hospital as the child is just 3 days old, medical 

shopkeeper. 

These 155 RDW were further asked to name all of the providers with whom they consulted when 

their child had health problems. The possible responses were read out by the interviewers to the 

respondents who answered them in turn. The results are presented in Table 7.36. Over one-third 

(35.5%) of the RDW reported of consulting with the AHW or CMA followed by 32% mentioned 

traditional healers. About one-fifth of the children were also taken to the doctor or medical shops 

for treatment. Likewise 17% of the RDW also said that they took their child to private 

practitioner for check ups. Overall, among neonates who were provided care of any type after 

s/he experienced a danger sign, 78.7% were taken at some point to a trained health worker or a 

health facility. The overall findings reveal that aside from modern health facility, the practice of 

consulting traditional healers during newborn sickness was found to be common in the study 

areas. 

131

Table 7.36 Percent distribution of RDW places visited or persons consulted when their child had 

problems within 4 weeks following the birth (n=155) 

Whether visited any of the following providers for this 

Yes 

No 

health problem 

AHW/CMA 35.5 64.5 

Traditional healer 31.6 68.4 

Medical shop 19.4 80.6 

Private practitioner 16.8 83.2 

ANM 6.5 93.5 

Nurse 5.8 94.2 

HA 2.6 97.4 

FCHV 1.9 98.1 

Trained TBA 1.3 98.7 

VHW 1.3 98.7 

MCHW 1.3 98.7 

Untrained TBA 0.6 99.4 

Doctor 22.6 77.4 

The RDW (n=155) were also asked if they sought care from the health facility in addition to the 

health care providers when their newborn had problems within four weeks after the birth. Of the 

155 RDW whose child had complications, over two-thirds (68.4%; n=106) affirmed to have 

sought services from the health facility. Among those who sought services from the health 

facility, 6 (5.6%) respondents said that their child was admitted there for one to 12 days (Table 

not shown). Those RDW (n=100) who sought services from a health facility but did not admit 

their child there were asked about number of times they visited health facility for consultation. In 

response, about two-thirds said that they visited only once and over one quarter visited twice. 

Only 9 of the 100 RDW visited 3 times or more to the health facility for the treatment of their 

child (Table not shown). 

Those RDW (n=49) who did not seek care from a health facility when their child had health 

problems were enquired about the reasons for not seeking care from the health facilities. More 

than half of these 49 RDW said that they did not feel it necessary to take the child for 

consultation. About one-fifth of these RDW said that they had called TBA, FCHV or CMA at 

home for check ups. About one in every 10 of these 49 RDW gave the reasons such as: no 

reliable services available, financial problems, and inaccessible for not taking their child to the 

health facility (Table not shown). 

Size of newborn at birth and weight 

The judgment of the RDW whose last delivery was a live birth regarding the weight of their 

newborn at birth was also sought during interview. On the question “when your child was born, 

was s/he very large, larger than average, average, smaller than average or very small?” about 

37% said that their child was of average size at birth and about 42% mentioned the child was 

very large or larger than average. About one-fifth (20.8%) of the RDW said that their child was 

very small or smaller than average (Figure 7.16). 

132

Figure 7.16 Percent distribution of RDW reporting the size of their child at birth 

Percent 

100 

80 

60 

40 

20 

0 

3.6 

Very large 

38.1 37.3 

Larger than 

average 

Average 

17.2 

Smaller than 

average 

3.6 0.1 

Very small 

Do not know 

n= 889 

RDW with live birth (n=889) were also asked if their child was weighed at birth or at any time 

after birth. Over two-fifths (42.7%) of the RDW reported that their newborn was weighed. 

When further analyzed by place of delivery of the child, 93% of the children delivered at a health 

facility followed by 27% of children who were delivered at home with the assistance of SBA and 

16% without SBA’s assistance were reported to be weighed (Table not show). Those RDW 

(n=380) who reported of their child was weighed were again asked when s/he was weighed for 

the first time. Nearly two-thirds (64.2%) of the children were weighed on the same day of birth, 

and 11% were weighed within 1-3 days of birth. Over one in every 10 RDW said that their 

children were weighed after 43 days or more of birth (Figure 7.17). 

Figure 7.17 Percent distribution of RDW by time when the child was first weighed among 

RDW whose infant has been weighed at any time 

Percent 

100 

80 

60 

40 

20 

0 

64.2 

11.3 12.1 12.1 

Same day Within 1-3 days Within 4-42 days After 43 or more 

days 

0.3 

Do not know 

n=380 

Availability of maternal and newborn services 

In order to assess the status of the availability of maternal and newborn services in the 

community all the RDW who had given a live birth in the past one year were asked “During the 

past 12 months have you ever requested any of the following services and been told that they 

were not available?” The interviewers read out the specific types of services to the respondents. 

The vast majority of the respondents claimed that they had never requested any of the listed services 

and been told that they were not available during the past 12 months (Table 7.37). Among the listed 

services, comparatively a higher number (5.3%) of RDW reported that they had to come back 

133

from the health facility without getting child vaccinated while quite a smaller percentage of the 

RDW said so for other types of services. 

Table 7.37 Percent distribution of RDW who had to come back from the health facility without 

getting desired services related to their or their newborn’s health 

During the past 12 months have you ever requested any of the Yes No DK Number 

following services and been told that they were not available?” 

Vitamin A for your child ± 0.9 98.3 0.8 889 

Vitamin A for yourself 0.6 98.3 1.1 900 

Iron tablets 1.3 97.3 1.3 900 

Tetanus toxoid 1.2 97.9 0.9 900 

Contraceptives 0.3 98.4 1.2 900 

Child vaccinations ± 5.3 94.0 0.7 889 

Treatment for childhood illness (for example, pneumonia, 0.9 98.3 0.8 889 

diarrhea, severe bacterial infection) ± 

While visiting for ANC/ while visiting for check ups 0.7 99.3 - 900 

± Among RDW with live birth. 

134

Chapter 8 

Birth Preparedness, Access to Emergency Funds and Transportation 

The NFHP has planned to implement the Birth Preparedness Package (BPP) to promote 

improved antenatal, delivery and postpartum preparations and care in its program districts. These 

components include encouraging people for the arrangement of money, transport, food items, 

clothes, identification of suitable blood donors, and trained health workers to be present at 

delivery. Information regarding the preparation of such items made for both the normal and 

emergency delivery by the RDW themselves and their family members during the recent 

childbirth was collected in the present survey. Likewise, information on the availability of the 

financial schemes in the study areas for the emergency delivery was also sought. Thus, this 

chapter discusses on these issues. Results for key CB-MNC Core Indicators are included in the 

table below. 

CB-MNC Core Indicators for birth preparedness, access to emergency funds and transportation 


Estimates 

(n) 

11.1 Mean value of birth preparedness index (BPI) among RDW who delivered 2- 

11 months prior to the survey., where the BPI for each respondent is 

calculated as the percentage of the following seven factors that the respondent 765 51.6 

reports: 

1. … received pre-natal care at least one time by a trained provider during last 


2. … names prolonged labor as a danger sign during delivery 765 87.2 

3. … names excessive bleeding as a danger sign during delivery 765 66.5 

4. …family made financial preparations for emergencies. 765 47.6 

5. … family made preparations for emergency transportation. 765 2.9 

6. … birth was attended by skilled provider. 765 37.4 

7. … received post-partum care within 6 weeks of delivery from a trained 

provider. 765 45.9 

11.2 Percentage of RDW who made at least two types of preparations for delivery: 900 51.1 

11.12 Percentage of RDW who set aside money for care during the delivery 900 34.6 

11.3 Percentage of RDW who arranged for a health worker or TBA to attend their 

last delivery 900 8.6 

11.4 Percentage of RDW who arranged to deliver their last child in a health facility 900 15.2 



• At least two types of preparation from points 1-5 

11.17 Percentage of RDW who can identify the location of a qualified health 

facility to go to in case emergency during delivery 889 88.2 

13.3 Percentage of RDW who know of any individuals in their community that 

loan money to women who need it for an emergency during pregnancy or 

delivery 

13.4 Percentage of RDW who borrowed money from individuals in their 

community that loan money to women who need it for an emergency during 

pregnancy or delivery 

900 

900 

48.7 

10.4 

900 91.2 

900 28.7 

13.5 Percentage of RDW who used transportation because of obstetric emergency 

during most recent delivery 900 35.8 

135

8.1 Birth preparedness 

Preparation for delivery 

All the RDW, husbands, MIL and FIL were asked if they had made any preparation for their or 

their wives’/DIL’s recent delivery. In response, just over two-thirds of the RDW (67.9%) said 

that they had made some sort of preparation for the childbirth. The percentage of those giving a 

positive response was slightly higher among the husbands and MIL and lower among the FIL 

(Table 8.1). The highest proportion (55.8%-77.1%) of the respondents of all types said that they 

had arranged money for the last birth; those giving this response was much higher among 

husbands and lower among FIL. Arrangement of foods was the second in order of preparedness 

for delivery, which was mentioned by about 60% of the MIL, 48% of RDW, 47% of husbands 

and 45% of FIL. Arrangements of blood transfusion, emergency transport, trained attendant, and 

health facility are considered as the important components of the birth preparedness package, 

however, quite a small proportion (

delivery. Women with low parity and those belonging to the highest SES are more likely to make 

preparation for the delivery than their respective counterparts. 

Table 8.2 Percent distribution of RDW who made any preparations during their last pregnancy 

for their delivery by selected background characteristics 



15-19 70.1 107 

20-24 68.7 367 

25-29 73.3 262 

30-34 57.3 96 

35-49 54.4 68 

Literacy * 



Ethnicity * 



Tharu 59.1 149 

Dalit 65.8 114 



Other 66.1 59 


None 45.9 111 


TV only 74.6 71 



they sold livestock and other items to manage expenses incurred during delivery. The average, 

minimum and maximum amount they spent for the management of delivery expenses are 

presented in Table 8.3. 

Table 8.3 Percent distribution of RDW by ways of managing expenses incurred during the 

delivery of the last child among all RDW (n=900) (Multiple Response) 

Ways of managing expenses Percent and number 

Amount (in Rs) 

Percent Number Average Minimum Maximum 

Borrowed money 28.7 258 3020 100 15000 

Spend savings 51.1 460 2811 35 15000 

Relatives contributed 5.7 51 2049 200 8000 

Selling of livestock and poultry/ 

selling of paddy/ selling of liquor 2.2 20 3355 100 14000 

Other± 2.7 24 2650 100 10000 

± Other includes: wage labor, selling bicycle, salary, parents gave money, husband sent money from abroad, 

business, selling rickshaw, driving. 

Table 8.4 further shows data on expenses incurred during the delivery of the last child among the 

women who delivered at the health facility or at home and persons with whom they received 

assistance during delivery. As expected, the average expenses incurred for the C-section was 

much higher (Rs. 9,162) followed by Rs. 4,745 for delivery at health facility with elective but not 

C-section. On an average, Rs 1,865 was spent for the delivery at home attended by SBA or 

trained health worker. 

Table 8.4 Percent distribution of RDW by ways of managing expenses incurred during the 

delivery of the last child according to the place of delivery or type of assistance received, among 

RDW whose most recent delivery resulted in live birth (n=889) 

Description 

No of Minimum Maximum Median Average 

cases 

At health facility 

C-section 48 0 22000 10000 9162 

Emergency admission but not C- 159 0 24300 4000 4630 

section 

Elective and not C-section 101 0 23000 3000 4745 

At home 

Use of SBA or trained health worker 77 0 7000 1600 1865 

Use of TTBA/TBA or someone else 450 0 16000 300 938 

outside family 

Use family only 54 0 3000 150 580 

Total 889 0 24300 120 2534 

All RDW (n=900) were asked if they set aside any money for care specifically during delivery. 

Approximately 35% of the RDW reported that they had arranged money specifically for care 

during delivery (Table 8.5). RDW who reported that they had set aside money were asked how 

much they set aside. Among these 311 RDW, the average amount of money that they set aside 

was NR 3,107. The highest percentage (37.0%) of respondents said that they or their family had 

set aside Rs 1,000 – Rs 2,000 followed by about 25% who had set aside more than Rs 4,000. 

About 15% of the RDW mentioned that they had set aside less than one thousand rupees. 

138

Table 8.5 Percent distribution of RDW who or whose family members arranged money for care 

during the delivery 


Whether you or any members of your family set aside any money 

specifically for care during the delivery 

Yes 311 34.6 

No 589 65.4 

Total 900 100.0 

Amount of money set aside specifically for care during the 

delivery (in rupees; among RDW who set aside money for care 

during delivery) 

8.6% of the RDW reported arranging a trained health worker, prior to the delivery, to attend their 

last delivery (Table 8.7). This finding indicates the need to educate the community in the study 

areas about the importance of arranging the trained health workers ahead of time in attending the 

delivery. 

Table 8.7 Percent distribution of RDW who had arranged ahead of time for someone to attend 

their last delivery 

Persons arranged ahead of time to attend the delivery (Multiple Response)) Number Percent 

Doctor 33 3.7 

Staff nurse 21 2.3 

ANM 18 2.0 

MCHW 5 0.6 

HA 1 0.1 

AHW/CMA 21 2.3 

VHW 2 0.2 


Untrained TBA 10 1.1 

FCHV 15 1.7 

Relative/friend 46 5.1 

Other (sister-in-law/ mother/ medical shopkeeper) 5 0.5 

No one 756 84.0 

Total (n) 900 - 

Data that describe the percentage of RDW who arranged ahead of time for a trained health 

worker to attend their last delivery, stratified by selected background characteristics of the RDW, 

are presented in Table 8.8. A slightly higher proportion of younger women compared to elder 

ones reported arranging ahead of time for a trained health worker to attend their last delivery; 

however, the observed difference was not statistically significant. Those arranging trained 

attendant in advance was much higher among literate respondents, and RDW belonging to 

Brahmin / Chhetri / Tibeto-Burman ethnic groups, than their respective counterparts. Likewise, 

significantly a higher proportion of the RDW with exposure to media reported arranging a 

trained birth attendant than those not exposed to it. Similarly, a strong association between the 

advance arrangement of a trained attendant and the SES of the RDW was also observed as a 

greater percentage of women in the highest SES stratum reported arranging of trained attendant 

as compared to those in lower SES strata. 

140

Table 8.8 Percent distribution of RDW who arranged ahead of time a trained health worker to 

attend their last delivery by their selected background characteristics 



ns 

15-19 7.5 107 

20-24 10.1 367 

25-29 8.0 262 

30-34 8.3 96 

35-49 4.4 68 

Literacy * 



Ethnicity * 



Tharu 4.0 149 

Dalit 3.5 114 

Muslim 1.5 65 


Other 5.1 59 


None 2.7 111 


TV only 4.2 71 



Table 8.9 Percent distribution of RDW by prior arrangement of place to deliver their last child 

Places arranged for the delivery of the last Number Percent 

At home 175 19.4 


Private clinic / nursing home 45 5.0 

Primary health care center 9 1.0 



Other (medical shop/ parents home) 2 0.2 

No 586 65.1 

Total 900 100.0 

Differentials on the arrangement of health facility to deliver the child by the selected background 

characteristics of the RDW reveal that a lower percentage of respondents between 20-24 years 

arranged the health facility than the respondents of other age group, however, the observed 

difference was not statistically significant. A significantly higher proportion of the literate 

respondents as compared to the illiterate ones had arranged health facility to deliver their last 

child (Table 8.10). Ethnicity wise data reveal that Muslim, Dalit and Tharu castes are less likely 

to arrange health facility for delivery while Brahmin and Chhetri are more likely to do so. 

Distance to the health facility have also significant effect on the arrangement of the health 

facility as 18% of the RDW residing within a distance of less than 30 minutes compared to only 

12% residing in a distance of 30 minutes or more reported of arranging health facility to deliver 

their last child. Likewise, a higher proportion of the women who had exposure to media, had less 

than 2 living children and belonging to the category of the highest SES reported arranging the 

health facility than their respective counterparts. 

142

Table 8.10 Percent distribution of RDW who arranged to deliver their last child in a health 

facility by their selected background characteristics 



ns 

15-19 13.1 107 

20-24 16.9 367 

25-29 14.5 262 

30-34 15.6 96 

35-49 11.8 68 

Literacy * 



Ethnicity * 



Tharu 7.4 149 

Dalit 9.6 114 

Muslim 1.5 65 


Other 8.5 59 


None 3.6 111 


TV only 7.0 71 


Travel time to the nearest health facility * 



Do not know 100.0 1 


of foods (Table not shown). Only 1.4% of all RDW were able to name two or more types of 

preparation that they made for the post-delivery period. Differentials by background 

characteristics on the preparation for care of the mother and newborn during the first month of 

the delivery was also observed significantly according to the literacy status of the women, their 

ethnicity, exposure to media, number of living children, and their SES. Literate women are 

significantly more likely to make preparation than illiterate ones. The practice of making 

preparation for care of the mother and newborn during the first month of the delivery was 

significantly lower among Muslim, Tharu and Dalit women as compared to the women of other 

ethnic groups. Likewise, women who had exposure to media, have less than 2 living children, 

and who belong to the highest SES group are more likely to make preparation for care of mother 

and children in the first month of delivery than their respective counterparts (Table 8.11). 

Table 8.11 Percent distribution of RDW who made any preparation for care of the mother and 

newborn during the first month following the delivery by selected background characteristics 



ns 

15-19 19.6 107 

20-24 23.2 367 

25-29 26.3 262 

30-34 17.7 96 

35-49 27.9 68 

Literacy * 



Ethnicity * 



Tharu 14.1 149 

Dalit 23.7 114 

Muslim 6.2 65 


Other 18.6 59 


None 12.6 111 


TV only 15.5 71 



Preparation for emergency during pregnancy, delivery or postpartum 

All four types of respondents included in the study were asked if they had made any preparations 

for emergencies during their or their wife’s/DIL’s last pregnancy, delivery or after delivery. In 

response, about 65% of the husbands followed by 59% MIL and 52% FIL reported that they had 

made preparations. A smaller percentage (48.7%) of the RDW compared to their husbands and 

in-laws gave an affirmative response. Data presented in Table 8.12 indicate that people in the 

study areas have a tendency to make financial preparations as opposed to other types of 

preparations as nearly two-thirds (64.4%) of the husbands followed by 58% MIL, 52% FIL and 

48% RDW reported making financial preparation. Preparation for other issues such as 

transportation, identification of health workers and facility, and blood, which are considered as 

the basic components of the birth preparedness packages, were made by quite a small proportion 

of the respondents of all four categories. Only 10.4% of all RDW named two or more types of 

preparation that they made for emergencies. It is therefore necessary to disseminate information 

to the community about the need of making such preparations for the emergencies during 

pregnancy, delivery and postpartum period. 

Table 8.12 Percent distribution of RDW, husbands, MIL and FIL by types of preparations for 

emergencies during their or their wife/DIL’s pregnancy, delivery or after delivery 


(n=900) (n=292) (n=264) (n=190) 

Whether made any preparation for 

emergencies during your /your wife’s or DIL’s 

pregnancy, delivery, or after delivery 

Yes 48.7 65.4 59.1 52.1 

No 51.3 34.6 40.9 47.9 

Kinds of preparation made (Multiple 

Response) 

Financial 47.6 64.4 58.3 51.6 

Identification of health worker 4.8 6.2 7.6 7.9 

Transport 2.7 5.5 2.3 5.3 

Identification of facility 6.1 7.9 6.4 5.8 

Blood 0.3 0.3 - 1.1 

Food/ oil/ ghee 0.2 - 1.1 - 

Other (friends, TBA, clothes for new born) 0.5 - - 0.5 

Nothing 51.3 34.6 40.9 47.9 

Table 8.13 further shows differential in whether or not RDW prepared for emergencies during 

their last pregnancy, delivery or postpartum by their selected background characteristics. Age 

wise data indicate that significantly a higher proportion of the younger women compared to their 

elder counterparts reported of making preparation for emergencies. Likewise, over 60% of the 

literate RDW as against only 33% illiterate ones reported of doing so. With respect to the 

ethnicity or castes of the respondents, quite a small proportion (21.5%) of the Muslim women 

compared to over 60% of the Brahmin or Chhetri and Tibeto-Burman reported that they had 

made preparation for emergency. Exposure to media, parity, distance to the health facility and 

SES of the RDW was also strongly associated with that of making preparation for emergency. 

145

Table 8.13 Percent distribution of RDW who made any preparation for emergencies during 

pregnancy, delivery, or after delivery by their selected background characteristics 



15-19 52.3 107 

20-24 52.0 367 

25-29 49.6 262 

30-34 38.5 96 

35-49 35.3 68 

Literacy * 



Ethnicity * 



Tharu 39.6 149 

Dalit 43.0 114 



Other 50.8 59 


None 17.1 111 


TV only 38.0 71 


Travel time to the nearest health facility * 





making decision on these issues. Nearly 9 in every 10 responding husbands claimed that they 

get involved in making decision whereas over 76% of the MIL and over 84% of FIL said that 

they themselves are involved in this matter. It is clear that husbands, MIL and FIL all have roles 

as decision makers with respect to the financial and transportation issues. 

Table 8.14 Percent distribution of husbands, MIL and FIL reporting the main decision makers in 

the family with respect to the emergency care during their wives/DIL pregnancy or delivery 

Description Husbands MIL FIL 

(n=292) (n=264) (n=190) 

Persons in the family involved in making the decision 

regarding financial and transportation issues if your 

wife/DIL needs emergency care during her pregnancy 

or delivery (Multiple Response) 

Her father-in-law 24.7 54.2 84.2 

Her mother-in-law 23.3 76.1 62.6 

Her husband 89.4 61.7 62.1 

Wife / DIL 31.8 20.5 16.3 

Family members ± 7.9 4.5 4.2 

Other (neighbors) 1.0 - - 

Person in the family most responsible for making the 

final decision regarding financial and transportation 

issues with regard to emergency care during your 

wife’s/DIL’s pregnancy or delivery 

Her father-in-law 12.7 31.4 55.8 

Her husband 77.4 34.5 27.9 

Her mother-in-law 6.5 29.9 12.6 

Wife / DIL 1.7 3.4 2.1 

Family members ± 1.4 0.8 1.6 

Other (neighbors) 0.3 - - 

± Other family member includes: sister, brother, sister-in-law, father-in-law, mother-in-law, uncle. 

Furthermore, the husband, MIL and FIL were asked "in your family, who is the family member 

who is most responsible for making the final decision on financial and transportation matters 

relating to emergency care during wife's/DIL’s pregnancy or delivery?” Data presented in Table 

8.14 reveal that husbands seemed to be the main or final decision maker relating to these matters 

as reported by husbands (77.4%) and, to a lesser extent, by MIL (34.5%). However, over half 

(55.8%) of the FIL reported that they themselves make the final decision in this matter. 

The Birth Preparedness Index (BPI) 

The BPI is an index that is constructed from seven indicators that measure different aspects of 

the birth preparedness process. The BPI is calculated at the level of the individual RDW (among 

those who delivered 2-11 months prior to the survey) as the percentage of the following seven 

components that a RDW reports: 1) received antenatal care at least one time by a trained 

provider during last pregnancy; 2) names prolonged labor as a danger sign during delivery; 3) 

names excessive bleeding as a danger sign during delivery; 4) made financial preparations for 

emergencies during last pregnancy; 5) made preparations for emergency transportation during 

last pregnancy; 6) last birth was attended by skilled provider (defined as physician, nurse, ANM, 

or MCHW); and, 7) received post-partum care within 6 weeks of delivery from a trained 

provider following most recent delivery. The mean value of the BPI as measured in this survey 

147

was 52% across the 765 RDW respondents who delivered the live birth 2-11 months prior to the 

survey. 

8.2 Access to emergency funds and transportation 

This section deals with the formal and informal sources of lending in the community and 

borrowing status of the RDW and husbands, MIL and FIL of RDW. Availability and use of 

transport means to get emergency care by the RDW during their last delivery is also discussed in 

this section. 

Existence of individuals and groups in the community which lend money for women’s health 

All the respondents of four categories were asked if there are any individuals and groups in their 

areas that lend money to women in order to meet emergency during pregnancy or delivery. Over 

92% of the husbands followed by, 91% RDW, 90% FIL and 89% MIL said that there are 

individuals who lend money for an emergency during pregnancy or delivery (Figure 8.1). About 

29% of all RDW reported that they borrowed money from individuals in their community for an 

emergency during pregnancy or delivery (Table not shown). 

Figure 8.1 Percent distribution of husbands, MIL and FIL of the RDW reporting the existence 

of individuals in their areas that loan money to women who need it for an emergency during 


100 

91.2 92.1 89.4 90.0 

Percent 

80 

60 

40 

20 

0 


n= 900 RDW, 292 husband, 264 MIL and 190 FIL 

When asked about the existence of any groups in their respective areas that lend money to 

women in need for an emergency during pregnancy or delivery, the percentage of the 

respondents affirming the existence of such groups ranged from 29% (of RDW) to about 40% (of 

FIL); Table 8.15). All respondents were asked to mention the types of groups existing in their 

areas. Of the type of lending groups mentioned existing in their areas, saving and credit scheme 

was mentioned by relatively a higher percentage of respondents (13.0%-17.9%) followed by the 

local non-governmental organizations (6.4%-10.5%) and mothers group (2.7%-4.1%) 

respectively. The other types of groups which lend money to women for an emergency during 

pregnancy or delivery as mentioned by a few percentages of the respondents were mothers 

group, commercial banks, women related groups, poverty alleviation groups and so on. 

148

Table 8.15 Percent distribution of RDW, husbands, MIL and FIL by knowledge about existence 

of group that lend money to women who need it for an emergency during pregnancy or delivery 


(n=900) (n=292) (n=264) (n=190) 

Knowledge about the existence of groups in the 

areas that loan money to women who need it 

for an emergency during pregnancy or delivery 

Yes 29.1 32.2 34.5 39.5 

No 70.9 67.8 65.5 60.5 

Kinds of groups (Multiple Response) 

Saving and credit scheme 13.0 14.4 17.0 17.9 

Local non-governmental organization 6.4 8.9 9.1 10.5 

Mothers group 4.1 2.7 3.4 3.7 

Poverty alleviation group 2.2 2.4 1.1 0.5 

Bank 2.1 1.0 1.9 3.7 

Women related group§ 1.7 1.7 3.0 2.1 

Other group± 2.3 2.4 2.3 4.2 

§ Women related group includes: Women Welfare Group, Pashupati Women Group, Women Upliftment Service Group, Women 

Progress Cooperative Society, Progressive Women Group, Suryodaya Women Group, Women Animal Raising Group. 

± Other group includes: Janajati Group, Lali Gurans Group, Tharu Samuha/Laxmi Samuha, Shakti Karyakram Samuha, 

Hariyali Samuha, Shakti Samuha, Naulapur Samuha, Kamaiya Samuha, Sungabha Samuha, Deurali Samuha, Krishi Samuha, 

Panchamala Samuha, Grameen Samuha, Prem Jyoti Samaj Samiti, Samudayik Samuha. 

A total of 3% out of all 900 RDW said they had borrowed money from these groups for an 

emergency during their most pregnancy or delivery (Table not shown). However, quite a higher 

percentage of husbands and MIL compared to those of RDW reported borrowing money either 

from individuals or groups for an emergency during their wives/DIL’s most recent delivery. For 

instance, more than a quarter (26.7%) of 292 husbands, and 32% each of the 264 MIL and 190 

FIL reported that they had borrowed from any of the sources to meet the emergency during their 

wives/DIL’s most recent pregnancy or delivery (Table not shown). 

Availability of transport schemes 

All four categories of the respondents were also asked about the availability of transportation in 

their areas for women who have an emergency during pregnancy or delivery. The majority 

(>85%) of the respondents of all four categories reported about the availability of ambulance 

services followed by nearly half mentioned the availability of bus services in case of emergency 

during pregnancy or delivery. Availability of rickshaw or ox cart was also mentioned by nearly 

one-third of the respondents of all four categories. Nearly one-fifth of the respondents also 

mentioned about the availability of taxi for an emergency. The above findings clearly indicate 

that women in the study areas have access to different transport means for emergency needs. 

149


availability of transportation for women who need it for an emergency during pregnancy or 

delivery 

Types of transportation available in the area for women RDW Husband MIL FIL 

who have an emergency during pregnancy or delivery 


Ambulance 86.8 87.7 88.3 90.0 

Bus 47.1 41.4 43.6 42.1 

Rickshaw 35.2 38.0 35.2 33.2 

Ox cart 32.6 34.9 32.2 31.1 

Taxi 18.2 18.2 16.7 18.4 

Carried 12.8 13.0 10.6 12.6 

Motorcycle 3.3 5.8 4.2 4.2 

Jeep/van 5.0 4.5 4.5 3.7 

Tempo 2.2 2.1 2.3 3.2 

Bicycle 1.9 6.5 3.0 3.2 

Private car 3.0 3.1 2.7 2.6 

Tractor 2.2 1.4 1.9 1.6 

Other± 1.2 1.4 1.1 1.6 

Three wheeler (similar to rickshaw but made of wood) 1.4 - 2.3 1.1 

Total (n) 900 292 264 190 

± Other includes: truck, Jholi – stretcher made at local level, bullock cart, doli, stretcher. 

All the RDW were also asked whether they were in need of transportation due to obstetric 

emergency during their most recent delivery. In response, over one-third (36.1%; or n=325) of 

the 900 RDW reported that they were in need of transportation (Table not shown). Of the RDW 

(n=325) who were in need of transportation due to obstetric emergency, almost all (99.1%; or n= 

322) out of 325 RDW said that they used the transportation to go to the health facility or health 

care providers (Table not shown); thus, a total of 35.8% (322/900) of RDW used transportation 

because of obstetric emergency during most recent delivery. Among these 322 respondents, the 

majority (67.4%) reported that they used an ambulance. Slightly over one in every 10 RDW who 

used emergency transportation reported using either bus or rickshaw and another 6% reported 

using a taxi (Table 8.17). Further analysis reveals that about 64% of the women used ambulance 

for emergency delivery while 36% had used it to go hospital or health facility for elective 

delivery. 

150

Table 8.17 Percent distribution of RDW by type of transport used to go health facility or health 

personnel due to obstetric problems during their last delivery 

Type of transportation used (Multiple Response) Number Percent 

Ambulance 217 67.4 

Bus 37 11.5 

Rickshaw 35 10.9 

Taxi 20 6.2 

Ox cart 19 5.9 

Jeep/van 9 2.8 

Private car 7 2.2 

Motorcycle 3 0.9 

Tractor 1 0.3 

Carried 1 0.3 

Bicycle 1 0.3 

Other± 8 2.5 

Three wheeler (similar to rickshaw but made of wood) 6 1.9 

Total (n) 322 - 

± Other includes: truck, Jholi – stretcher made at local level, bullock cart, doli, stretcher. 

Those RDW who reported using emergency transportation to go to health facility or health 

personnel during their last delivery due to obstetric problems were asked about the amount they 

spent for the transportation. Data presented in Table 8.18 reveal that, among those 322 RDW 

who used emergency transportation, more than one-third (35.7%) had spent less than Rs 500 

followed by 29% spent Rs 500-999 and another 24% spent Rs 1,000 or more. About 8% of the 

RDW said they used their own transport means. When enquired about the source of money that 

they used to meet transportation costs incurred during the obstetric emergency, more than 6 in 

every 10 RDW reported to have used their personal savings and about a quarter said that they 

took a loan. 

151

Table 8.18 Percent distribution of RDW by amount they spent for transport while going to the 

health facility or health personnel due to obstetric problems during their last delivery 


Amount spent for the transportation (in Rs) 

Less than 200 41 12.7 

200-499 74 23.0 

500-999 92 28.6 

1000 or more 76 23.6 

Neighbor or familiar person did not charge money/ local ambulance 5 1.6 

Own transport means 25 7.8 


Total 322 100.0 

Source of money for transportation 

Used savings 199 61.8 

Took loan 77 23.9 

Used my own means 20 6.2 

Performed labor 5 1.6 

Sold personal goods 1 0.3 

Other± 20 6.2 

Total 322 100.0 

± Other includes: husband is driver, money not charged, father-in-law arranged money, brought from parents, sold food grains, 

used money sent by husband from abroad. 

152

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SCF US, (2001): Saving Newborn Lives. State of the World’s Newborns. Washington DC: Save 

the Children Federation US. 

Stoll B. (1997): The Global Impact of Neonatal Infection. Clinical Perinatology 1997; 24:1-21. 

UNICEF, (2001): State of the World’s Children. New York: UNICEF. 

153

University of North Carolina at Chapel Hill (2002: Compendium of Indicators for Evaluating 

Reproductive Health Programs, pp. 117. MEASURE Evaluation Manual Series No. 6. 

MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel 

Hill. 

WHO (1994): World Health Organization. Mother-baby Package: Implementing Safe 

Motherhood in Countries. Geneva, Switzerland: Maternal Health and Safe Motherhood 

Program. 

WHO (1996): World Health Organization. Perinatal Mortality – a Listing of Available 

Information. Geneva, Switzerland: Maternal Health and Safe Motherhood Program, 1996. 

154

Annexes 

155

Annex 1 

List of sampled wards by Village Development Committee, Jhapa District 

S. No. Name of VDC Ward Number 

1 Baniyani 9 

2 Jalthal 3 

3 Maheshpur 1 

4 Pathariya 4 

5 Anarmani 1 

6 Anarmani 4 

7 Arjundhara 6 

8 Budhabare 6 

9 Garamani 7 

10 Khudunabari 6 

11 Sanischare 7 

12 Shantinagar 3 

13 Bahundangi 4 

14 Chandragadhi 4 

15 Dhaijan 9 

16 Chakchaki 1 

17 Charpane 5 

18 Ghailadubba 6 

19 Kumarkhod 8 

20 Sharanamati 2 

21 Surunga 4 

22 Tagandubba 2 

23 Mahabhara 4 

24 Satasidham 8 

25 Topgachchi 2 

26 Topgachchi 9 

27 Gauriganj 5 

28 Khajurgachhi 2 

29 Kohabara 8 

30 Lakhanpur 8 

156

Annex 2 

Methods for calculation of asset index for CB-MNC baseline survey 

Introduction 

Many evaluation studies develop variables to measure socio-economic status (SES) in order 

to describe the surveyed population(s) and explore the association between SES and key 

outcome variables of interest. In this survey an asset index (AI) was constructed as a 

measure of SES using the statistical procedure of principal components analysis (PCA). This 

procedure has been previously described in the literature 1 and used extensively with 

Demographic Health Survey data 2,3 . 

General methods 

PCA is used to determine the weights for the various asset variables that are then used to 

calculate the value of the AI. The weights are the standardized first principal component of 

the variance-covariance matrix of the observed household assets. These weights are then 

used to create an AI using the following formula: 

Ai=γ 1 x 1i +…+γ k x ki 

where, Ai is the asset index for household i, the x ik 's are the k-th asset, and the γ's are the 

weights. The variables that were used to calculate the AI in the CB-MNC baseline survey are 

electricity, television, bicycle, radio, source of drinking water, type of toilet, floor material, 

roof material, wall material. Based on the value of the AI that was calculated for each 

household, households were then ranked into wealth quintiles. 

The STATA statistical software program was used to conduct the PCA and generate values of 

the AI for each household. The STATA commands that were used to generate an AI score 

for each household and then create AI quintiles were factor, score, and xtile. 

Specific method use for calculation of A i for a household in the CB-MNC baseline survey 

The variables listed above are used in the calculation of A i for a given household. Each 

possible response category for the included variables contributes to the calculated value of A i . 

The list of response categories for the included variables, along with their corresponding 

scoring coefficients generated by the STATA command score, are as follows 4 : 

Scoring Coefficients 

Variable | 1 

-------------+---------- 

drinkw1 | 0.07010 

drinkw2 | -0.04102 



1 Filmer D and Pritchett LH. Estimating Wealth Effects Without Expenditure Data—or Tears: An Application to 

Educational Enrollments in States of India. Demography, Volume 38-Number 1, February 2001: 115-132. 

2 Gwatkin, D., Rutstein, S., Johnson, K., Pande, R. & Wagstaff, A. (2000) Socio-Economic Differences In Health, 

Nutrition, And Population. Washington, DC, The World Bank. 

3 Gwatkin, D. R., Rrutstein, S., Johnson, K., Suliman, E. A. & Wagstaff, A. (2003) Initial country-level differences 

about socio-economic differences in health, nutrition, and population (second edition). Washington, DC, The World 

Bank. 

4 Note: the different response options for variables such as drinking water, etc., correspond to the response categories 

on the questionnaire, which may have subsequently been modified during analysis as certain response categories may 

have been dropped (due to lack of responses) or added (due to their frequent appearance as an “other” response). 

157






toilet1 | 0.12797 

toilet2 | 0.34302 

toilet3 | 0.52651 

toilet4 | 0.00000 

toilet5 | 0.05261 

Electricity | 0.27738 

Telephone | 0.13155 

Bicycle | 0.30812 

Radio | 0.19256 

roof1 | -0.22315 

roof2 | 0.22559 

roof3 | -0.10992 

roof4 | 0.16201 

roof5 | 0.00883 

roof6 | -0.03183 

wall1 | 0.00000 

wall2 | 0.24001 

wall3 | 0.01956 

wall4 | 0.11324 

wall5 | 0.32497 

wall6 | 0.13148 

wall7 | 0.03911 

wall8 | 0.03789 

wall9 | -0.00918 

wall10 | -0.00933 

wall11 | 0.02286 

wall12 | 0.00674 

wall13 | 0.02520 

floor1 | 0.00000 

floor2 | 0.33978 

floor3 | 0.07975 

floor4 | 0.08939 

floor5 | 0.58416 

floor6 | 0.02618 

The score "asset index for i-th individual", or A i , was calculated in the following manner: 

A i = scoring coefficient drinkw1 *standardized(drinkw1) - scoring coefficient drinkw2 *standardized(drinkw2) + scoring 

coefficient drinkw3 *standardized(drinkw3) ..... + scoring coefficient floor6 *standardized(floor6) 

where standardized(x) means: (x i -x_mean)/sd(x). 

For example, for Respondent 1 whose main source of drinking water is a public tap (i.e., 

drinkw1 = 0, drinkw2 = 1, drinkw3 through drinkw9 = 0), and given the unweighted mean 

values and standard deviations for drinkw1, drinkw2, and drinkw3 as displayed in the table 

below, A1 would be calculated as follows: 

A 1 = 0.07010*[(0 – 0.0275862)/0.1638311] - 0.04102*[(1 – 0.0287356)/0.1671106] + 0.01204*[(0 – 

0.0511494)/0.2203658] ..... + 0.02618*standardized(floor6) 

Table: Illustrative variables with mean, standard deviation and scoring coefficient used for PCA 

Variable Mean Standard deviation Scoring coefficient 

drinkw1 .0275862 .1638311 0.07010 

drinkw2 .0287356 .1671106 -0.04102 

drinkw3 .0511494 .2203658 0.01204 

158

159 

Annex 3 

CB-MNC Baseline Survey of Recently Delivered Women, Jhapa District 

List of Indicators 

# Indicator Denominator Estimates 

(N) 

I Birth registration 

1.1 Percentage of children less than 1 year old whose birth is registered with 

VDC, among women whose last child is alive 871 26.3 

II FCHV services 

2.1 Percentage of RDW who know the name of their FCHV 900 52.9 

2.2 Percentage of RDW who know their FCHV 900 77.0 

Antenatal period 

2.3 Percentage of RDW who met FCHVs during their last pregnancy 900 24.0 

2.4 Mean number of service contacts with FCHV during last pregnancy (among 

RDW who met FCHVs during their last pregnancy) 216 2.7 

2.5 Percentage of RDW who were counseled in at least 3 out of 5 key birth 

preparedness topics during last pregnancy (among RDW who met FCHVs 216 46.8 

during their last pregnancy) 

2.6 Percentage of RDW who were counseled by FCHV using a flip chart during 

their last pregnancy (among RDW who met FCHVs during their last 

pregnancy) 

216 26.4 

2.7 Percentage of RDW who state that there is a mothers group in their area 900 13.3 



2.9 Mean number of times RDW attended mothers group during last pregnancy 

(among RDW who attended mothers group during last pregnancy) 14 2.6 

Primary Health Care Outreach Clinic 

2.10 Percentage of RDW who have heard of the Primary Health Care Outreach 

Clinic (PHC/ORC) 900 30.3 

2.11 Percentage of RDW who used the PHC/ORC prior to or following their most 

recent delivery for the following services: 





5. Any service 

900 

900 

900 

900 

900 

2.12 Percentage of RDW who know when the PHC/ORC in their area is held 900 18.4 

Postnatal period 

2.13 Mean number of service contacts between RDW and FCHV during postnatal 

period following most recent delivery (among RDW who know their FCHV, 

and who delivered 2-11 months prior to the survey) 

2.14 Mean number of days following delivery when first contact of RDW with 

FCHV took place (among RDW who met FCHV post-delivery, and who 

delivered 2-11 months prior to the survey). 

12.4 

3.3 

8.3 

3.5 

18.0 

765 0.2 

92 1 15.9 

2.15 Percentage of RDW who received following services from FCHV during 

postnatal period following most recent delivery (among RDW who met 

FCHV post-delivery, and who delivered 2-11 months prior to the survey): 

1. Diagnose or treat newborn’s respiratory infection or diarrhea? 93 41.9 

2. Check to see if your newborn had any other health problem? 93 34.4 

3. Provide vitamin A for mother? 93 71.0 

4. Provide iron tablets for mother? 93 59.1 

5. Check to see if the mother had a delivery- related problem (e.g. infection)? 93 24.7 

1 One respondent stated “do not know”.


(N) 

6. Make referral to health service provider? 93 24.7 

7. Advice on breastfeeding or infant care? 93 67.7 

8. Advice or help with birth registration? 93 39.8 

9. Family planning supplies? 93 30.1 

2.16 Percentage of RDW who attended a mothers group meeting during postnatal 

period following their most recent delivery among RDW who delivered 2-11 765 1.3 

months prior to the survey) 

III RDW knowledge 

3.1 Percentage of RDW who know at least three danger signs during pregnancy 900 25.9 

3.2 Percentage of RDW who know at least three danger signs during delivery 


3.3 Percentage of RDW who know at least three maternal danger signs during 

postnatal period among RDW with live birth 889 39.6 

3.4 Percentage of RDW who know at least three newborn danger signs among 


3.5 Percentage of RDW who have correct knowledge of at least three hygiene 

during childbirth. 889 49.4 

3.6 Percentage of RDW who know that labor longer than 8 hours is dangerous or 

very dangerous to the woman in labor among RDW with live birth 889 94.5 

3.7 Percentage of RDW who know that breached delivery is dangerous or very 

dangerous to the woman in labor among RDW with live birth 889 97.1 

IV Delivery of commodities 

4.1 Percentage of RDW who received at least two doses of tetanus toxoid during 

last pregnancy (based on recall) 900 62.0 

4.2 Percentage of RDW who received at least two doses of tetanus toxoid during 

last pregnancy (by card) 900 8.4 

4.3 Percentage of RDW who received at least three doses of tetanus toxoid 

anytime (by card + history) 900 72.6 

4.4 Percentage of RDW who received/bought iron supplements while pregnant. 900 68.1 

4.5 Mean number of days that RDW took iron /folic acid tablets while pregnant. 

• Among all RDW 

• Among RDW who took iron while pregnant 

890 

603 

67.5 

99.6 

4.6 Percentage of RDW who received/bought deworming tablets while pregnant. 900 25.4 

4.7 Mean number of days that RDW take iron /folic acid tablets following 

delivery up to six weeks after delivery. 

• Among all RDW (Among RDW who delivered 2-11 months prior to the 

survey with live birth) 

• Among RDW who took iron following delivery (and who delivered 2-11 

months prior to the survey) 

212 32.7 

4.8 Percentage of RDW who received Vitamin A capsule within six weeks of 

delivery among RDW who delivered 2-11 months prior to the survey 765 36.3 

4.9 Percentage of infants who received Vitamin A capsule in most recent Vitamin 

A campaign day among infants who were 6 months or older on National 

Vitamin A Day. 

160 

755 1 

9.2 

272 93.4 

4.10 Percentage of RDW who have requested any of the following commodities in 

the past 12 months and been told that they were not available: 

Vitamin A for your child among RDW with live birth 889 0.9 

Vitamin A for yourself 900 0.6 

Iron tablets 900 1.3 

Tetanus toxoid 900 1.2 

Contraceptives 900 0.3 

Child vaccinations among RDW with live birth 889 5.3 

Treatment for childhood illness among RDW with live birth 889 0.9 

1 Ten respondents stated “do not know”.


(N) 

Other commodities 900 0.7 

V Quality of care 

5.1 Percentage of RDW who received acceptable quality ANC during last 

pregnancy (acceptable quality defined as at least 6 key ANC tasks performed) 900 44.9 

among all RDW 

5.2 Percentage of RDW receiving post-natal care who were counseled in at least 

two maternal danger signs 406 46.1 

5.3 Percentage of RDW who were counseled by a health worker, FCHV or TBA 

prior to or following her delivery in at least two newborn issues among RDW 

whose infant lived at least two months and who delivered 2-11 months prior 757 53.1 

VI 

to the survey. 

Utilization of health care services 


6.1 Percentage of RDW who received pre-natal care at least one time during last 


6.2 Percentage of RDW who received pre-natal care at least one time by a trained 

provider during last pregnancy 900 74.2 

6.3 Percentage of RDW who received pre-natal care four or more times by a 

trained provider during last pregnancy 900 44.7 

6.4 RDW’ mean number of months pregnant at time of first ANC visit (among 

RDW who received ANC) 698 1 3.9 

Delivery period 

6.5 Percentage of RDW whose birth was attended by a skilled provider among 


6.6 Percentage of RDW whose birth took place at a health facility among RDW 

with live birth 889 34.6 

6.7 Percentage of RDW whose birth took place at a health facility due to an 

obstetric emergency among RDW with live birth 889 20.8 


6.8 Percentage of RDW who received post-partum care within 3 days of delivery 

from a trained provider among RDW who delivered 2-11 months prior to the 

survey 

6.9 Percentage of RDW who received post-partum care within six weeks of 

delivery from a trained provider among RDW who delivered 2-11 months 

prior to the survey 

765 43.5 

765 45.9 

6.10 Percentage of RDW who received following services from health worker 

among RDW who attended a 6-week postnatal checkup at health facility or 

PHC/ORC, among RDW who were more than 2 months post-delivery and 

who visited a health facility for check ups: 

1. Examination of abdomen? 637 4.7 

2. Internal examination? 637 2.7 

3. Asked if you had excessive bleeding / severe abdominal pain? 637 6.4 

4. Counseled you about Family Planning? 637 9.7 

5. Counseled you about breastfeeding? 637 15.4 

6. Counseled you about immunization? 637 81.8 

7. Provided advice on newborn care? 637 11.5 

Newborn care 

6.11 Percentage of RDW whose infant received newborn care within 1 day after 



6.12 Percentage of RDW whose infant received newborn care within 3 days after 



876 40.2 

876 40.9 

1 One respondent stated “do not know”. 

161


(N) 

6.13 Percentage of RDW whose infant received newborn care within four weeks of 

delivery from a trained provider among RDW who delivered 2-11 months 757 45.4 

prior to the survey and whose infant lived at least two months. 

6.14 Percentage of newborns who visited health facility or PHC/ORC 6 weeks 

post-delivery (among RDW who delivered 2-11 months prior to the survey) 765 86.6 

6.15 Percentage of newborns who received following services from health worker 

among newborns who attended a 6-week post-delivery checkup at health 

facility or PHC/ORC, among RDW who were more than 2 months postdelivery: 

1. Baby’s name entered in health post register? 662 97.9 

2. Health worker asked questions about baby’s feeding habits? 662 19.0 

3. Baby was weighed and weight was recorded in register or other 

document? 662 39.3 

4. Baby was given vaccination? 662 97.9 

5. Baby received physical examination? 662 13.1 

6. Health worker encouraged you to register baby’s birth? 662 10.4 

VII Family planning 

7.1 Percentage of RDW with knowledge of the following FP methods: 

1. Female sterilization 900 95.9 

2. Male sterilization 900 92.6 

3. Pill 900 91.1 

4. IUD 900 69.0 

5. Injection (Depo-Provera) 900 97.9 

6. Condom 900 91.4 

7. Norplant 900 82.4 

8. Periodic abstinence 900 45.9 

9. Withdrawal 900 35.7 

7.2 Percentage of RDW who used any family planning method after their most 

recent delivery among women who delivered between 2-11 months prior to 775 36.3 

the survey. 

7.3 Percentage of RDW who first used a modern family planning method after 

their most recent delivery among women who delivered between 2-11 months 775 31.9 

prior to the survey. 

7.4 Mean number of weeks post-delivery when RDW first started using any 

family planning method (among RDW who used any family planning method 

after their most recent delivery and who delivered between 2-11 months prior 281 13.4 

to the survey.) 

7.5 Percentage of RDW who are currently using a modern family planning 

method among women who delivered between 2-11 months prior to the 

survey and who were not currently pregnant. 

766 29.9 

7.6 Percentage of RDW who intend to use FP method in the future (among RDW 

who are not currently using FP method) 629 83.0 

7.7 Percentage of RDW who know where to go if they want to obtain FP methods 

or services (among RDW who are not currently using FP method) 629 94.8 

7.8 Percentage of RDW who were counseled by FCHVs or health worker to use 

birth spacing or FP at any time after their most recent delivery among women 

who delivered between 2-11 months prior to the survey. 

7.9 Mean number of weeks post-delivery at which RDW were first counseled on 

FP or birth spacing (among RDW who were counseled by FCHVs to use birth 

spacing or FP at any time after their most recent delivery and who delivered 

between 2-11 months prior to the survey.) 

7.10 Percentage of RDW who were counseled by FCHVs to use birth spacing or 

FP at any time after their most recent delivery among women who delivered 

between 2-11 months prior to the survey. 

775 24.4 

187 5.5 

775 14.2 

162


(N) 

7.11 Percentage of RDW who were counseled by FCHVs on birth spacing or FP 

using teaching materials following their most recent delivery among RDW 

who were counseled by FCHVs to use birth spacing or FP at any time after 110 9.1 

their most recent delivery among women who delivered between 2-11 months 

prior to the survey. 

VIII Key ENC behaviors and practices 

8.1 Percentage of RDW who used clean home delivery kit (CHDK) during their 

most recent delivery among RDW with live birth 889 32.3 

8.2 Percentage of RDW whose newborns’ cord was cut with a clean / new 

instrument OR a CHDK was used among RDW with live birth 889 93.1 

8.3 Percentage of RDW delivering at home whose newborns’ cord was cut with a 

clean / new instrument OR a clean birth kit was used among RDW with live 581 89.5 

birth 

8.4 Percentage of RDW reporting that new or sterilized string or thread was used 

to tie cord OR a birth kit was used among RDW with live birth 581 95.0 

8.5 Percentage of newborns that have nothing applied on cord stump. among 


8.6 Percentage of RDW who report that their baby was dried before the placenta 

was delivered among RDW with live birth 889 50.2 

8.7 Percentage of RDW who report that their baby was wrapped in cloth before 

the placenta was delivered among RDW with live birth 889 51.6 

8.8 Percentage of RDW who report that their baby was not bathed during first 24 

hours after birth among RDW with live birth 889 17.4 

8.9 Percentage of RDW who breastfed their infant within one hour of birth 


8.10 Percentage of RDW who gave colostrums to their newborn child among 


8.11 Percentage of RDW who did not give anything other than breastmilk in the 

first 3 days after birth. (Pre-lacteal feeds) among RDW with live birth 889 58.2 

8.12 Percentage of RDW who breastfed their infant exclusively at one to six 

months (by month of infant’s age) 432 54.2 

0 month 55 96.4 

1 month 63 77.8 

2 month 84 58.3 

3 month 57 54.4 

4 month 76 39.5 

5 month 97 22.7 

8.13 Mean number of completed months of age at which mother first started giving 

food or drink other than breastmilk to baby 586 3.9 

IX Behavior change communication 

IX-A Exposure to messages 

9.1 Percentage of RDW who report exposure to the following messages during 

their most recent pregnancy: 

1. A pregnant women should make 4 ANC visits with a trained health 

worker 900 52.7 

2. A newborn should be breastfed for the first time immediately after birth 900 43.4 

3. A mother and newborn should have their health checked by a trained 

health worker within 3 days after birth among RDW with live birth 889 21.9 

IX-B Knowledge 

9.2 Percentage of RDW who state correct knowledge regarding the following 

topics: 

1. # of recommended ANC visits (answer = 4) 900 29.8 

2. when should a newborn be breastfed for the first time (answer = 

immediately after birth) 900 31.7 

163


(N) 

3. When should postnatal checkups for mother and newborn take place 

(answer = within 1 day (24 hours) after birth) among RDW with live 

889 2.9 

birth 

4. When a newborn should be bathed for the first time (answer = later than 

24 hours following birth) 900 10.0 

IX-C Steps to BCC: SBA 

9.3 Exposure – formal: Percentage of respondents reporting formal exposure to 

message regarding need for SBA in previous 2 months 900 42.3 

9.4 Exposure – formal or informal: Percentage respondents reporting formal or 

informal exposure to message regarding need for SBA in previous 2 months 900 49.2 

9.5 Knowledge: Percentage respondents with correct knowledge regarding need 

for SBA 889 84.9 

9.6 Attitude (positive): Percentage of RDW who state that it is important or very 

important to have their birth attended by a skilled health worker 889 97.5 

9.7 Social network support: Percentage respondents who perceive support for 

need for SBA in their social network 900 77.1 

9.8 Self-efficacy: Percentage respondents who feel they are able to ensure that an 

SBA is present during delivery 900 50.9 

9.9 Intent to act: Percentage respondents who state that an SBA will be present 

during their next delivery 900 45.1 

9.10 Behavior: Percentage respondents who had an SBA present during their last 

delivery among RDW with live birth 889 36.6 

9.11 Advocacy: Percentage respondents who have advocated regarding need for 

SBA to others 900 48.4 

X Skilled birth attendance 

10.1 Percentage of RDW who can identify a SBA who will attend a delivery in 

their home among RDW with live birth. 889 23.4 

10.2 Percentage of RDW who can identify a health facility in her community 

where she can go to deliver among RDW with live birth. 889 98.5 

10.3 Percentage of RDW who can identify a health facility in her community 

where she can go in case she has an emergency while delivering at home 

889 98.8 

among RDW with live birth. 

10.4 Among RDW with live birth who state that it is important or very important 

to have their birth attended by a skilled health worker, the percentage who 

state the following reasons for it being important: 

1. To assess the condition of the mother and newborn 867 27.9 

2. To confirm the position of the fetus 867 13.7 

3. For infection-free delivery 867 13.0 

4. for the safety of the mother 867 68.4 

5. for the safety of the newborn 867 63.0 

6. to manage any complications easily 867 30.3 

7. to recognize danger signs 867 11.1 

8. in case of serious problems with the delivery 867 29.4 

9. in order to have a normal delivery 867 27.7 

10. other 867 0.3 

10.5 Among RDW with live birth who state that it is important or very important 

to have their birth attended by a skilled health worker, the Percentage of 

RDW whose delivery is attended by a skilled health worker 

164 

867 37.5 

10.6 Among women who state that it is important or very important to have their 

birth attended by a skilled health worker but whose delivery was not attended 

by a skilled health worker, the percentage who gave the following reasons for 

not having their birth attended by a skilled health worker: 

1. I didn’t have a problem and thus it was not necessary 542 74.5 

2. Do not know who to ask 542 0.4 

3. No service available nearby 542 2.6


(N) 

4. No practice in the community 542 0.4 

5. Family members do not allow 542 0.7 

6.Will cost too much 542 6.8 

7. Another type of health worker attended 542 10.9 

8. Other 542 3.5 

XI Birth preparedness 

XI-A General birth preparedness 

11.1 Mean value of birth preparedness index (BPI) among RDW who delivered 2- 

11 months prior to the survey, where the BPI for each respondent is 

calculated as the number of the following seven factors that the respondent 765 51.6 

reports: 

1. … received pre-natal care at least one time by a trained provider during last 


2. … names prolonged labor as a danger sign during delivery 

765 87.2 

3. … names excessive bleeding as a danger sign during delivery 

765 66.5 

4. …family made financial preparations for emergencies. 765 47.6 

5. … family made preparations for emergency transportation. 765 2.9 

6. … birth was attended by skilled provider. 765 37.4 

7. … received post-partum care within 6 weeks of delivery from a trained 

provider. 765 45.9 

11.2 Percentage of RDW who made preparations for delivery: 



By type of preparation 

1. Financial 900 64.8 

2. Transport 900 3.1 

3. Food 900 48.4 

4. Identification of birth attendant 900 2.9 

5. Identification of facility 900 5.0 

6. Blood 900 0.4 

7. Materials for clean delivery 900 5.1 

8. Other (clothes for mother/child) 900 6.7 

9. Other 900 - 

11.3 Percentage of RDW who arranged for a health worker or TBA to attend their 

last delivery 900 8.6 

11.4 Percentage of RDW who arranged to deliver their last child in a health facility 900 15.2 

11.5 Percentage of RDW who made preparations for the maternal and newborn 

care during the first month post-delivery: 



By type of preparation 


2. Identification of health worker 900 1.2 

3. Identification of health facility 900 1.4 

4. Blood 900 0.1 

5. Other (Food, oil, ghee) 900 2.7 

6. Other 900 1.2 

XI-B Family support for birth preparedness 

11.6 Percentage of RDW who discussed with husbands about planning for delivery 

during their last pregnancy 900 70.9 

11.7 Percentage of RDW who were accompanied to ANC visit at least one time by 

family member 900 51.7 

900 

900 

900 

900 

67.9 

51.1 

23.4 

1.4 

165


(N) 

11.8 Percentage of RDW who ate more than usual while they were pregnant 900 38.9 

11.9 Percentage of RDW who received more care and support than usual from 

family members while they were pregnant 900 63.8 

11.10 Percentage of RDW who ate more than usual during post-partum period 889 73.8 

11.11 Percentage of RDW who received more care and support than usual from 

family members during post-partum period 889 85.8 

XI-C Financial birth preparedness 

11.12 Percentage of RDW who set aside money for care during the delivery 900 34.6 

11.13 Mean amount of money that RDW set aside for care during the delivery 

(among RDW who set aside money for care during the delivery) 299 3107 

11.14 Percentage of RDW who managed expenditure of delivery through the 

following strategies: 

1. Borrow money 900 28.7 

2. Spend savings 900 51.1 

3. Relatives helped to pay 900 5.7 

4. Other strategy 900 2.2 

XI-D Preparedness for emergencies 



900 48.7 


900 10.4 

11.16 By type of preparation 


2. Transport 900 2.7 

3. Identification of health worker 900 4.8 

4. Identification of health facility 900 6.1 

5. Blood 900 0.3 

6. Other (food, oil, ghee) 900 0.2 

7. Clothes for mother and newborn 900 0.1 

8. Other (friends, TBA) 900 0.4 

11.17 Percentage of RDW who can identify the location of a qualified health facility 

XII 

to go to in case emergency during delivery 889 88.2 

Management of emergencies 


12.1 Percentage of RDW who report experiencing a danger sign during their most 

recent pregnancy. 900 47.6 

12.2 Percentage of RDW who sought care at a health facility after experiencing a 

danger sign during their most recent pregnancy (among RDW who report 

experiencing a danger sign). 

428 56.8 

Delivery period 

12.3 Percentage of RDW who report experiencing a danger sign during their most 

recent delivery among RDW with live birth. 889 33.6 

12.4 Percentage of RDW who sought care at a health facility after experiencing a 

danger sign during their most recent delivery (among RDW with live birth 

who report experiencing a danger sign). 

12.5 Percentage of RDW who were referred to seek care at a health facility by a 

health worker (among RDW with live birth who report experiencing a danger 

sign during delivery). 

299 53.8 

299 29.8 

12.6 Percentage of RDW who sought care at a health facility during delivery 

(among RDW with live birth those who were referred by a health worker) 89 70.8 


12.7 Percentage of RDW who report experiencing a danger sign during the 

postpartum period following their most recent delivery among RDW with live 

birth. 

889 30.3 

166


(N) 

12.8 Percentage of RDW who sought care at health facility after experiencing a 

danger sign during the postpartum period following their most recent delivery 269 28.6 

(among RDW with live birth who report experiencing a danger sign). 

12.9 Percentage of RDW who were referred to seek care at a health facility by a 

health worker (among RDW with live birth who report experiencing a danger 269 22.3 

sign during the postpartum period following their most recent delivery). 

12.10 Percentage of RDW who sought care at a health facility during the 

postpartum period following their most recent delivery (among RDW with 60 45.0 

live birth who were referred by a health worker) 

Newborn 

12.11 Percentage of RDW who report that their infant experienced a danger sign 

during the neonatal period following their most recent delivery among RDW 876 21.9 

with a live birth whose infant lived at least two months. 

12.12 Percentage of RDW who sought care at health facility for their infant after 

s/he experienced a danger sign during the neonatal period (among infants who 192 48.4 

lived at least two months and who experienced a danger sign). 

12.13 Percentage of RDW who report that their infant experienced hypothermia 

during the neonatal period following their most recent delivery (among 

876 0.9 

infants who lived at least two months). 

12.14 Percentage of RDW who cared for their neonate’s hypothermia through skinto-skin 

contact (among neonates who experienced hypothermia). 8 62.5 

12.15 Percentage of RDW who sought or provided care of any type for their infant 

after s/he experienced a danger sign during the neonatal period (among 

192 80.7 

infants who experienced a danger sign). 

12.16 Mean number of days delay before seeking care for sick neonate (among 

neonates were provided care of any type for their infant after s/he experienced 153 2.1 

a danger sign during the neonatal period). 

12.17 Percentage of sick neonates who were first taken to a trained health worker 

(among neonates were provided care of any type for their infant after s/he 

155 64.5 

experienced a danger sign during the neonatal period). 

12.18 Percentage of sick neonates who were taken at any time to a trained health 

worker or a health facility (among neonates were provided care of any type 155 78.7 

for their infant after s/he experienced a danger sign during the neonatal 

period). 

12.19 Percentage of sick neonates who were taken at any time to a health facility 

(among neonates were provided care of any type for their infant after s/he 

155 68.4 

experienced a danger sign during the neonatal period). 

12.20 Percentage of sick neonates who were admitted to a health facility (among 

neonates were provided care of any type for their infant after s/he experienced 

a danger sign during the neonatal period). 

155 3.9 

XIII Emergency finance and transport systems 

13.1 Percentage of RDW who know of any groups in their community that loan 

money to women who need it for an emergency during pregnancy or delivery 900 29.1 

13.2 Percentage of RDW who borrowed money from groups in their community 

that loan money to women who need it for an emergency during pregnancy or 

delivery 

13.3 Percentage of RDW who know of any individuals in their community that 

loan money to women who need it for an emergency during pregnancy or 

delivery 

13.4 Percentage of RDW who borrowed money from individuals in their 

community that loan money to women who need it for an emergency during 


900 3.0 

900 91.2 

900 28.7 

13.5 Percentage of RDW who used transportation because of obstetric emergency 

during most recent delivery 900 35.8 

167


(N) 

XIV Post-partum hemorrhage and Misoprostol 

14.1 Percentage of RDW who received information about bleeding after childbirth 

during their last pregnancy. 900 53.9 

14.2 Percentage of RDW who received information about a drug that can reduce 

bleeding after childbirth during their last pregnancy. 900 16.0 

14.3 Percentage of RDW who received information that bleeding after childbirth 

can cause death during their last pregnancy. 900 47.0 

14.4 Percentage of RDW who receive Oxytocin during delivery (among RDW 

who had live birth and did not deliver via caesarean section). 841 23.4 

14.5 Percentage of RDW who know that excessive bleeding during or after 

delivery is dangerous or very dangerous to the woman in labor among RDW 889 97.6 


14.7 Percentage of RDW who report bleeding more than normal immediately 

following delivery (among RDW with live birth and had no delivery with 

841 34.5 

caesarean section) 

14.8 Percentage of RDW who report that they used more than 2 cloths to absorb 

blood during the first 24 hours following delivery (among RDW with live 841 74.2 

birth and had no delivery with caesarean section) 

14.9 Percentage of RDW who report the following side effects following delivery: 

(among RDW with live birth and had no delivery with caesarean section) 

1. Faintness or dizziness 841 27.6 

2. Lose consciousness or faint 841 7.1 

3. Shivering 841 20.7 

4. Nausea 841 7.6 

5. Fever 841 8.9 

6. Diarrhea 841 5.0 

XV Newborn birth weight 

15.1 Percentage of live births in which the mother estimated the baby’s size at 

birth as very small or smaller than average. among RDW with live birth. 888 1 20.8 

15.2 Percentage of RDW reporting that their youngest child was weighed at birth 

or at any time after birth among RDW with live birth. 889 42.7 

1 One respondent stated “do not know” 

168

Annex 4 

Survey Instruments 

169

NEPAL FAMILY HEALTH PROGRAM 

COMMUNITY-BASED MATERNAL AND NEWBORN CARE PROGRAM (CB-MNC) 

BASELINE SURVEY, 2005 

(MOH/NFHP/VARG) 

SCREENING QUESTIONNAIRE TO IDENTIFY RECENTLY DELIVERED WOMEN (RDW) 

Serial No. 

District: 

Household head: 

Cluster #: 

VDC: 

Ward: 

Table 1: Initial Screening Questions 

# Question Response Skip 

A1 How many women usually live in this house who 

have children who are less than one year old? 

# of women: [ ___ ] 

(if # > 0, write names of 

A2 

A3 

A4 

How many women usually live in this house who 

had a stillbirth (gestation period 28 weeks or 

more within the past 12 months? 

How many women usually live in this house who 

gave birth in the past 12 months to a child who 

was born alive but later died? 

How many children are there who usually live in 

this house who are less than one year old whose 

mother does not live here? 

women in Q1 below) 

# of women: [ ___ ] 



# of women: [ ___ ] 



# of children: [ ___ ] 

A5 # of eligible women (EW) = A1 ( __ ) + A2 ( __ ) + A3 ( __) = ( ___ ) Complete Table 2 below for all EW. 

Go to next house if # EW = 0. 

Table 2: Questions To Select Respondents 

Ask the questions below to each eligible woman (i.e., RDW) who usually lives in this house. 

# Question Woman # 1 Woman # 2 Woman # 3 Skip 

Q1 What is your name? 

Q2 

On what day, month and year did you 

last give birth? 

(Interviewer check Q2): Did birth 

take place less than one year ago 

today? 

Day: [ | ] 

Month: [ | ] 

Year: [ | ] 

Yes … 1 

No .… 2 

Q3 What was the gender of the child? Male ……. 1 

Female ….. 2 

Q4 Was your baby born alive? Yes … 1 

No .… 2 

Q5 Is your baby still alive? Yes … 1 

No .… 2 

Q6 

Q7 

How many completed months old 

was your baby when s/he died? 

All women listed in Q1 whose names 

are not crossed out are eligible to be 

interviewed. Note their eligibility in 

the cells to the right and begin their 

interview with Section 1. 

Completed 

months ____ 

Eligible? 

Yes … 1 

No .… 2 

Day: [ | ] 

Month: [ | ] 

Year: [ | ] 

Yes … 1 

No .… 2 

Male ……. 1 


Yes … 1 

No .… 2 

Yes … 1 

No .… 2 

Completed 

months ____ 

Eligible? 

Yes … 1 

No .… 2 

Day: [ | ] 

Month: [ | ] 

Year: [ | ] 

Yes … 1 

No .… 2 

Male ……. 1 


Yes … 1 

No .… 2 

Yes … 1 

No .… 2 

Completed 

months ____ 

Eligible? 

Yes … 1 

No .… 2 

if “no”, respondent is 

not eligible. Cross out 

her name and go to next 

woman or Q7 

if “no”, go to next 

woman or Q7 

if “yes”, go to next 

woman or, if no other 

woman, Q7 

go to next woman 

or, if no other woman, 

Q7 

Conduct interview(s) 

Do not conduct 

interview(s) 

170

NEPAL FAMILY HEALHT PROGRAM 




HOUSEHOLD LISTING FORM 

Instructions to interviewer: Complete this Household Listing Form by interviewing the 

household head. If the household head is not present or otherwise unable to provide the 

required information, interview a senior member of the household and note their name 

in the table below. 

District:……………………………………… 

Name of VDC ……………………………… 

Ward No …………………………………… 

Village name ………………………………… 

Cluster No. ………………………………… 

Household No. ……………………………… 

Name of the household head ……………… 

Name of the respondent …………………… 

Relationship of respondent to household head (if 

respondent is not household head) ……….. 

Form No. 

INTERVIEWER VISITS 

1 2 3 

DATE [DD/MM/YY] / / / / / / 

INTERVIEWER'S NAME: 

RESULT 

NEXT VISIT: DATE / / / / 

[DD/MM/YY] 

TIME 

*RESULT CODES: 

1 = Interview completed 

2 = Respondent refused to be interviewed 

3 = Time and date set for later 

4 = Respondent not at home 

5 = Other (specify): _________________________ 

171

HOUSEHOLD SCHEDULE 

Interviewer: “Now I would like to ask for some information about the people who usually 

live in your household or who are staying with you now” 

# USUAL RESIDENTS 

AND VISITORS 

Please give me the names of 

the persons who usually live 

in your household or are 

staying with you now and 

guests of the household who 

stayed here last night, starting 

with the head of the 

household. Be sure to include 

yourself. 

(WRITE FULL NAMES) 

RELATI- 

ONSHIP 

TO RDW 

What is the 

relationship 

of (NAME) 

to the RDW 

identified 

on Page 1 of 

this 

questionnair 

e? 

RESIDENCE SEX AGE MARITAL 

STATUS 

Does 

(NAME 

) usually 

live 

here? 

(1) (2) (3) (4) 

Yes=1 

No=2 

Did 

(NA- 

ME) 

sleep 

here last 

night? 

(5) 

Yes=1 

No=2 

Is (NA- 

ME) 

male or 

fem-ale? 

(6) 

M=1 

F=2 

How 

old is 

(NA 

ME) 

in 

comp 

leted 

years 

? 

(If 

less 

than 

one 

year 

write 

"00") 

(7) 

Year 

(For all those 

10 years and 

above.) 

What is his/her 

marital status 

now? 

1=Never 

married 

2=Married 

3=Widow/ 

widower 

4=Divorced/ 

separated 

5=Currently 

married but 

never lived 

with husband 

ELIGIB- 

ILITY 

Circle line 

number of 

RDW(s) 

who are 

eligible for 

individual 

interview. 

Two circles 

means that 

RDW is 

eligible but 

not present. 

ELIGIB- 

ILITY 1 

Circle line 

number of 

MIL of 

RDW, FIL 

of RDW, 

and husband 

of RDW 

who are 

eligible for 

individual 

interview. 

(8) (9) (10) 

s 

1 1 1 

2 2 2 

3 3 3 

4 4 4 

5 5 5 

6 6 6 

7 7 7 

8 8 8 

9 9 9 

10 10 10 

11 11 11 

12 12 12 

TABLE OF RESPONDENTS 

Which of the following respondents are available to be interviewed in this household (circle as appropriate) 

RDW(s): # ___ FIL of RDW MIL of RDW Husband of RDW 

Codes for Column 3: Relationship to RDW (add “A”, “B”, “C”, etc. to code if there is more than one RDW) 

1=Father-in-law (FIL) 

4= Self 

2= Mother-in-law (MIL) 5= Son or Daughter 

3= Husband 6= Other 

1 Note: A maximum of one MIL, FIL, and husband of RDW should be interviewed per household. If there is 

more than one RDW, give priority to interviewing the MIL, FIL and husband of the RDW who has most 

recently given birth. 

172





QUESTIONNAIRE FOR RECENTLY DELIVERED WOMEN 

Form No. 

Women No. 


Name of VDC ……………………………… 

Ward No …………………………………… 


Cluster No. ………………………………… 




S. No. in HH Roster 

Respondent type 1= RDW 2= FIL 3= MIL 4= Husband 


1 2 3 

DATE [DD/MM/YY] / / / / / / 


RESULT 

NEXT VISIT : DATE [DD/MM/YY] / / / / 

TIME 






5 = Other (specify): _________________________ 

INTRODUCTION AND CONSENT 

Namaste! My name is _____, and I am from Valley Research Group (VaRG) Kathmandu. VaRG is conducting this study 

for Ministry of Health/HMG. MOH has been implementing Nepal Family Health Program in this district with the 

objectives of improving mother and child health status. We are here to find about the health of mothers and children to 

help you and your community to keep mothers and children healthy. We are asking many women in many communities the 

same questions in order to understand their knowledge, attitudes and behavior regarding the mother and child health. We 

would very much appreciate your participation in this survey. This information will help MOH to improve its program in 

the districts. The survey usually takes around one hour. But I assure you that your name will not be shared with anyone 

else and your answers to my questions will be combined with answers from many other people so that no one will know 

that the answers you give me today belong to you. Your privacy is protected and I assure that your answers are kept 

confidential. 

Your participation in this survey is voluntary and you can choose not to answer any individual question or all of the 

questions. However, we hope that you will participate in this survey since your views are important. 

May I proceed with the questions? 

RESPONDENT AGREES TO BE INTERVIEWED…………………… 1 

RESPONDENT DOES NOT AGREE TO BE INTERVIEWED……… 2 → END INTERVIEW & THANK THE 

RESPONDENT 

173

Copy the responses from Q4, 5 and 6 from the screening questionnaire 

Q4 Was your baby born alive? Yes ……………………………. 1 

No .……………………………. 2 

Q5 Is your baby still alive? Yes ……………………………. 1 

No .……………………………. 2 

Q6 How many completed months old was your baby when s/he died? Completed months ____ 


Interviewer: “Now I would like to ask some questions about you and your household.” 

Q. # Question Codes Go to Q 

101 In what month and year were you born? Month [__ _ | __ _] Year [_ __ | _ __] 

Don’t know month ……………. 98 

Don’t know year ………………..98 

102 How old are you? Age in completed years [___ | ___] 

Don’t know ...........................................98 

103 Have you ever attended school? Yes ..........................................................1 

No............................................................2 106 

104 What is the highest class you completed? Grade……………………… 

105 (Interviewer: Check Q. 104) Grade 5 or below.....................................1 

Grade 6 and above...................................2 107 

106 Now, I would like you to read out loud as much Can not read at all ...................................1 

of this sentence as you can. 

Able to read only parts of sentence .........2 

“Churot khanu ramro bani hoina” 

Able to read whole sentence....................3 

(Show card to the respondents) 

107 Did your husband ever attend school? Yes ..........................................................1 

No............................................................2 109 

108 What was the highest class he completed? Grade ………………………. 

Don’t know............................................98 

109 What is your caste or ethnicity? 

(Write caste in space provided. Do not fill 

box) 


110 Apart from your own housework, are you Yes……………………….……...1 112 

currently working? 

No……………………….………2 

111 As you know, some women take up jobs for Yes……………………….……...1 

which they are paid in cash or kind. Others sell No……………………….………2 114 

things, have a small business or work on the 

family farm or in the family business. 

Are you doing any of these things or any other 

work now or during the last 12 months? 

112 What is your occupation, that is, what kind of 

work do you mainly do? 

Labor ………………………....……… 1 

Agriculture…………………..………. 2 

Private office employee.………..…… 3 

Govt. office employee …………….… 4 

Small business – sewing, carpentry … 5 

Shopkeeper ………………………… 6 

Others (Specify) _______________ 7 

113 Are you paid or do you earn in cash or kind for 

this work or are you not paid at all? 

Cash only ……………………………... 1 

Cash and kind ………………………… 2 

In kind only …………………………… 3 

Not paid ……………………………….. 4 

174


114 What is your husband’s occupation? Labor …………………….…..…… 1 

Agriculture…………………..…..…. 2 

Private office employee.……...…..… 3 

Govt. office employee ………….….. 4 

Small business – sewing, carpentry… 5 

Shopkeeper ………………………… 6 

Unemployed ……………………….. 7 

Student …………………………….. 8 

Incapacitated …………………….… 9 

Others (Specify) _______________ 10 

115 Do you watch television almost every day, at 

least once a week, less than once a week, or not 

at all? 

116 Do you listen to the radio almost every day, at 


at all? 

117 What form of transport do you normally use to 

go to the health facility / clinic / nursing home 

/ pharmacy / health provider where you go for 

most of your health care needs? 

118 How many hours or minutes does it take you to 

reach the health facility / clinic / nursing home 

/ pharmacy / health provider using this 

transportation? 

(Hours:………….. Minutes:………….) 

119 How much does it cost to use this 

transportation to go from your home to the 

facility and then return home? 

120 In the past 12 months, have you ever been 

unable to access health services because 

service delivery point was not staffed? 

121 In the past 12 months, have you ever been 

unable to access health services because travel 

between home and service delivery point was 

unsafe? 

Almost every day .................................... 1 

At least once a week................................ 2 

Less than once a week............................. 3 

Not at all.................................................. 4 




Not at all.................................................. 4 

Walking ……………………………1 

Bus …………………………………2 

Rickshaw …………………………..3 

Other (specify) ________________ 4 

In minutes:………………… 

Don’t know..........................................998 

Rupees ……….…… ___ ___ ___ 

No cost (walking) ………………..997 

Don’t know…………………..…. 998 

Yes………………....…….....…………. 1 

No………………..……..……….…….. 2 

Don’t know …………………..…..…... 8 

Yes………………....…….....…………. 1 

No………………..……..……….…….. 2 

Don’t know …………………..…..….. .8 

Section 2: Fertility 

Interviewer: “Now I would like to ask you about pregnancy and childbearing.” 

Q. # Question Codes Skip 

201 How old were you when you (first) got 

married? (Gauna for Terai origin) 

Age in completed years 

Don’t know ………………………… 98 

202 How old were you when you first became 

pregnant? 

Age in completed years: 

Don’t know …………….…………. 98 

203 How many times have you been pregnant? # of times: …………….. 

Don’t know ……………….………. 98 

204 Was your most recent delivery the first time Yes …………………...……………. 1 

you gave birth? 

No ……………………………….… 2 

205 In what year and month did your delivery Month: 

previous to your most recent delivery take 

place? 

Year: 

If # = 1, 

go to 206 

206 

175

Q. # Question Codes Skip 

206 Are you pregnant now? Yes …………………...……………. 1 

No ……………………………….… 2 

Unsure …………………………….. 8 

207 At the time you last became pregnant did you 

want to become pregnant then, did you want 

to wait until later, or did you not want to 

have any (more) children at all? 

208 How many sons and daughters have been 

ever born to you (including those who might 

currently be away from home)? 

(IF NONE ENTER "00".) 

209 Of all the children born to you, how many 

sons and daughters are alive now? 

Then ………………………………….. 1 

Later ………………………………….. 2 

Not at all ……………………………… 3 

Total sons: 

Total daughters: 

Sons living: 

Daughters living: 

None...................................................... 97 

If 208 = 

209, go to 

211 

(IF NONE ENTER "00".) 

210 How many of your children who were born 

alive died in the first month of life? # of children ……………….. _____ 

211 Have you ever delivered a child who was Yes …………………...……………. 1 

stillborn? 

No ……………………………….… 2 213 

212 How many times have you delivered a # of times: …………….. 

stillborn (gestation period 28 weeks or 

more child? 

213 Check Q5 and circle below: 

Youngest child is alive……………………………………………………………….1 

Youngest child is not alive……………………………………………………….…..2 301 

214 Is your youngest child’s birth registered with 

the VDC? 

Yes………………….........………...1 

No………………………..…...……2 

Don’t know………………..….....…8 

Section 3: FCHV Services: General and Antenatal 

Interviewer: “Now I would like to ask you some questions about your FCHV and the services she 

provides to pregnant women.” 

Q. # Question Codes Go to Q. 

301 Do you know who the FCHV is who serves 

your area? 

(Prompt: “Do you know the woman who 

gives out vitamin A to children under 

five in your area twice a year”) 

302 What is the FCHV’s name? 

303 What is her ethnicity? 

(Write caste in space provided. Do not 

fill box) 

Yes...........................................................1 

No ............................................................2 

Don’t know …………………………... 8 

Name: ___________________________ 

Don’t know ……………………….…..98 


304 Please tell me which of the following kinds of help or services 

does your FCHV provide? 

(READ ALL RESPONSES) Yes No DK 

1. Health information including mothers groups? 1 2 8 

2. Provide advice to pregnant women? 1 2 8 

3. Provide advice to post-partum mother? 1 2 8 

4. Provide advice regarding newborn? 1 2 8 

310 

310 

176


5. Provide advice and treatment regarding children’s diarrhea? 1 2 8 

6. Provide advice and treatment regarding children’s 

1 2 8 

respiratory infection (including pneumonia)? 

7. Supply condoms and pills? 1 2 8 

8. Vitamin A for mother / child? 1 2 8 

9. Provide HIV/AIDS/STI information? 1 2 8 

305 Did you meet the FCHV in your 

community for services or advice during 

Yes...........................................................1 

No ............................................................2 310 

your last pregnancy? 

306 How many times did you meet with your 

FCHV during your last pregnancy outside 

of the mothers group to receive services or 

# of times: …………….. 

Don’t know ……………………. 98 

advice? 

307 Did your FCHV discuss specific plans for any of the following 

with you during your last pregnancy? 


1. Identifying/using a skilled birth attendant? 1 2 8 

2. Emergency transport for delivery? 1 2 8 

3. Finances for delivery care? 1 2 8 

4. About source of Emergency Obstetric Care? 1 2 8 

5. Identify person to accompany mother in emergency? 1 2 8 

308 Did you receive advice from your FCHV on any of the 

following topics during your last pregnancy? 


1. Seek ANC 4 times from health worker? 1 2 8 

2. Take rest and avoid heavy work? 1 2 8 

3. Proper, balanced diet? 1 2 8 

4. Tetanus toxoid vaccination? 1 2 8 

5. Obtain iron and deworming tablets? 1 2 8 

6. Danger signs for pregnant woman? 1 2 8 

7. Using a skilled birth attendant? 1 2 8 

8. Use Clean Home Delivery Kit? 1 2 8 

9. Deliver in clean, light surface/room? 1 2 8 

10. Danger signs during delivery? 1 2 8 

11. Make at least 3 PNC visits? 1 2 8 

12. Mother should take Vitamin A after delivery? 1 2 8 

13. Danger signs for post-partum woman? 1 2 8 

14. Use family planning following delivery? 1 2 8 

15. Wrap the newborn in a clean and dry cloth? 1 2 8 

16. Do not bathe the newborn within 24 hrs.? 1 2 8 

17. Keep the newborn’s cord dry and clean (do not apply 1 2 8 

anything)? 

18. Breastfeed the newborn within 1 hr. after birth? 1 2 8 

19. Continue exclusive breastfeeding? 1 2 8 

20. Danger signs in newborn? 1 2 8 

21. Financial preparation for your delivery? 1 2 8 

22. Identifying emergency transport options? 1 2 8 

23. Arranging for blood in case of emergency? 1 2 8 

309 Were you counseled individually or in a 

group by your FCHV on maternal and child 

health using a flip chart during your last 

pregnancy? 

SHOW FCHV FLIP CHART 

177 

Yes…………............…………..……….1 

No………………............………..……..2 

Don’t know ……………………….……8


310 Is there a mothers group in your area? Yes...........................................................1 

No ............................................................2 

Don’t know ……………………….……8 

311 Did you attend the mothers group meeting Yes...........................................................1 

during your last pregnancy? 

312 Why didn’t you attend the mothers group 

during your last pregnancy? 

313 How many times did you attend the 

mothers group when you were last 

pregnant? 

No ............................................................2 

Too far …………….…………………. 1 

Not interested ……….……………..… 2 

Social exclusion …….……………….. 3 

Nobody informed me about it …….…. 4 

I did not know when it is held ……..… 5 

Don’t know if there is a mothers group 6 

Other (specify) ___________________ 7 

# of times: …………….. 

314 

314 

313 

Don’t know ……………………. 98 

Interviewer: “Now I would like to ask you some questions about Primary Health Care Outreach 

Clinics” 

314 Have you heard of the Primary Health Care 

Outreach Clinic (PHC/ORC)? 

Yes……………………..………….1 

No…………..……………………..2 401 

315 What date of month PHC/ORC is 

scheduled in your area? 

Date: ____ ____ 

Don’t know ………………………….. 98 

314 

316 Did you use the Primary Health Care 

Outreach Clinic at any time following your 

most recent delivery for any of the 

following services? (Read all) 





SUPERVISOR FILLS OUT: 

Yes 

1 

1 

1 

1 

No 

2 

2 

2 

2 

Section 4: Antenatal Care 

Interviewer: “Now, I would like to ask you some questions about when you were pregnant prior 

to your most recent delivery.” 


401 Did you see anyone for antenatal care for the Yes .......................................................... 1 

pregnancy prior to your most recent delivery? 

402 Whom did you see? 

(Ask: “Anybody else?” Continue until no 

further answers.) 

(Circle all responses.) 

403 How many times did you receive antenatal care 

during the pregnancy prior to your most recent 

delivery? 

No ........................................................... 2 410 

Doctor ..................................................... 1 

Nurse/ANM ............................................ 2 

HA/AHW................................................ 3 

MCHW ................................................... 4 

VHW....................................................... 5 

FCHV...................................................... 6 

TTBA...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Number of times ____ ____ 

Don’t know ........................................... 98 

178


404 How many months pregnant were you when Number of months 

____ 

you first received antenatal care for the Don’t know ........................................... 98 

pregnancy prior to your most recent delivery? 

405 As part of your antenatal care during the pregnancy 

prior to your most recent delivery, were any of the 

following done at least once? 

(Read each service, circle appropriate response) Yes No DK 

1. Was your abdomen examined? 1 2 8 

2. Did you receive iron tablets? 1 2 8 

3. Did you receive deworming tablets? 1 2 8 

4. Did you receive TT vaccination? 1 2 8 

5. Was your weight measured? 1 2 8 

6. Was your height measured? 1 2 8 

7. Was your blood pressure measured? 1 2 8 

8. Did you give a urine sample? 1 2 8 

9. Did you give a blood sample? 1 2 8 

406 Who are the people who accompanied you at 

least one time to your antenatal care? 




407 Where did you receive antenatal care for your 

most recent antenatal care visit? 

If source is hospital, health center, or clinic, 

write the name of the place. Probe to 

identify the type of source and circle the 

appropriate code to the right. 

_____________________________________ 

Name of place 

179 

Husband……...…………........…….1 

Mother-in-law . . . ………....…........2 

Father-in-law…………………...…..3 

Mother……………...….......... ……4 

Other family member…………....... 5 

Friend / Neighbor ………………....6 

Nobody (went alone) ………………7 

Other (specify)_________________8 

Don’t know......................................98 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 

Sub-health post ....................................... 4 

PHC/OR clinic........................................ 5 

Pvt. Clinic/n. Home ................................ 6 

Pharmacy ................................................ 7 

FCHV...................................................... 8 

TBA ........................................................ 9 

Other (specify) __________________ 10 

Don’t know _____________________ 98 

408 

409 During any of your antenatal care visits with health workers during your pregnancy prior 

to your most recent delivery, were you counseled on: (READ ALL RESPONSES) 

Yes No Don’t know 

1. Financial preparation for your delivery? 1 2 8 

2. Breastfeeding immediately after birth? 1 2 8 

3. Danger signs during pregnancy? 1 2 8 

4. Tetanus toxoid vaccination? 1 2 8 

5. Wrapping the newborn? 1 2 8 

6. Using a skilled birth attendant? 1 2 8 

7. Family planning? 1 2 8 

8. Identifying emergency transport options? 1 2 8 

9. Arranging for blood in case of emergency? 1 2 8 

410 Did you discuss planning for your delivery 

with your husband while you were pregnant? 

411 Did you receive tetanus toxoid injection when 

you were pregnant prior to your most recent 

delivery? 

Yes .......................................................... 1 

No ........................................................... 2 

Yes .......................................................... 1 

No ........................................................... 2 

Don’t know …………………………….8 

413 

413


412 How many times did you receive immunization Number of shots 

against tetanus (TT) during that pregnancy? Don’t know ............................................. 8 

413 Do you have an antenatal card from when you 

were pregnant prior to your last delivery? 

(if respondent says “yes”): “May I please see 

it?” 

Yes (seen) ……………………………. 1 

Yes (not seen) ………………….……... 2 

No ………………………….……..…... 3 

414 Instructions for interviewer: 

(Look at the antenatal card and record the Number of shots 

number of TT injections for which a date is 

listed on the card during her last 

Don’t know ........................................... 98 

pregnancy.) 

(Do not use an antenatal card for a previous 

pregnancy.) 

415 In total, how many injections for TT have you Number of shots 

had in your lifetime? 

Don’t know ........................................... 98 

416 Were you given or did you buy any iron/folic Yes .......................................................... 1 

acid tablets when you were pregnant prior to No ........................................................... 2 

your most recent delivery? 

Don’t know …………………………….8 

(SHOW IRON TABLETS.) 

417 During the whole pregnancy, for how many 

days did you take the tablets? 

418 Where did you obtain the iron/folic acid 

tablets? 

If “FCHV” is not mentioned, then prompt 

“Did you received iron/folic acid tablets 

from the FCHV?” 

(Otherwise, do not prompt. If respondent 

gives more than one answer, circle all 

answers.) 

419 When you were pregnant, did you receive 

deworming tablets? 

420 When you were pregnant, did you eat less than 

usual, about the same amount as usual, or more 

than usual? 

421 When you were pregnant, did you receive less 

care and support than usual, about the same 

care and support as usual, or more care and 

support than usual from your family members? 

422 What types of care/support did you receive 

from your family members? 

(Probe: “Any other?”) 

(CIRCLE ALL RESPONSES GIVEN) 

Number of days….. 

Don’t know……………………..… 998 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Pharmacy ................................................ 7 

FCHV...................................................... 8 

Other (specify) ___________________ 9 

Yes .......................................................... 1 

No ........................................................... 2 

Don’t know ……………………..……..8 

Less than usual........................................ 1 

Same as usual.......................................... 2 

More than as usual .................................. 3 

Don’t know ............................................ .8 


Same as usual.......................................... 2 


Don’t know ............................................ .8 

Given more food to eat ........................... 1 

Given more nutritious food to eat........... 2 

Advised for more rest ............................. 3 

Reduced heavy load................................ 4 

Advised/accompanied for physical checkup 

............................................................ 5 

Other (specify) ___________________ 6 

415 

415 

419 

419 

424 

424 

424 

180


423 From whom did you receive above-mentioned 

care/support(s)? 



424 Please tell me where you can go or who you 

can see for health services if you have danger 

signs while you are pregnant. 

In what village / town is that facility (health 

provider) located? (write response below) 

___________________________________ 

location 

(Multiple responses possible. Circle all 

responses.) 

425 How many check-ups should a woman have 

with a trained health worker while she is 

pregnant? 

426 Have you heard the message: “A pregnant 

woman should have her health checked four 

times by a trained health worker” 

If yes, ask “from whom or where?” 

Prompt: “from anybody or anywhere else?” 

Record all responses 

427 What are the symptoms during pregnancy 

indicating the need to seek immediate care? 

(Ask: “Any others?” Continue until no 



Husband .................................................. 1 

Mother-in-law......................................... 2 

Father-in-law........................................... 3 

Sister-in-law............................................ 4 

Daughter ................................................. 5 

Son .......................................................... 6 

Other ___________________________ 7 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Other(specify)___________________ 7 

Don’t know ………………………….. 98 

Checked by supervisor 

# of checkups ___________ 

Don't know ......................................98 

From FCHV ….......................................1 

From health worker................................2 

From friends...........................................3 

Haven't heard the message ................... 4 

Other (specify) ___________________ 5 

Vaginal bleeding (any amount) .............. 1 

Severe lower abdominal pain.................. 2 

Severe headache...................................... 3 

Convulsion.............................................. 4 

Blurred vision and swelling of hands and 

face.......................................................... 5 

Other (specify) ___________________ 6 

Don’t know ........................................... 98 

428 When you were pregnant, did you experience any of the following 

problems at anytime? 

(Read out all responses one after another) 

(Record all responses accordingly.) Yes No 

1 Blurred vision? 1 2 

2 Severe lower abdominal pain? 1 2 

3 Severe headache? 1 2 

4 Convulsion? 1 2 

5 Swelling of the hands, body or face? 1 2 

6 Any vaginal spotting or bleeding? 1 2 

7 None of the above 7 501 

181


429 What did you do or whom did you consult for 

the problems that you stated above? 

(Prompt: “anything else?” 

Circle all answers) 

Traditional treatment at home ………. 1 

Given medicine at home …………………. 2 

Hospital …………………………………… 3 

PHCC /HP/ SHP ………………………….. 4 

Pvt. Clinic/n. Home ………………………. 5 

Bought medicine from pharmacy …………. 6 

Consulted FCHV ………………………….. 7 

Consulted MCHW ………………………… 8 

Consulted a TBA ………………………….. 9 

Consulted other HW ……………………... 10 

Consulted dhami / jhankri ……………….. 11 

Consulted relative/neighbor/friend ………. 12 

Nothing …………………………………... 13 

Other: _____________________(specify) 14 

Section 5: Delivery Care 

Interviewer: “Now, I would like to ask you some questions about your most recent delivery.” 


501 Who assisted with your most recent delivery? 

(Prompt: “Anybody else?”) 

(Circle all responses) 

(If mother was delivered by TBA and she 

did not know if the TBA was trained, record 

the name of the TBA below): 

______________________________ 

502 Who else was present at the delivery outside 

the room where the delivery took place? 



Doctor…………………………….….1 

Staff Nurse . . . ………....……….…...2 

ANM….…………...……………....... 3 

MCHW………………………....……4 

HA …………………………………..5 

AHW / CMA …………...….. ………6 

VHW........……………………………7 

Trained TBA…………………….…...8 

Untrained TBA………………….……9 

FCHV……………………..…………10 

Relative/Friend ……………………..11 

Other (specify)__________________12 

Nobody …………………………….. 13 

Trained TBA………………………....1 

Untrained TBA………………………2 

FCHV……………………..…………3 

Friends/Neighbors......……………….4 

Mother-in-law......………………..….5 

Father-in-law......…………………….6 

Husband....………….……………….7 

Mother....…………………………….8 

Father......……………...…………….9 

Other relative ………………….….. 10 

Nobody ………………………….. 11 

Other (specify)_________________12 

Don’t know.........................….........98 

182


503 Where did you give birth in your most recent 

delivery? 





_____________________________________ 

Name of place 

504 Had you planned during your pregnancy to 

deliver in a health facility or did you start to 

deliver at home and then decide to go the 

health facility because of some problem 

occurring during your labor or delivery? 

505 Was your child delivered by caesarean section? 

(Prompt: Ask “did a doctor cut open your 

abdomen to deliver the baby?”) 

506 Why didn’t you deliver in a health facility? 

(Probe: “Any other reason?”) 


507 Was it an instrumental delivery? 

(Prompt: Ask “Was the baby delivered with 

the help of machine or instruments?”) 

508 Was the baby born head first or did other parts 

of the body, including the placenta, come out 

first? 

509 Did a health worker give you an injection in 

the thigh or buttocks right after the baby was 

born? 

510 Did you bleed a lot more than normal 

immediately following the birth of your baby ? 

511 How many cloths did you use to absorb the 

blood during the first 24 hours after your baby 

was born? 

183 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 


Pvt. Clinic/n. Home .................................5 

Your home …………………………..… 6 

Other home ………………………….… 7 

Other (specify) ___________________ 8 

Planned to go during pregnancy ………. 1 

Started to deliver at home …………..… 2 

Other (specify) ___________________ 3 

Yes……………………………….1 

No………………………………..2 

Cost too much ………………………… 1 

Facility not open ……………………… 2 

Too far / no transportation ……………. 3 

Don’t trust facility / poor quality service 4 

No female provider at facility ………… 5 

Husband / family did not allow ……….. 6 

Not necessary …………………………. 7 

Not customary ………………………… 8 

Other (specify) ___________________ 9 

Yes……………………..………….….1 

No…………………………..…….…..2 

Don’t know……………………….…..8 

Head first .…………………………….. 1 

Other parts of body …………………… 2 

Don’t know ………………………….. .8 

Yes…………………………………….1 

No……………………………………..2 

Don’t know…………………..………..8 

Yes…………………………………….1 

No……………………………………..2 

Don’t know……………………………8 

# of cloths: ____ 

Don’t know/can’t remember ………. 98 

512 (PROBE: “Was it more than two cloths?”) Yes……………………………………1 

No……………………………….…....2 

Don’t know……………………..……8 

513 Now I am going to ask you some questions regarding how 

you felt immediately following the delivery: Yes No DK 

1. In the first 6 hours following delivery, did you feel faint 

or dizzy? 

2. In the first 6 hours following delivery, did you actually 

faint or lose consciousness? 

3. In the first six hours following delivery, did you 

experience shivering? 

• (if yes) for how many hours? (don’t know = 98) 


experience nausea? 

1 2 8 

1 2 8 

1 2 8 

1 2 8 

506 

506 

506 

514 

507 

513


• (if yes) for how many hours? (don’t know = 98) 


1 2 8 

experience fever? 

• (if yes) for how many hours? 

6. In the first six hours following delivery, did you have a 1 2 8 

watery stool? 

• (if yes) how many times? (don’t know = 98) 

514 

515 Who was the main person who decided who 

would attend your most recent delivery? 

Self……………………………….…...1 

Mother-in-law......……………..……...2 

Father-in-law......……………………..3 

Husband....………….………………..4 

Self and husband together …………… 5 

Mother / father ……………………....6 

Other relative ……………………….. 7 

Other (specify)___________________8 

Don’t know.........................…......…..98 

516 Who was the main person who decided where Self…………………………………...1 

your most recent delivery would take place? Mother-in-law......………………..…..2 

Father-in-law......……………………..3 

Husband....………….………………..4 

Self and husband together ……………5 

Mother / father ………………..……..6 

Other relative ……………………….. 7 

Other (specify)___________________8 

Don’t know.........................…....…....98 

Interviewer: “Now I’d like to ask you some questions about delivery services in your community.” 

517 Who should be present at birth to help deliver 

the baby safely? 

(Ask: “Anybody else who could be suitable 

instead?” Continue until no further 

responses.) 


Doctor………………………….……..1 

Staff Nurse . . . ………....……….…….2 

ANM….…………...…………..…..…. 3 

MCHW……………………….…….…4 

HA …………………………………....5 

AHW/ CMA …………...……… ….…6 

VHW........………………………….…7 

Trained TBA……………………….....8 

Untrained TBA…………………….…9 

FCHV…………………………….…10 

Relative/Friend......……………….…..11 

Other (specify)__________________12 

184


518 Please tell me the name and training background 

of a trained health provider that you know who 

will attend a delivery in your home. Please tell 

me the name and location of the health facility 

where s/he works. 



___________________________________ 

Name of provider 

___________________________________ 

Location 

Confirm the training background of the 

provider 

519 Please tell me the name and location of a health 

facility in your community where you can go to 

deliver your child as well as its location. 

Location: _______________________________ 

Confirm the type of health facility and 

location 

Training background 

Doctor………………………….……..1 

Staff Nurse . . . ………....……….…….2 

ANM….…………...…………..…..…. 3 

MCHW……………………….…….…4 

HA …………………………………....5 

AHW/ CMA …………...……… ….…6 

VHW........………………………….…7 



FCHV…………………………….…10 

Other (specify)__________________11 


Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Pvt. Clinic/n. Home .................................6 

Other (specify) ___________________ 7 

Don’t know ………………………..… 98 

Checked by supervisor 


facility in your community where you can go to 

receive emergency services if you have a 

problem during delivery at home. 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Location: _______________________________ Pvt. Clinic/n. Home .................................6 

Other (specify) ___________________ 7 

Confirm the type of health facility and Don’t know ………………………..… 98 

location 

Checked by supervisor: 

521 How long does it take you to travel to this (as Minutes: _____ _____ ____ 

mentioned in Q520) provider or facility? Don’t know ………………………998 

(Hour:………. Minute:………..) 

522 Doctors, nurses, midwives, and MCHWs have 

received special training in how to deliver 

babies. In your opinion, how important is it for 

your delivery to be attended by one of these 

types of health workers? Is it very important, 

somewhat important or not important? 

Very important........................................ 1 

Somewhat important .............................. 2 

Not important ......................................... 3 

Don’t know ............................................ .8 

526 

526 

185


523 Why do you think that it is important that your 

delivery should be attended by one of these 

health personnel? 

(Ask: “Any other reasons?” Continue until no 

further responses.) 


524 What was the respondent’s response to 

Question 501? 

525 You have stated that it is important for your 

delivery to be attended by a health worker who 

is specially trained in how to deliver babies. 

However, this type of specially trained health 

worker did not attend your delivery. Can you 

please tell me why a specially trained health 

worker did not attend your delivery? 

526 In your opinion, what things need to be kept 

clean during childbirth? 



527 What are the signs/symptoms during labor 




528 In your opinion, how dangerous is it to a women 

in labor when the labor is longer than 8 hours? 

Is it not dangerous, somewhat dangerous, 

dangerous, or very dangerous? 

529 In your opinion, how dangerous is it to a women 

when the baby does not come out head-first 

during delivery? Is it not dangerous, somewhat 

dangerous, dangerous, or very dangerous? 

To examine the condition of mother 

and child…………..........…......…...….1 

To confirm the position of the fetus…...2 

For infection free delivery..…………...3 

For the safety of mother .…………..….4 

For the safety of child……….……..….5 

To manage complications easily.…..….6 

To identify danger signs ………..…..…7 

In case of serious problem with the 

delivery ……………………………..... 8 

In order to have a normal delivery ….. 9 

Other (specify)……………….….…... 10 

Don’t know ……………………….….98 

1, 2, 3 or 4 ……………………………..1 

5 to 13 ……………….….…………….2 

I didn’t have a problem and therefore it 

was not necessary………………………1 

Do not know who to ask ………………2 

No service available nearby……………3 

No practice in the community………….4 

Family members do not allow..………...5 

Will cost too much ……………………6 

Another type of health worker attended ..7 

Other (specify) __________________ 8 

Don’t know ………………………… 98 

Clean nails .............................................. 1 

Clean hands............................................. 2 

Blade....................................................... 3 

Surface .................................................... 4 

Thread..................................................... 5 

Perineum................................................. 6 

Mother’s clothes ………………………. 7 

Other (specify) ___________________ 8 

Don’t know ........................................... 98 

Labor longer than 8 hours....................... 1 

Appearance of baby’s hand first ............ 2 

Appearance of baby’s leg first................ 3 

Appearance of umbilical cord first ......... 4 

Excessive bleeding before or after 

delivery ................................................... 5 

Convulsion.............................................. 6 

Other (specify) ___________________ 7 

Don’t know ........................................... 98 

Not dangerous ……………………….... 1 

Somewhat dangerous ……………….… 2 

Dangerous …………………………….. 3 

Very dangerous ……………………….. 4 

Don’t know ………………………….. .8 



Dangerous …………………………….. 3 


Don’t know ………………………….. .8 

526 

186


530 In your opinion, how dangerous is it to a women Not dangerous ……………………….... 1 

when she experiences excessive bleeding during 

or after delivery? Is it not dangerous, somewhat 



Dangerous …………………………….. 3 


531 What amount of blood loss during labor or 

delivery is dangerous for the mother? 

Don’t know ………………………….. .8 

1. Liters: ______ ______ 

2. Manas: ______ ______ 

3. Cloths: ______ ______ 

5. Other (specify): _________________ 

Don’t know …………………………. 98 

532 During your delivery, did you experience any of the following 

problems at anytime? 

(Read out all responses one after another.) 

(Record all responses accordingly) Yes No 

1 So much bleeding that it wet your clothes and you feared it was 1 2 

life threatening? 

2 Convulsions? 1 2 

3 Prolonged labor (>8 hours)? 1 2 

4 The baby’s hand, leg or cord came out first ? 1 2 


533 What did you do or whom did you consult for Traditional treatment at home ………. 1 



Hospital …………………………………… 3 


PHCC /HP/ SHP ………………………….. 4 











Other: _____________________(specify) 

14 

Interviewer: “Now I would like to ask you some questions regarding whether or not you were referred 

for any of these problems.” 

534 Did a health worker refer you or advise you to 

go to a health facility for treatment for any of 

the problems that you mentioned above? 

Yes…………………………………….1 

No……………………………………..2 

Don’t know………………………….. .8 

537 

537 

535 After you were advised to seek care, did you go Yes ...…………………………..… 1 

to any health facility? 

No …...…………………………... 2 537 

536 Where did you go? Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 


PHC/ORC ............................................... 5 


Pharmacy ................................................ 7 

Other (specify) ___________________ 8 

Don’t know/don’t remember ……….... 98 

Interviewer: ”I would now like to ask you some further questions about attendance of a trained health 

worker during delivery.” 

187


537 In the past three months, have you seen, heard, or Yes……..…………….…………..…..1 

read anything about attendance of a trained health No……………………………..……..2 539 

worker during delivery on the radio or television 

or in the newspaper or anywhere else? 

538 Please tell me where you saw or heard a 

message on attendance of a trained health 

worker during delivery. 

(Prompt “anywhere else?” until no more 

responses. Circle appropriate responses in 

Unaided column. Then read out any 

remaining media sources using the sentence: 

“Did you hear anything about attendance of 

a trained health worker during delivery 

through (media source)?” If respondent 

answers “yes”, circle “2” in Aided column. 

If respondent answers “no”, circle “3” in 

Unexposed column. 


539 Have any friends, family members or other 

acquaintances spoken with you informally during 

the past two months about attendance of a trained 

health worker during delivery? 

Media source Unaid 

ed 

Aided Unex 

posed 

1. FCHV flip chart 1 2 3 

2. From FCHV 1 2 3 

3. From TBA 1 2 3 

4. From a health worker at 1 2 3 

the health facility 

5. Community groups 1 2 3 

6. Posters, pamphlets, leaflets 1 2 3 

7. Newspaper 1 2 3 

8. Radio 1 2 3 

9. TV 1 2 3 

10. Others (specify) _____ 

Yes……..………………..….………..1 

No………………………………..…..2 

Interview reads “I am going to read you a number of statements and then ask you if you strongly 

disagree, disagree, agree, or strongly agree with the statements” 

540 “People who attended my most recent delivery do Strongly disagree ………………….…. 1 

not feel it is necessary to have a trained health Disagree ……………………………… 2 

worker present at a delivery." 

Agree ………………………………….. 3 

541 “If I have another child, I will not be able to 

ensure that a trained health worker is present at 

my delivery." 

542 “If I have another delivery, I will ensure that a 

trained health worker is present at my delivery.” 

543 Have you ever encouraged or discouraged your 

friend or family member to arrange for a trained 

health worker to be present at her delivery ? 

Strongly agree ………………………... 4 

Strongly disagree ………………….…. 1 

Disagree ……………………………… 2 

Agree ………………………………….. 3 


Strongly disagree ………………….…. 1 

Disagree ……………………………… 2 

Agree ………………………………….. 3 


Encouraged …………………………… 1 

Discouraged …………………………... 2 

Neither encouraged nor discouraged …. 3 

Section 6: Misoprostol and Post-Partum Hemorrhage 

Interviewer: “Now, I would like to ask you some questions about bleeding after childbirth.” 

Q 

# 

Questions Response Skip 

Obstetric History 

601 During your pregnancy prior to your last 

delivery, did you receive any information about 

bleeding after childbirth? 

602 What information did you receive about 


(Prompt: “Did you receive any other 

information?”) 


Yes ...…………………………..… 1 

No …...…………………………... 2 

Don’t know/don’t remember ….… 8 

Can cause death ……………….… 1 

Go to health facility promptly …... 2 

Get help from health worker ….… 3 

Other (specify) _______________ 4 

604 

604 

188

Q 

Questions Response Skip 

# 

603 Please name all the sources from which you 

learned about bleeding after childbirth. 

Radio … ......................................... 1 

Television … ……………………. 2 

Pamphlet/flyer … ……………….. 3 



Poster … ………………..……….. 4 

FCHV… ........................................ 5 

Women’s group … ………….…... 6 


Health worker… ............................ 7 

Health facility … …………..……. 8 

Neighbor/family/friend/ relative… 9 

Other (specify) ______________ 10 

604 During your pregnancy prior to your last 

delivery, did you receive any information about 

a medicine that can be taken to reduce bleeding 

after childbirth? 

Yes ...…………………………..… 1 

No …...…………………………... 2 

Don’t know/don’t remember. …… 8 

Section 7: Post-Partum Care 

Interviewer: “Now, I would like to ask you some questions about your health during the month 

after your most recent delivery.” 


Interviewer: “I would like to begin by asking you some questions about your FCHV and the postnatal 

services she provides.” 

701 (Copy response from Question 301) Yes .......................................................... 1 

No ........................................................... 2 

Don’t know …………………………..98 


FCHV during the six weeks following your last 

delivery outside of the mothers group to 

receive services or advice?? 

189 

# of times: …………….. 

If zero times…… ………………….97 

Don’t know ……………………. 98 

# of days: …………….. 

Don’t know ……………………. 98 

703 How soon after your last delivery did you first 

meet with your FCHV? 

704 What services, help or advice did your FCHV provide you or 

your newborn during the six weeks following your last 

delivery? (READ ALL RESPONSES) Yes No DK 

1. Diagnose or treat newborn’s respiratory infection or 1 2 8 

diarrhea? 

2. Check to see if your newborn had any other health 

1 2 8 

problem? 

3. Provide vitamin A for mother? 1 2 8 

4. Provide iron tablets for mother? 1 2 8 

5. Check to see if the mother had a delivery- related problem 1 2 8 

(e.g. infection)? 

6. Make referral to health service provider? 1 2 8 

7. Advice on breastfeeding or infant care? 1 2 8 

8. Advice or help with birth registration? 1 2 8 

9. Family planning supplies? 1 2 8 

705 Did you receive advice from your FCHV on any of the 

following topics during the six weeks following your last 

delivery? (READ ALL RESPONSES) Yes No DK 

1. Take rest? 1 2 8 

2. Avoid heavy work? 1 2 8 

3. Diet? 1 2 8 

706 

706 

706


4. Breastfeeding counseling? 1 2 8 

5. Post-partum danger signs for mother? 1 2 8 

6. Danger signs for newborn? 1 2 8 

7. Iron tablets? 1 2 8 

8. Family planning? 1 2 8 

706 How many times did you attend the mothers 

group in your community during the six weeks 

# of times: …………….. 

following your last delivery? 

Don’t know ……………………. 98 

Interviewer: “Now I am going to ask you some more detailed questions about the postnatal care that 

you received.” 

707 Did a health professional, FCHV or a 

traditional birth attendant check on your health 

during the first three days after birth? 

Yes……………………..………….1 

No…………..……………………..2 709 

708 Who checked on your health during the first Doctor ..................................................... 1 

three days after birth? 

Nurse/ANM ............................................ 2 

HA/AHW................................................ 3 

(Ask: “Anybody else?” Continue until no MCHW ................................................... 4 


VHW....................................................... 5 

FCHV...................................................... 6 


TTBA...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Don’t know / don’t remember ………...98 

Interviewer: “Now I am going to ask you some detailed questions about the postnatal care that you 

received between four days up to six weeks after the birth.” 

709 Did a health professional, FCHV or a 

traditional birth attendant check on your health 

between four days and six weeks after birth? 

710 How many times did a health professional, 

FCHV or a traditional birth attendant check on 

your health between four days and six weeks 

after birth? 

190 

Yes……………………..………….1 

No…………..……………………..2 714 

# times: ______________________ 

Don’t Know …………………….…… 98 

711 Where did these checks take place? 

Hospital……………….…………..……1 

PHC……………………………...…..…2 

Prompt: “Anywhere else?” 

HP………………………………..…….3 

SHP……………………………...….…..4 

Circle all responses 

Private clinic………………….….…….5 

NGO clinic……………….……………..6 

PHC / ORC ……………………………7 

Home ………………………………….. 8 

Other (specify) ___________________ 9 

712 How many of these visits occurred at home? # times: ______________________ 

713 Who checked on your health between four 

days and six weeks after birth? 




Don’t Know …………………….…… 98 

Doctor ..................................................... 1 

Nurse/ANM ............................................ 2 

HA/AHW................................................ 3 

MCHW ................................................... 4 

VHW....................................................... 5 

FCHV...................................................... 6 

TTBA...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Don’t know / don’t remember ………...98


Interviewer: “Now I am going to ask you some questions regarding care that you may have received at 

a health facility following your delivery.” 

714 Did you go to a health facility or PHC ORC 

approximately 6 weeks after your most recent 

delivery for a checkup or to have your child 

vaccinated? 

Yes……………………………….1 

No………………………………..2 

Taken to child only………………3 

716 

718 

715 Why didn’t you go to a health facility or PHC 

ORC? 


Do not think it is necessary………….…1 


No service available nearby………....…3 


Family members do not allow………….5 

Will cost too much ………………….…6 

Received treatment from guruwa or other 

traditional healer ………………...…….7 

Didn’t know I should get a checkup …. 8 

Felt unsafe to go ……………………… 9 

Other (specify) __________________ 10 

716 What facility or PHC ORC did you go to? Hospital……………….…………..……1 

PHC……………………………...…..…2 

HP………………………………..…….3 

SHP……………………………...….…..4 

Private clinic………………….….…….5 

NGO clinic……………….……………..6 

Outreach clinic …………………………7 

Other (specify) ___________________ 8 

717 Which of the following activities were conducted by the health worker during your 

postnatal checkup? (READ ALL) 

Yes No DK 

1 Examination of abdomen? 1 2 8 

2 Internal examination? 1 2 8 

3 Asked if you had excessive bleeding / severe abdominal 1 2 8 

pain? 

4 Counseled you about Family Planning? 1 2 8 

5 Counseled you about breastfeeding? 1 2 8 

6 Counseled you about immunization? 1 2 8 

7 Provided advice on newborn care? 1 2 8 

718 Interviewer: Check question Q4 and 

confirm that recently delivered child was a 

live birth 

719 Did you take your baby when you visited the 

health facility approximately six weeks postdelivery? 

720 Why not? 


722 

Yes…………………………………….1 

No……………………………………..2 722 

Yes……………………………….1 

No………………………………..2 

Do not think it is necessary………….…1 


No service available nearby………....…3 


Family members do not allow………….5 

Will cost too much ………………….…6 

Received treatment from guruwa or other 

traditional healer ………………...…….7 

Didn’t know newborn needs checkup .. 8 

Felt unsafe to take my child ……….… 9 

Other (specify) __________________ 10 

721 

722 

191


721 Which of the following activities were conducted by the health worker during your baby’s 

checkup? (READ ALL) 

Yes No DK 

1 Baby’s name entered in health post register? 1 2 8 

2 Health worker asked questions about baby’s feeding habits? 1 2 8 

3 Baby was weighed and weight was recorded in register or 1 2 8 

other document? 

4 Baby was given vaccination? 1 2 8 

5 Baby received physical examination? 1 2 8 

6 Health worker encouraged you to register baby’s birth? 1 2 8 

722 After your most recent delivery, for about how Number of days……….. 

many days did you take iron or folic tablets? 

(Show iron tablets) 

Don’t know………….………………998 

(If not taken at all enter ‘000’) 

723 In the first 42 days after delivery, did you 

receive a Vitamin A dose like this? 

(Show Vitamin A capsule) 

724 What are the symptoms of the mother 

indicating the need for her to seek immediate 

health care during the six weeks after 

delivery? 

(Ask: “Anything else?” Continue until no 


Yes……………………..………….1 

No…………..……………………..2 

High fever…………………………….. 1 

Pain in lower abdomen or smelling 

vaginal discharge……………………... 2 

Excessive bleeding…………………..... 3 

Severe headache………………………. 4 

Convulsion and fit…………………….. 5 

Others (Specify)___________________ 6 

Do not know……………………….…. 98 


725 Following your delivery, did a health worker, FCHV or TBA counsel you on the following 

maternal danger signs or issues? (READ ALL) 

Yes No DK 

1 High fever? 1 2 8 

2 Severe lower abdominal pain? 1 2 8 

3 Smelly discharge? 1 2 8 

4 Excessive bleeding? 1 2 8 

5 Severe headache? 1 2 8 

6 Convulsions? 1 2 8 

7 Breast problems? 1 2 8 

8 Where to go for services? 1 2 8 

726 During the first six weeks after your most 

recent delivery, did you eat less than usual, 

about the same amount as usual, or more than 

usual? 

727 During the first six weeks after your most 

recent delivery, did you receive less care and 

support than usual, about the same care and 

support as usual, or more care and support than 

usual from your family members? 

728 What types of care/support did you receive 

from your family members? 


(Circle All Responses Given) 


Same as usual.......................................... 2 


Don’t know ............................................. 8 


Same as usual.......................................... 2 


Don’t know. ............................................ 8 


Given more nutritious food to eat ........... 2 


Reduced heavy load ................................ 4 

Advised/accompanied for check-up........ 5 

Other (specify)____________________ 6 

730 

730 

730 

192


729 From whom did you receive above-mentioned 

care/support(s)? 



730 Please tell me where you would go or who you 

would see for health services if you have 

danger signs during the six weeks after you 

have delivered. 



___________________________________ 

location 


responses.) 

731 Within how many days after birth should 

mothers and newborns have their health 

checked by a health worker ? 

732 Have you heard the message: “Mothers and 

newborns should have their health checked by 

a health worker with 24 hours after birth?” 


Prompt: “From anybody or anywhere else?” 

Husband .................................................. 1 

Mother-in-law ......................................... 2 

Father-in-law........................................... 3 

Sister-in-law............................................ 4 

Daughter ................................................. 5 

Son .......................................................... 6 

Other (specify)____________________ 7 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post .............................................. 3 


PHC/OR clinic ........................................ 5 


Other(specify)____________________ 7 

Don’t know ………………………….. 98 


Days: _____ _____ 

Don't know.........…………............98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 


733 During the six weeks following your most recent delivery, did you experience any of the 

following problems at anytime? 


(Record all responses accordingly) 

Yes No 

1 2 

1 So much bleeding that it wet your clothes and you feared it 

was life threatening? 

2 High fever? 1 2 

3 Severe lower abdominal pain? 1 2 



734 What did you do or whom did you consult for 




Traditional treatment at home ……………. 

1 


Hospital …………………………………… 3 

PHCC /HP/ SHP ………………………….. 4 










Other: _____________________(specify) 14 

193


Interviewer: “Now I would like to ask you some questions regarding whether or not you were referred 

for any of these problems.” 

735 Did a health worker refer you or advise you to 

go to a health facility for treatment for any of 

the problems that you mentioned above? 

Yes…………………………………….1 

No……………………………………..2 

Don’t know……………………………8 

801 

801 

736 After you were advised to seek care, did you 

go to any health facility? 

Yes ...………………………….…..… 1 

No …...………………………….…... 2 801 

737 Where did you go? Hospital................................................... 1 

PHCC...................................................... 2 

Health post .............................................. 3 


PHC / ORC ............................................. 5 


Pharmacy ................................................ 7 

Other (specify)____________________ 8 

Don’t know/don’t remember ……….... 98 

Section 8: Post-Partum Family Planning and Birth Spacing 

Interviewer: “Now, I would like to talk about family planning – the various ways or methods that a 

couple can use to delay or avoid a pregnancy.” 


801 Which family planning ways or methods have you heard about? 

(For methods not mentioned spontaneously, ask:) 

Have you ever heard of (METHOD)? 

(Interviewer: Circle code “1” for each method mentioned spontaneously. Then proceed 

down the column, reading the name and description of each method not mentioned 

spontaneously. Circle code “1” if method is recognized, and code “2” if not recognized.) 

READ DESCRIPTION OF EACH METHOD Yes No 

1 FEMALE STERILIZATION: Women can have an operation to avoid having any 

more children. 1 2 

2 MALE STERILIZATION: Men can have an operation to avoid having any more 

children. 1 2 

3 PILL: woman can take a pill every day to avoid becoming pregnant. 1 2 

4 IUD: Women can have a loop or coil placed inside them by a doctor or a 

nurse. 1 2 

5 INJECTION: Women can have an injection by a health provider that stops 

them from becoming pregnant for one or more months. 1 2 

6 CONDOM: Men can put a rubber sheath on their penis before sexual 

intercourse. 1 2 

7 NORPLANT: Capsule to be inserted into women's arm. It prevents pregnancy 

for seven years. 1 2 

8 PERIODIC ABSTINENCE: Couples can avoid having sexual intercourse on 

certain days of the month when the woman is more likely to become 1 2 

pregnant. 

9 WITHDRAWAL: Men can be careful and pull out before climax. 1 2 

802 Have you done something or used any 

method to delay or avoid getting 

pregnant at any time after your most 

recent delivery? 

Yes...........................................................1 

No............................................................2 805 

194


803 What was the first method you used 

after the delivery? 

804 How many weeks or months after the 

delivery did you first start using this 

method? 

(Months:……….. Weeks:…….. ) 

Female Sterilization ………………………… 1 

Male Sterilization ………………………….… 2 

Pill …………………………………………… 3 

IUD ……………………………………...…… 4 

Depo-Provera …………………………...…… 5 

Norplant ……………………………………… 6 

Condom ……………………………………… 7 

Periodic abstinence ……………………..…… 8 

Withdrawal ………………………………..… 9 

Other (specify) ________________________ 10 

In weeks: ____ ____ 

805 Check 206 and circle appropriate code: 

Not pregnant / unsure ……………………………………………………………………. 1 

Currently pregnant ………………………………………………………………………. 2 809 

806 Are you or your husband currently doing 

something or using any method to delay 

or avoid getting pregnant? 

Yes...........................................................1 

No............................................................2 808 

807 Which method are you using? Female Sterilization ………………………… 1 

Male Sterilization ………………………….… 2 

Pill …………………………………………… 3 

IUD ……………………………………...…… 4 

Depo-Provera …………………………...…… 5 

Norplant ……………………………………… 6 

Condom ……………………………………… 7 

Periodic abstinence ……………………..…… 8 

Withdrawal ………………………………..… 9 

Other (specify) _______________________ 10 

808 Can you tell me what is (are) the reasons 

that you are not currently using a family 

planning method? 

Probe: Any other? 


809 Do you think you will use a method to 

delay or avoid pregnancy at any time in 

future? 

Not available…...............................................1 

Not available nearby.......................................2 

No one at health facility .................................3 

Spouse did not like .........................................4 

Family members did not like .........................5 

Provider behavior not good ...........................6 

Want more children........................................7 

Difficult to get pregnant .................................8 

Menopausal/hysterectomy..............................9 

Religion ........................................................10 

Confused about method................................11 

Was not satisfied using it..............................12 

Health/fertility concerns...............................13 

Inconvenient to use.......................................14 

Infrequent sex...............................................15 

Husband away from home............................16 

Side effects (specify)....................................17 

Other (specify)..............................................26 

Yes..................................................................1 

No...................................................................2 

Don’t know ....................................................8 

810 

195


810 (Check 806 and tick appropriate box) 

Currently using..……………….. .... 

Then ask: 

“Where did you obtain (current method) 

the last time?” 

Currently not using..……………..... 

Then ask: 

“Where do you go if you want to get FP 

methods or services?” 

811 Did a health worker or FCHV counsel 

you on birth spacing or Family Planning 

at any time following your most recent 

delivery? 

812 How many weeks following your most 

recent delivery were you counseled on 

birth spacing and Family Planning for 

the first time? 

Government hospital ......................................1 

PHC ................................................................2 

Health post......................................................3 

SHP.................................................................4 

PHC ORC ......................................................5 

Private doctor .................................................6 

Private hospital / clinic ...................................7 

NGO clinic .....................................................8 

Pharmacy/chemist ..........................................9 

Shop..............................................................10 

Friends / relatives .........................................11 

FCHV ...........................................................12 

VHW ............................................................13 

MCHW.........................................................14 

Other (specify)..............................................15 

Don’t know...................................................98 

Yes..................................................................1 

No...................................................................2 814 

# of weeks: _____ _____ 

Don’t know …………………………….. 98 

813 Who counseled you at that time? Doctor...........................................................1 

Nurse/ANM..................................................2 

HA/AHW .....................................................3 

MCHW.........................................................4 

VHW ............................................................5 

FCHV ...........................................................6 

TTBA ...........................................................7 

TBA .............................................................8 

Other (specify) ......___________________ 9 

Don’t know / don’t remember ...................98 

814 Did your FCHV provide you with 

family planning information and 

services following your most recent 

delivery? 

815 What type of information and services 

related to family planning did she 

provide you following your most recent 

delivery? 

Probe: “Anything else?” 


Yes................................................................1 

No.................................................................2 901 

FP counseling ...............................................1 

Gave condoms ..............................................2 

Gave pills......................................................3 

Referred for FP services...............................4 

Other (specify)..............................................5 

816 Did the FCHV use any of the following materials or visuals aids to explain about family 

planning to you? (Read All) 

Yes No DK 

1 Flip chart? 1 2 98 

2 Pictures? 1 2 98 

3 Posters? 1 2 98 

196

Section 9: Immediate Newborn Care 

Interviewer: “Now, I would like to ask you some questions about the care of your child after delivery.” 


901 Interviewer: Check question Q4 and 

confirm that recently delivered child was a 

live birth 

Yes…………………………………….1 

No……………………………………..2 923 

Interviewer: “Now, I would like to ask you some specific questions pertaining to the baby immediately 

following the delivery.” 

902 Was the cord cut before the placenta was Yes…………………………………….1 

delivered? 

No……………………………………..2 

903 Was a Clean Home Delivery Kit used during 

delivery? 

(Show example of a CHDK) 

Don’t know……………………….…..8 

Yes…………………………………….1 

No……………………………………..2 

Don’t know……………………….…..8 

904 What instrument was used to cut the cord? New Blade..……………………..…….1 

Boiled Blade ………………………….2 

Unboiled used blade………………….3 

Knife…………………………………..4 

Grass Cutter (hansiya)………………...5 

Weapon (khukuri)…………………….6 

Scissor…………………………….…..7 

Other (specify) ___________________8 

Don’t know …………………………..98 

905 What was used to tie the cord? New ties ………………………………. 1 

Boiled string or thread ………………... 2 

Unboiled used string or thread ……..…. 3 

Other (specify) ____________________4 

Don’t know …………………….……..8 

906 Did anybody apply anything on the stump after 

the baby’s cord was cut? 

907 What did they apply ? 

(Prompt: “Anything else?”) 


908 Was your baby dried before the placenta was 

delivered? 

909 Was your baby wrapped in cloth before the 

placenta was delivered? 

910 Where was the baby placed before the placenta 

was delivered? 

Yes ………………………………....….1 

No …………………………..……....…2 

Don’t know ……………………………8 

Oil……………………………….……1 

Ash…………………………….……..2 

Sindoor………………………….……3 

Ointment/powder……………..………4 

Animal dung…………………...……..5 

Turmeric/turmeric powder………...….6 

Ghyu ………………………………… 7 

Other (specify) _________________ 8 

Don’t know…………………………..98 

Yes ………………………………..….1 

No ……………………………………2 

Does not know……………………….8 

Yes …………………………………….1 

No………………………………………2 

Does not know …………………………8 

On the floor …………………………… 1 

On the cot ……………………………... 2 

With the mother ………………………. 3 

With someone else ……………………. 4 

Other (specify) ___________________ 5 

Don’t know …………………………… 8 

906 

908 

908 

197


911 How long after birth was your baby bathed 

for the first time? 

198 

Within 1 hour ……………………… 1 

2-24 hours …………………………. 2 

After 24 hours …………………….. 3 

Don't know......................................….8 

912 Did your baby cry immediately after birth? Yes ………………………………....….1 

No …………………………..……....…2 

Don’t know …………………………...8 

913 Did your baby need any help for breathing or 

crying shortly after birth? 

Yes ………………………………....….1 

No …………………………..……....…2 

Don’t know …………………………...8 

914 What was done to help the baby cry or breath Dried the baby ………………………... 1 

at the time of birth? 

Rubbed back ………………………….. 2 

Rubbed the feet ………………………. 3 

Mouth to mouth resuscitation ………... 4 

Heated the cord ………………………. 5 

Patting the baby ………………………. 6 

Squeeze the cord ……………………… 7 

Held the baby upside down …………… 8 

Other (specify) __________________ 9 

Don’t remember …………………….. 98 

915 Did you ever breastfeed (NAME)? Yes…………………………………….1 

916 How long after birth did you first put 

(NAME) to the breast? 

915 

915 

No……………………………………..2 923 

During the first hour after delivery.….1 

More than 1 hour. ..……………….…2 

Don’t know……………………….…8 

917 Did you give (NAME) the first liquid 

(begauti) that came from your breasts? 

Yes…………………………………….1 

No……………………………………..2 

918 In the first three days after birth was 

(NAME) given anything to drink other than 

Yes……………………......………….1 

No……………………......……...…..2 

breast milk? 

919 Interviewer: Check question Q 5 and 

confirm that respondent has a live infant 

Yes……………………......……..….1 

No……………………......……..…..2 923 

aged less than one year of age 

920 Are you still breastfeeding (NAME)? Yes…………………………………….1 

No……………………………………..2 922 

Interviewer: “Now I would like to ask you about liquids (NAME) drank yesterday during the day or at night. 

Did (NAME) drink:” (READ ALL) 

Yes 

No 

921 1 Plain water? 1 2 

2 Honey? 1 2 

3 Non-breast (animal) milk? 1 2 

4 Infant formula? 1 2 

5 Fruit juice? 1 2 

6 Daal? 1 2 

7 Yogurt or mohi? 1 2 

8 Tea? 1 2 

9 Ghyu? 1 2 

10 Did you give any other liquids (specify) _______? 1 2 

Interviewer: “Now I would like to ask you about the food (NAME) ate yesterday during the day or at night, 

either separately or combined with other foods. Did (NAME) eat:” (READ ALL) 

Yes 

No 

11 Jaulo? 1 2 

12 Lito? 1 2 

13 Biscuits? 1 2


14 Noodles? 1 2 

15 Fruits? 1 2 

16 Vegetables? 1 2 

17 Bread? 1 2 

18 Bhaat? 1 2 

19 Meat, fish or eggs? 1 2 

20 Did you give any other solids (specify) _________? 1 2 

922 At how many completed months of age did you 

first start giving food or drink other than 

breastmilk to your baby? 

923 Please tell me when should a newborn child be 

bathed after the birth? 


breast fed for the first time after the birth? 

925 Have you heard the message: “A newborn 

should be breast fed within one hour after 

birth.” 




# months: ____ ____ 

Baby exclusively breastfed until now .. 95 

Don’t know ………………………….. 98 

Immediately after the birth.………….....1 

Within 24 hours after birth.………….....2 

After 24 hours after birth...…………......3 

Should not be bathed....…………...........4 

Other (specify) __________________ 5 

Don’t know……………..………………8 

Immediately after the birth…………......1 

After the placenta is out.........………….2 

After bathing the new born……………..3 

After 24 hours after birth.......…………..4 

Other (specify) __________________ 5 

Don’t know……………..………………8 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 

Section 10: Newborn Care During First Month 

Interviewer: “Now, I would like to ask you some questions about the health of your child during the 

month after your most recent delivery.” 


1001 What are the symptoms of the infant within 

7 days after delivery indicating the need to 

seek immediate health care? 

(Prompt: “Any other symptoms?”) 


199 

Poor sucking or feeding…………….… 1 

Fast or difficult breathing ……………. 2 

Feels cold or too hot…………………. .3 

Difficult to wake/lethargic/unconscious.4 

Pustules on skin 1 large or more than 10 

small ones……………………………..5 

Severe umbilical infection redness of skin 

around the cord/ foul smelling discharge 

OR bleeding from the cord……………6 

Other (specify) __________________ 7 

Don’t know…………………………..98 

1002 Interviewer: Check questions Q4, Q5 and Q6. Which of the following conditions is 

true: 

Baby still alive…………………………………………………………………….1 

Baby born alive, then died at 2+ months……………………………………….2 

Baby born alive, then died at 0-1 months………………………………………3 

Baby stillborn…………………………………………………………………….4 

1026 

1029 

Interviewer: “I would like to start by asking you some detailed questions about the postnatal care that your 

most recently delivered child received.”


1003 During the first four weeks after your most 

recent delivery, did a health professional, 

Yes……………………..………….1 

No…………..……………………..2 1010 

FCHV or a traditional birth attendant check 

on your newborn’s health? 

1004 How many days after birth did the first visit 

take place? 

# of days: ____ _____ (if 4+ days) 1006 

(Write “00” if same day as birth) Don’t know ………………………..… 98 

1005 Who checked on your newborn’s health Doctor ..................................................... 1 

during the first three days after birth? Nurse/ANM ............................................ 2 

HA/AHW ................................................ 3 

(Ask: “Anybody else?” Continue until no MCHW.................................................... 4 


VHW....................................................... 5 

FCHV...................................................... 6 


TTBA ...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Don’t know / don’t remember ………98 

1006 Note to interviewer: compare responses to 1003 and 1005 with the responses to 707-708 and 

confirm that any discrepancies between care provided to mother and newborn are accurate. 

Interviewer: “Now I am going to ask you some detailed questions about the postnatal care that your 

newborn received between four days up to four weeks after the birth.” 

How many times did a health professional, # times: ___________ 

FCHV or a traditional birth attendant check (if 0 times) ………………………..…. 97 1009 

on your newborn’s health between four days Don’t Know …………………….…… 98 

and four weeks after birth? 

1007 How many of these visits occurred at home? # times: ______________________ 

Don’t Know …………………….…… 98 

1008 Who checked on your newborn’s health 

between four days and four weeks after 

birth? 

1009 

1010 




Doctor ..................................................... 1 

Nurse/ANM ............................................ 2 

HA/AHW ................................................ 3 

MCHW.................................................... 4 

VHW....................................................... 5 

FCHV...................................................... 6 

TTBA ...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Don’t know / don’t remember ………98 

Prior to or following your delivery, did a health worker, FCHV or TBA counsel you at any time on the 

following newborn issues? (READ ALL) 

Yes No DK 

1 Keeping the baby warm? 1 2 8 

2 Breastfeeding? 1 2 8 

3 Newborn Danger signs (e.g. fast breathing, poor 1 2 8 

feeding, less weight, fever, cord infection, etc.)? 

4 Cord care? 1 2 8 

5 Special care of small baby? 1 2 8 

6 Immunization? 1 2 8 

1011 Did your child receive a Vitamin A capsule 

in the Baishakh distribution? 

Yes………………….……..…………. 1 

No………………..……..…….…….... 2 

Don’t know …………….…..…..……. 8 

200


1012 Did your newborn experience any of the following health problems at anytime in the first 

four weeks following delivery? 


(Record all responses accordingly.) 

Yes 

No 

1 Fever? 1 2 

2 Feeding problem? 1 2 

3 Trouble breathing? 1 2 

4 Fast breathing? 1 2 

5 Chest-in-drawing? 1 2 

6 Drowsy? 1 2 

7 Abdominal tenderness? 1 2 1014 


9 Persistent vomiting? 1 2 

10 Unconscious? 1 2 

11 Red/discharging eye? 1 2 

12 Skin pustules? 1 2 

13 Skin around cord red? 1 2 

14 Felt cold? 1 2 


1013 Did you care for your child’s hypothermia 

through skin-to-skin contact? 

Yes………………....…….....…………. 1 

No………………..……..……….…….. 2 

1014 What did you do or whom did you consult 

for the problems that you stated above? 



Traditional treatment at home ……………. 1 


Hospital …………………………………… 3 

PHCC /HP/ SHP ………………………….. 4 










Other: _____________________(specify) 14 

Now I’d like to ask you some questions about the first time that your child was sick. 

1015 How long was your child sick before you Write in days ………. 

sought medical help for the first time? Don't know ………………………..… 98 

1016 How many days old was your child at that Write in days ………. 

time? 

Don't know ………………………..… 98 

1026 

201


1017 What health problem did your newborn have Fever …………………………………. 1 

at that time? 

Feeding problem ……………………... 2 

Trouble breathing …………………….. 3 

Fast breathing ………………………… 4 

Chest-in-drawing …………………….. 5 

Drowsy ………………………………. 6 

Abdominal tenderness ………………. 7 

Convulsions ………………………….. 8 

Persistent vomiting …………………… 9 

Unconscious …………………………. 10 

Red/discharging eye ………………… 11 

Skin pustules ………………………… 12 

Skin around cord red ………………… 13 

Felt cold …………………………….. 14 

1018 What specifically made you decide to seek 

medical help in that instance? 

1019 Whom did you go to first for this health 

problem? 

Other (specify) __________________ 15 

Child very ill ………………………….. 1 

Child referred for care ……………...…. 2 

Child showed danger sign …………….. 3 

Other (specify) ___________________ 4 

Doctor ………………………… 

Nurse …………………………… 

ANM ………………………….. 

HA ……………………………… 

AHW/CMA……………………… 

MCHW ………………………… 

VHW …………………………… 

FCHV ………………………… 

Trained TBA …………………… 

Untrained TBA ………………… 

Family member ………………… 

Friend/Neighbors ……………… 

Private practitioner ……………… 

Medical shop …………………… 

Traditional healer …………… 

Other (specify) ________________ 

1020 Did you eventually go to any of the following providers for this health problem? 

(Read responses.) 


Yes 

No 

1 Traditional healer? 1 2 

2 Medical shop? 1 2 

3 Private practitioner? 1 2 

4 Untrained TBA? 1 2 

5 Trained TBA? 1 2 

6 FCHV? 1 2 

7 VHW? 1 2 

8 MCHW? 1 2 

9 AHW/CMA? 1 2 

10 HA? 1 2 

11 ANM? 1 2 

12 Nurse? 1 2 

13 Doctor? 1 2 

14 Other (specify)? 1 2 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

202


1021 Was care sought from a health facility? Yes……………………..………….1 

No…………..……………………..2 1025 

1022 If care was sought from a health facility, was 

the child admitted? 

1023 If child was admitted, how many days he/she 

was admitted? 

Yes……………………..………….1 

No…………..……………………..2 1024 

Number of days admitted 1026 

1024 I understand that your child was not admitted 

but that you visited a health facility. Please 

specify the number of times the health 

facility was visited 

1025 Why didn’t you seek care for any of your 

child’s health problems? 


1026 When your child was born, was s/he very 

large, larger than average, average, smaller 

than average, or very small? 

1027 Was your child weighed at birth or at any 

time after birth? 

1028 How old was your child when s/he was 

weighed for the first time? 

(____ months ____ days) 


can see for health services if your newborn 

child has danger signs. 



___________________________________ 

location 


responses.) 

Number of visits 1026 

Not felt necessary ……………… 

No reliable service …………… 

Financial problem ……………… 

Health service not easily accessible 

Don't know where to go ………… 

Don't have friend to go ………… 

Didn’t have any health problems … 

Others (Specify) _______________ 

Don't know ……………………… 

1 

2 

3 

4 

5 

6 

7 

8 

98 

Very large …………………………….. 1 

Larger than average …………………… 2 

Average ………………………………. 3 

Smaller than average …………………. 4 

Very small ……………………………. 5 

Don’t know ……………………..…… 8 

Yes……………………..………….1 

No…………..……………………..2 

Don’t know …………………….. ..8 

In days: 

Don’t know …………………..…….. 998 

Hospital................................................... 1 

PHCC ...................................................... 2 

Health post .............................................. 3 

Sub-health post........................................ 4 

PHC/OR clinic ........................................ 5 

Pvt. Clinic/n. Home................................. 6 

Doctor ..................................................... 7 

Nurse/ANM ............................................ 8 

HA/AHW ................................................ 9 

MCHW.................................................. 10 

VHW..................................................... 11 

FCHV.................................................... 12 

TTBA .................................................... 13 

Other(specify)___________________ 14 

Don’t know ………………………….. 98 

1029 

1029 

203 


1030 During the past 12 months have you ever requested any of the following services and been 

told that they were not available? (Read each commodity, circle appropriate response) 

Yes No DK 

1. Vitamin A for your child? 1 2 8 

2. Vitamin A for yourself? 1 2 8


3. Iron tablets? 1 2 8 

4. Tetanus toxoid? 1 2 8 

5. Contraceptives? 1 2 8 

6. Child vaccinations? 1 2 8 

7. Treatment for childhood illness (for example, pneumonia, 

diarrhea, severe bacterial infection)? 

8. Any other commodities (specify) _________? 1 2 8 


Interviewer: “Now, I would like to ask you some questions about how you prepared for the arrival of 

your child.” 


1101 During your last pregnancy did you make Yes …………………………..…………1 

any preparations for your delivery? 

1102 What preparations did you make for the 

delivery? 

(Prompt: “Did you do anything else to 

prepare?”) 


1103 How did you manage expenditure (if any) 

related to delivery of the baby? 

(Note: For each item listed below, if 

response is ‘yes’ proceed to next column; 

otherwise go to next item below) 

1) Did you borrow money? 

2) Did you spend savings? 

3) Did relatives contribute towards the 

expenditure? 

4) Any other method of coping? 

(specify) ______________________ 

1104 Did you or any members of your family set 

aside any money specifically for care 

during the delivery ? 

1105 How much money did you set aside 

specifically for care during the delivery ? 

1106 During your last pregnancy did you arrange 

ahead of time to have someone attend your 

delivery? 

No …………………………………….. 2 1103 

Financial …………………………….... 1 

Transport ……………………………… 2 

Food …………………………………... 3 

Identification of birth attendant …..…... 4 

Identification of facility ….…….…...… 5 

Blood …………….……………………. 6 

Materials for clean delivery ...……….... 7 

Other (specify) ___________________ 8 

Yes No 

1 2 

1 2 

1 2 

1 2 

How much money 

raised through strategy 

(in NR) 

____________ 

____________ 

____________ 

____________ 

Yes …………………………..…………1 

No …………………………………….. 2 1106 

Rupees: ___ ___ ___ ___ ___ 

Don’t know ………………………99998 

Yes …………………………..…...…… 1 

No …………………………………….. 2 1108 

204


1107 Who did you arrange to attend your 

delivery? 

(Prompt: “Did you arrange for anybody 

else to attend your delivery?”) 


1108 During your last pregnancy did you arrange 

for a place to deliver your child? 

1109 Where did you arrange to deliver your 

child? 

1110 Did you make any preparation for care of 

the mother and newborn during the first 

month following the delivery? 

1111 What preparations did you make for care of 

the mother and newborn during the first 

month following the delivery? 


prepare?”) 


1112 Did you make any preparation for 

emergencies during pregnancy, delivery, or 

after delivery? 

1113 What kind of preparation did you make? 


prepare?”) 


Doctor…………………….………….1 

Staff Nurse . …………....……….…...2 

ANM….……….……...…………....... 3 

MCHW…………………………....…4 

HA ………………………….………..5 

AHW/CMA ………………...…..……6 

VHW........……………………………7 

Trained TBA………………………....8 


FCHV……………………....………10 

Relative/Friend......…..…….……….11 

Other (specify)__________________12 

Nobody ……………………………… 13 

Yes …………………………..…...…… 1 

No …………………………………….. 2 1110 

Hospital................................................... 1 

Primary health care center ...................... 2 

Health post .............................................. 3 

Sub-health post........................................ 4 

Private clinic / nursing home .................. 5 

NGO clinic ……………………………. 6 

Other (specify) ____________________7 

At home _________________________8 

Yes …………………………..…...…… 1 

No …………………………………….. 2 1112 


Identification of health worker …...…... 2 


Blood …………….……………………. 4 

Other (specify) ___________________ 5 

Yes …………………………..…...…… 1 

No …………………………………….. 2 1201 


Transport ……………………………… 2 

Identification of health worker …..…..... 3 


Blood …………….……………………. 5 

Other (specify) ___________________ 6 


Interviewer: “Now, I would like to ask you some questions about emergency fund schemes and transport 

in your community.” 


1201 Are there any groups in your area that loan 

money to women who need it for an 

emergency during pregnancy or delivery? 

Yes …………………………...……….. 1 

No ………………………..…………… 2 1204 

205


1202 What kind of groups are they? 

Mothers group ………………………… 1 

Saving and credit scheme ……………... 2 

Prompt: “Any others?” 

Circle all responses. 

Bank ………………………………...… 3 

Local non-governmental organization .. 4 

Other (specify) ___________________ 5 

1203 Did you borrow money from any of these 

groups for an emergency during your most 

recent pregnancy or delivery? 

1204 Are there any individuals in your area that 

loan money to women who need it for an 


1205 Did you borrow money from one or more of 

these individuals for an emergency during 

your most recent pregnancy or delivery? 

1206 What types of transportation are available 

in your area for women who have an 


(Ask “Any other types?”) 


1207 Did you need transportation because you 

had an obstetric emergency during your 

most recent delivery? 

1208 Did you use transportation because you had 

an obstetric emergency during your most 


1209 What type of transportation did you use? 

(Ask “Did you use any other types of 

transport?”) 


1210 How much did the transportation cost? 

(Probe based on the response to the 

previous question so that all costs are 

included) 

1211 Where did you get the money for this 

transportation? 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Yes …………………………...……….. 1 

No ………………………..…………… 2 1206 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Private car ……………………………. 1 

Taxi …………………………………... 2 

Ambulance …………………………… 3 

Bus …………………………………… 4 

Rickshaw …………………………….. 5 

Ox cart ……………………………….. 6 

Tractor ………………………………... 7 

Tempo ………………………………... 8 

Carried ……………………………….. 9 

Other (specify) __________________ 10 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Private car ……………………………. 1 

Taxi …………………………………... 2 

Ambulance …………………………… 3 

Bus …………………………………… 4 

Rickshaw …………………………….. 5 

Ox cart ……………………………….. 6 

Tractor ………………………………... 7 

Tempo ………………………………... 8 

Carried ……………………………….. 9 

Other (specify) __________________ 10 

Rupees: 

___ ___ ___ ___ 

Own transport means……………...9997 

Don’t know ……………………….9998 

Used savings …….................................. 1 

Took loan .........................................….. 2 

Sold personal goods ........………........... 3 

Performed labor .............……................ 5 

Other (specify) ___________________ 9 

end 

end 

Thank you for your time and cooperation in answering my questions. The information that you have 

provided will help us to improve the health of women and children throughout Nepal. 

206





QUESTIONNAIRE FOR HUSBAND AND MOTHER-IN-LAW 

Form No. 

Respondent No. 

RDW No. 


Name of VDC ……………………………… 

Ward No …………………………………… 


Cluster No. ………………………………… 







1 2 3 

DATE [DD/MM/YY] / / / / / / 


RESULT 


TIME 






5 = Other (specify): _________________________ 











confidential. 





RESPONDENT DOES NOT AGREE TO BE INTERVIEWED……… 

2 → END INTERVIEW & THANK THE RESPONDENT 

207




Don’t know ...........................................98 

102 Have you ever attended school? Yes...........................................................1 

No............................................................2 105 












at all? 



at all? 

Section 2: FCHV Questions 

208 




Not at all.................................................. 4 




Not at all.................................................. 4 


Interviewer: “Now, I would like to ask you some questions about when your wife/daughter-in-law 

was pregnant prior to her most recent delivery.” 

201 Do you know who is the FCHV who serves Yes .......................................................... 1 

your area? 


gives out vitamin A to children under five in 

your area twice a year”) 

No............................................................ 2 

Don’t know …………………..………...8 

301 

301 


FCHV during your wife’s / DIL’s last 

pregnancy to receive information or advice? 

# of times: …………….. 

None…………………………….97 

Don’t know ……………………. 98 

203 Did you receive advice from your FCHV on 

any of the following topics during your wife’s / 

DIL’s last pregnancy? 

(READ ALL RESPONSES) Yes No Don’t know 

1. Wife / DIL should seek ANC 1 2 8 

2. Danger signs for pregnant woman 1 2 8 

3. Using a skilled birth attendant 1 2 8 

4. Danger signs during delivery 1 2 8 

5. Wife / DIL should make at least 3 PNC visits 1 2 8 

6. Danger signs for post-partum woman 1 2 8 

7. Use family planning following delivery 1 2 8 

8. Do not bathe the newborn within 24 hrs. 1 2 8 

9. Keep the newborn’s cord dry and clean (do 1 2 8 

not apply anything) 

10. About source of Emergency Obstetric Care 1 2 8 

301


11. Danger signs in newborn 1 2 8 

12. Financial preparation for your delivery 1 2 8 

13. Identifying emergency transport options 1 2 8 

14. Arranging for blood in case of emergency 1 2 8 



Interviewer: “Now, I would like to ask you some questions about when your wife/daughter-in-law 

was pregnant prior to her most recent delivery.” 

301 Did you accompany your wife / DIL at least one Yes.......................................................... 1 303 

time to her antenatal care during her last No ........................................................... 2 

pregnancy? 

302 Why didn’t you accompany your wife / DIL to 

her antenatal care? 

303 When your wife / DIL was pregnant, did you 

provide her with less care and support than 

usual, about the same care and support as usual, 

or more care and support than usual? 

304 What types of care/support did you provide to 

your wife / DIL? 



305 While your wife / DIL was pregnant, did you 

ever have conversations about preparing for the 

birth with friends, families, neighbors, or other 

acquaintances? 

306 Please tell me where your wife / DIL can go or 

who she can see for health services if she has 

danger signs while she is pregnant. 



___________________________________ 

location 


responses.) 



pregnant? 







209 

Too far ……………………………….. 1 

Too busy ……………………………... 2 

Others accompanied her ……………… 3 

No need ……………………………… 4 

Other (specify) ___________________ 5 


Same as usual.......................................... 2 

More than usual ...................................... 3 

Don’t know ............................................. 8 





Advised/accompanied for physical checkup 

............................................................ 5 

Other (specify) ____________________ 6 

Yes…………............………………….1 

No………………............……………..2 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Other(specify)___________________ 7 

Don’t know ………………………….. 98 

Supervisor will fill out: 

# of checkups ___________ 

Don't know ......................................98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 

305 

305 

305







Vaginal bleeding (any amount) ............. 1 



Convulsion.............................................. 4 

Blurred vision and swelling of hands 

and face................................................... 5 

Other (specify) ____________________ 6 

Don’t know ........................................... 98 

Interviewer: “Now, I would like to ask you some questions about your daughter-in-law’s most recent 

delivery.” 

310 Who assisted with your wife’s / DIL’s most 




(If mother was delivered by TBA and she did 

not know if the TBA was trained, record the 

name of the TBA below): 

______________________________ 

311 Were you present at your wife’s / DIL’s most 

recent delivery (either inside or outside the 

room where the delivery took place)? 

312 Where did your wife / DIL give birth in her 

most recent delivery? 





_________________________________ 

Name of place 

313 Why didn’t your wife / DIL deliver in a health 

facility? 



Doctor………………………….….….1 

Staff Nurse . . . ………....…….……....2 

ANM….…………...………….…….... 3 

MCHW………………………..………4 

HA …………………………………...5 

AHW / CMA …………...….. …….…6 

VHW........………………….…..….…7 

Trained TBA………………...…….....8 


FCHV……………………..…..….…10 

Relatives/Friends......……………….11 

Other (specify)_________________12 

Nobody ……………………………. 13 

Don’t know.........................……........98 

Yes…………………………….…….1 

No…………………………….……..2 

Don’t know………………………....8 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 


Pvt. Clinic/n. Home ………...………… 5 

Your home …………………….…..… 6 

Other home …………………….….… 7 

Other (specify) ___________________ 8 




Don’t trust facility/poor quality service 4 


Husband / family did not allow …….. 6 


Not customary ……………………… 8 

Other (specify) ___________________ 9 

314 

314 

314 

314 

314 

210



would attend your wife’s / DIL’s most recent 

delivery? 

315 Is respondent the husband or the mother-inlaw? 

316 Did your DIL bleed a lot more than normal 

immediately following the birth of her baby ? 

317 How many cloths were used to absorb the blood 

during the first 24 hours after your DIL’s baby 

was born? 

Mother-in-law......……………..……. 1 

Father-in-law......……………………. 2 

Husband....………….………………. 3 

Mother / father …………………….... 4 

Other relative ………………………. 5 

Other (specify)_________________ 6 

Don’t know.........................….......…. 98 

Husband....………….…………….. 1 

Mother-in-law......……………..….. 2 

Yes……………………………….1 

No………………………………..2 

Don’t know……………………..8 

# of cloths: ____ 

Don’t know/can’t remember ………. 98 

318 (PROBE: “Was it more than two cloths?”) Yes……………………………….1 

No………………………………..2 

Don’t know……………………..8 

319 

319 

319 Who was the main person who decided where Mother-in-law......……………..…..1 

your wife’s / DIL’s most recent delivery would Father-in-law......…………………..2 

take place? 

Husband....………….……………..3 

Mother / father ……………………..4 

Other relative …………………….. 5 

Other (specify)_________________6 

Don’t know.........................….........98 







Doctor…………………………….1 

Staff Nurse . . . ………....………...2 

ANM….…………...…………....... 3 

MCHW………………………....…4 

HA ………………………………..5 

AHW/ CMA …………...….. ……6 

VHW........…………………………7 

Trained TBA……………………....8 

Untrained TBA……………………9 

FCHV……………………..………10 

Friends/Neighbors......…………….11 

Family member ………………….. 12 

Other (specify)_________________13 

Don’t know.........................….........98 

211


321 Please tell me the name and training 

background of a trained health provider that you 

know who will attend a delivery in your home. 

Please tell me the name and location of the 

health facility where s/he works. 



___________________________________ 


___________________________________ 

Location 


provider 


facility in your community where your wife / 

DIL can go to deliver her child as well as its 

location. 

Location: 

_______________________________ 

____________________________________ 


facility in your community where your wife / 

DIL can go to receive emergency services if she 

has a problem during delivery at home. 

Location: 

_______________________________ 

_____________________________________ 




your wife’s / DIL’s delivery to be attended by 

one of these types of health workers? Is it very 

important, somewhat important or not 

important? 


wife’s / DIL’s delivery should be attended by 

one of these health personnel? 

(Ask: “Any other reasons?” Continue until 

no further responses.) 


212 


Doctor………………………….……..1 

Staff Nurse . . . ………....……….…….2 

ANM….…………...…………..…..…. 3 

MCHW……………………….…….…4 

HA …………………………………....5 

AHW/ CMA …………...……… ….…6 

VHW........………………………….…7 



FCHV…………………………….…10 

Other (specify)__________________11 


Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Pvt. Clinic/n. Home …………………... 6 

Other (specify) ___________________ 7 

Don’t know ………………………..… 98 


Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Pvt. Clinic/n. Home ………………….. 6 

Other (specify) ___________________ 7 

Don’t know ………………………..… 98 




Not important ......................................... 3 

Don’t know ............................................. 8 


and child…………..........…......…...….1 








delivery ……………………………..... 8 


Other (specify)……………….….…... 10 

Don’t know ……………………….….98 

328 

328


326 What was the respondent’s response to 1, 2, 3 or 4 …………………………..1 328 

Question 310? 

5 to 13 or 98 …………….………….2 


wife’s / DIL’s delivery to be attended by a 

She didn’t have a problem and therefore it 


health worker who is specially trained in how to Do not know who to ask ………………2 

deliver babies. However, this type of specially No service available nearby……………3 

trained health worker did not attend your wife’s No practice in the community………….4 

/ DIL’s delivery. Can you please tell me why a Family members do not allow..………...5 

specially trained health worker did not attend 


your wife’s / DIL’s delivery? 

Another type of health worker attended .7 

Other (specify) __________________ 9 

Don’t know ………………………… 98 

328 In your opinion, what things need to be kept 

clean during childbirth? 



Clean nails .............................................. 1 

Clean hands............................................. 2 

Blade....................................................... 3 

Surface .................................................... 4 

Thread..................................................... 5 

Perineum................................................. 6 

Mother’s clothes ……………………. 7 

Other (specify) ____________________ 8 



330 



Do you think that any of these problems can kill 

a woman? 

PROBE: “Could a woman die from any of 

these problems?” 

331 In your opinion, how dangerous is it to a 


hours? Is it not dangerous, somewhat 



women when the baby does not come out headfirst 

during delivery? Is it not dangerous, 

somewhat dangerous, dangerous, or very 

dangerous? 



bleeding during or after delivery? Is it not 

dangerous, somewhat dangerous, dangerous, or 

very dangerous? 



213 

Don’t know ........................................... 98 






delivery ................................................... 5 

Convulsion.............................................. 6 

Other (specify) ____________________ 7 

Don’t know ........................................... 98 

Yes…………………….…………….1 

No………………………….………..2 

Don’t know……………..…………..8 



Dangerous …………………………….. 3 


Don’t know …………………….…….. 8 



Dangerous …………………………….. 3 


Don’t know …………………….…….. 8 



Dangerous …………………………….. 3 


Don’t know …………………….…….. 8 

1. Liters: ______ ______ 

2. Manas: ______ ______ 

3. Cloths: ______ ______ 

5. Other (specify): _________________ 

Don’t know …………………………. 98 

Interviewer: ”I would now like to ask you some further questions about attendance of a trained health 

worker during delivery.”


335 In the past two months, have you seen, heard, or 

read anything about attendance of a trained 

health worker during delivery on the radio or 

television or in the newspaper or anywhere else? 

Yes……..…………….………..1 

No……………………………..2 337 

336 Please tell me where you saw or heard a 

message on attendance of a trained health 

Media source Unaid 

ed 

Aided Unex 

posed 

worker during delivery. 

1. FCHV flip chart 1 2 3 

(Prompt “anywhere else?” until no more 2. From FCHV 1 2 3 

responses. Circle appropriate responses in 

Unaided column. Then read out any 3. From TBA 1 2 3 

remaining media sources using the sentence: 4. From a health worker at 1 2 3 

“Did you hear anything about attendance of 

a trained health worker during delivery 

the health facility 

5. Community groups 1 2 3 

through (media source)?” If respondent 6. Posters, pamphlets, leaflets 1 2 3 

answers “yes”, circle “2” in Aided column. 7. Newspaper 1 2 3 

If respondent answers “no”, circle “3” in 8. Radio 1 2 3 

Unexposed column. 

9. TV 1 2 3 

(Circle all responses) 10. Others (specify) _____ 

337 Have any friends, family members or other 

acquaintances spoken with you informally during 

the past two months about attendance of a trained 

health worker during delivery? 

Yes……..…………….………..1 

No……………………………..2 


338 When your wife / DIL was pregnant prior to 

her last delivery, did you receive any 

information about bleeding after childbirth? 

Yes ...…………………………..… 1 

No …...…………………………... 2 

Don’t know/don’t remember …... .8 








(Prompt: “Did you receive information from 

any other source?”) 


341 When your wife / DIL was pregnant prior to 

her last delivery, did you receive any 

information about a medicine that can be taken 

to reduce bleeding after childbirth? 

342 Please tell me if you agree or disagree with the 

following statements. Answer in the way that 

most closely represents your opinion. 

It is safer for women to deliver with the 

assistance of a doctor, nurse, or midwife than 

with a TBA or a relative. 

343 Any woman can develop a serious health 

problem related to pregnancy or childbirth. 

Can cause death ……………….… 1 

Go to health facility promptly …... 2 

Get help from health worker ….… 3 

Other (specify) _______________ 4 

Radio … ......................................... 1 

Television … ……………………. 2 

Pamphlet/flyer … ……………….. 3 

Poster … ………………..……….. 4 

FCHV… ........................................ 5 

Women’s group … ………….…... 6 

Health worker… ............................ 7 

Health facility … …………..……. 8 

Neighbor/family/friend/ relative… 9 

Other (specify) ______________ 10 

Yes ...…………………………..… 1 

No …...…………………………... 2 

Don’t know/don’t remember …... .8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

341 

341 

214


344 After a normal delivery, a woman needs a 

check-up. 

345 Matters related to childbirth are mostly 

women’s domain. Men are not supposed to be 

very involved. 

346 It is okay for a woman and her newborn baby 

to leave the house for medical care before the 

nwaran (i.e., naming and purification 

ceremony). 

347 A woman should plan ahead of time where she 

will deliver her baby and how she will get 

there. 

348 A woman should plan ahead of time what she 

will do if she has a serious health problem 

related to pregnancy or childbirth. 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Interviewer: “Now, I would like to ask you some questions about the health of your wife / DIL during the 

month after her most recent delivery.” 



health care during the first four weeks after 

delivery? 



High Fever…………………………….. 1 

Pain in lower abdomen or smelly vaginal 

discharge …………….………………... 2 






350 During the first six weeks after your wife’s / 

DIL’s most recent delivery, did you provide 

her with less care and support than usual, about 

the same care and support as usual, or more 

care and support than usual? 

351 What types of care/support did you provide to 

your wife / DIL? 



352 Please tell me where your wife / DIL can go or 

who she can see for health services if she has 

danger signs during the six weeks after she has 

delivered. 



___________________________________ 

location 


responses.) 




Do not know……………………….…. 98 


Same as usual.......................................... 2 


Don’t know ............................................. 8 





Advised/accompanied for check-up........ 5 

Other (specify) ___________________ 6 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Other(specify)____________________ 7 

Don’t know ………………………….. 98 


Days: _____ _____ 

Don't know.........…………............98 

352 

352 

352 

215








355 Is respondent the husband or the mother-inlaw? 

Section 4: Family Planning 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 

Husband....………….…………….. 1 

Mother-in-law......……………..….. 2 501 


Interviewer: “Now, I would like to talk about family planning – the various ways or methods that a couple 

can use to delay or avoid a pregnancy.” 

401 Have you done something or used any method 

to delay or avoid getting pregnant at any time 

after your wife’s most recent delivery? 

Yes .......................................................... 1 

No ........................................................... 2 404 

402 What was the first method you used after her 

delivery? 

403 How many weeks or months after the delivery 

did you first start using this method? 

(Months:……….. Weeks:…….. ) 

Female Sterilization ………………… 1 

Male Sterilization ………………….… 2 

Pill …………………………………… 3 

IUD ……………………………...…… 4 

Depo-Provera …………………...…… 5 

Norplant ……………………………… 6 

Condom ……………………………… 7 

Periodic abstinence …………………… 8 

Withdrawal ………………………..… 9 

Other (specify) ___________________ 10 

In weeks: 

____ ____ 

404 Is your wife pregnant now? Yes …………………...……………. 1 

No ……………………………….… 2 

Unsure …………………………….. 8 

405 Are you or your wife currently doing 

something or using any method to delay or 

avoid getting pregnant? 

408 

Yes .......................................................... 1 

No ........................................................... 2 407 

406 Which method are you using? Female Sterilization ………………… 1 

Male Sterilization ………………….… 2 

Pill …………………………………… 3 

IUD ……………………………...…… 4 

Depo-Provera …………………...…… 5 

Norplant ……………………………… 6 

Condom ……………………………… 7 

Periodic abstinence …………………… 8 

Withdrawal ……………….………..… 9 

Other (specify) ___________________ 10 

408 

216


407 Can you tell me what is (are) the reasons that 

you are not currently using a family planning 

method? 

408 

Probe: Any other? 


CHECK 404: 

YES, WIFE/WIVES PREGNANT 

Now I have some questions about the future. 

After the child(ren) your wife/wives/ partner(s) 

is/are expecting now, would you like to have 

another child or would you prefer not to have any 

more children at all? 

NO WIFE / PREGNANT OR UNSURE 

Now I have some questions about the future. 

Would you like to have (a/another) child, or 

would you prefer not to have any (more) children 

at all? 

409 How long would you like to wait from now 

before the birth of (a/another) child ? 

Not available........................................... 1 

Not available nearby ............................... 2 

No one at health facility.......................... 3 

Spouse did not like.................................. 4 

Family members did not like …………...5 

Provider behavior not good ………….…6 

Want more children ................................ 7 

Difficult to get pregnant.......................... 8 

Menopausal/hysterectomy ...................... 9 

Religion ................................................ 10 

Confused about method ........................ 11 

Was not satisfied using it...................... 12 

Health/fertility concerns ....................... 13 

Inconvenient to use ............................... 14 

Infrequent sex ....................................... 15 

I (husband) am away from home .......... 16 

Side effects (specify)______________ 17 

Other (specify)...................................... 26 

Have a/another child ………………….. 1 

No more/none ………………………… 2 

Wife/wives infecund/sterilized ……….. 3 

Undecided/don’t know ……………… 8 

Months……… 

410 

Soon/now ……………………….… 993 

Don’t know ……………….………. 998 

Yes …………………………………… 1 

No ……………………………………. 2 413 

(Year:……………. Month:…………..) 

410 Did a health worker or FCHV counsel you on 

birth spacing or Family Planning at any time 

following your wife’s most recent delivery? 

411 How many weeks following your wife’s most 

recent delivery were you counseled on birth # of weeks: _____ _____ 

spacing and Family Planning for the first time? Don’t know ………………………….. 98 

412 Who counseled you at that time? Doctor ..................................................... 1 

Nurse/ANM ............................................ 2 

HA/AHW................................................ 3 

MCHW ................................................... 4 

VHW....................................................... 5 

FCHV...................................................... 6 

TTBA...................................................... 7 

TBA ……………………….………….. 8 

Other (specify) ___________________ 9 

Don’t know / don’t remember ………...98 

413 Have you discussed the practice of family 

planning with your wife after your most recent 

delivery? 

Yes …………………………………… 1 

No ……………………………………. 2 

217


414 I will now read you some statements about 

contraception. Please tell me if you agree or 

disagree with each one. 

1. Contraception is women’s business and a 

man should not have to worry about it. 

Agree 

1 

Disagree 

2 

Don’t know 

8 

2. A woman is the one who gets pregnant so 

she should be the one to use contraception. 

1 

2 

8 











Other (specify) __________________ 5 





birth.” 




504 What are the symptoms of the infant within 7 

days after delivery indicating the need to seek 

immediate health care? 



Don’t know……………..……………..98 





Other (specify) __________________ 5 

Don’t know……………..……………..98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 






small ones……………………………..5 

Severe umbilical infection redness of 

skin around the cord/ foul smelling 

discharge OR bleeding from the cord…6 

Other (specify) __________________ 7 

Don’t know…………………………..98 

218




child / grandchild has danger signs. 



___________________________________ 

location 

Circle all response 

Hospital ...................................................1 

PHCC ......................................................2 

Health post ..............................................3 

Sub-health post........................................4 

PHC/OR clinic ........................................5 

Pvt. Clinic/n. Home.................................6 

Other(specify)___________________ 7 

Don’t know ………………………….. 98 




Interviewer: “Now, I would like to ask you some questions about how you prepared for the arrival of your 

child/grandchild.” 

601 During your wife’s / DIL’s last pregnancy Yes …………………………..…………1 

did you make any preparations for her 

delivery? 

No …………………………………….. 2 604 

602 What preparations did you make for her 

delivery? 


prepare?”) 


603 How did you prepare financially for the 

delivery? 


prepare financially?”) 



emergencies during her pregnancy, delivery, 

or after delivery? 



prepare?”) 


606 Which member(s) of your family are 

involved in making the decision regarding 

financial and transportation issues if your 

wife / DIL needs emergency care during her 

pregnancy or delivery? 

DO NOT READ RESPONSES 

PROMPT FOR ADDITIONAL RESPONSES 

MULTIPLE RESPONSE POSSIBLE – 

CIRCLE ALL RESPONSES 

219 


Transport ……………………………… 2 

Food …………………………………... 3 

Identification of birth attendant …..…... 4 


Blood …………….……………………. 6 

Materials for clean delivery ...……….... 7 

Other (specify) ___________________ 8 

Saved little by little ................................ 1 

Took loan or arranged for loan ........….. 2 

Sold livestock ..................………........... 3 

Sold milk ................................................ 4 

Performed labor .............……................ 5 

Member of saving and credit scheme … 6 

Other (specify) ___________________ 7 

603 

604 

if “1” is 

not circled 

Yes …………………………..…...…… 1 

No …………………………………….. 2 606 


Transport ……………………………… 2 

Identification of health worker …..…..... 3 


Blood …………….……………………. 5 

Other (specify) ___________________ 6 

Wife / DIL ………….……..…..…….1 

Her husband…………………..……..2 

Her mother-in-law………………..…3 

Her father-in-law……………….…...4 

Other (specify) __________________5


607 In your family, who is the one family 

member who is most responsible for making 

the final decision regarding financial and 

transportation issues with regard to 

emergency care during your wife’s / DIL’s 



ONLY ONE RESPONSE POSSIBLE 

Wife / DIL ………….……….……….1 

Her husband………………...….……..2 

Her mother-in-law………..……..……3 

Her father-in-law………………..…...4 

Other (specify) __________________5 

Section 7: Emergency Funding and Transport 


Interviewer: “Now, I would like to ask you some questions about emergency fund schemes and transport in 

your community.” 




Yes …………………………...……….. 1 

No ………………………..…………… 2 








groups or individuals for an emergency 

during your wife’s / DIL’s most recent 


705 What types of transportation are available in 

your area for women who have an emergency 

during pregnancy or delivery? 



Yes …………………………...……….. 1 

No ………………………..…………… 2 704 



Bank ………………………………...… 3 


Other (specify) ___________________ 5 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Private car ……………………………. 1 

Taxi …………………………………... 2 

Ambulance …………………………… 3 

Bus …………………………………… 4 

Rickshaw …………………………….. 5 

Ox cart ……………………………….. 6 

Tractor ………………………………... 7 

Tempo ………………………………... 8 

Carried ……………………………….. 9 

Other (specify) __________________ 10 



220





QUESTIONNAIRE FOR FATHER-IN-LAW 

Form No. 

Respondent No. 

RDW No. 


Name of VDC ……………………………… 

Ward No …………………………………… 


Cluster No. ………………………………… 







1 2 3 

DATE [DD/MM/YY] / / / / / / 


RESULT 


TIME 






5 = Other (specify): _________________________ 











confidential. 





RESPONDENT DOES NOT AGREE TO BE INTERVIEWED……… 

2 → END INTERVIEW & THANK THE RESPONDENT 

221




Don’t know ...........................................98 

102 Have you ever attended school? Yes...........................................................1 

No............................................................2 105 












at all? 



at all? 

Section 2: FCHV Questions 




Not at all.................................................. 4 




Not at all.................................................. 4 


Interviewer: “Now, I would like to ask you some questions about when your daughter-in-law was 

pregnant prior to her most recent delivery.” 

201 Do you know who is the FCHV who serves Yes........................................................... 1 

your area? 


gives out vitamin A to children under five in 

your area twice a year”) 

No............................................................ 2 

Don’t know ………………………….…8 

301 

301 


FCHV during your DIL’s last pregnancy to 

receive information or advice? 

# of times: …………….. 


None…………………………….97 

Don’t know ……………………. 98 


Interviewer: “Now, I would like to ask you some questions about when your daughter-in-law was 

pregnant prior to her most recent delivery.” 

301 While your DIL was pregnant, did you ever Yes…………............………………….1 

have conversations about preparing for the birth No………………............……………..2 

with friends, families, neighbors, or other 

acquaintances? 

222


302 Please tell me where your DIL can go or who 

she can see for health services if she has danger 

signs while she is pregnant. 



___________________________________ 

location 


responses.) 



pregnant? 












Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Other(specify)___________________ 7 

Don’t know ………………………….. 98 


# of checkups ___________ 

Don't know ......................................98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 

Vaginal bleeding (any amount) ............. 1 



Convulsion.............................................. 4 

Blurred vision and swelling of hands and 

face.......................................................... 5 

Other (specify)____________________ 6 

Don’t know........................................... 98 

Interviewer: “Now, I would like to ask you some questions about your daughter-in-law’s most recent 

delivery.” 

306 Who assisted with your DIL’s most recent 

delivery? 



(If mother was delivered by TBA and she did 

not know if the TBA was trained, record the 

name of the TBA below): 

______________________________ 

307 Were you present at your DIL’s most recent 

delivery (either inside or outside the room 

where the delivery took place)? 

Doctor………………..…..………….1 

Staff Nurse . . . ……………….……...2 

ANM….…………...….……..…....... 3 

MCHW……………….………......…4 

HA …………………….………..…..5 

AHW / CMA …………....…... ..……6 

VHW........……………….….….……7 

Trained TBA………………..….…....8 

Untrained TBA…………….…..……9 

FCHV………………………………10 

Relatives/Friends......……………….11 

Other (specify)_________________12 

Nobody ……………………………. 13 

Don’t know.........................….........98 

Yes…………………………………….1 

No……………………………………..2 

Don’t know………………..………….8 

223


308 Where did your DIL give birth in her most 






_________________________________ 

Name of place 

309 Why didn’t your DIL deliver in a health 

facility? 




would attend your DIL’s most recent delivery? 

311 Who was the main person who decided where 

your DIL’s most recent delivery would take 

place? 

Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 


Pvt. Clinic/n. Home ………………… 5 

Your home ………………………..… 6 

Other home ……………………….… 7 

Other (specify) ___________________ 8 




Don’t trust facility/poor quality service 4 


Husband / family did not allow …….. 6 


Not customary ……………………… 8 

Other (specify) ___________________ 9 

Mother-in-law......……………..…..1 

Father-in-law......…………………..2 

Husband....………….……………..3 



Other (specify)_________________6 

Don’t know.........................….........98 

Mother-in-law......……………..…..1 

Father-in-law......…………………..2 

Husband....………….……………..3 



Other (specify)_________________6 

Don’t know.........................….........98 

310 

310 

310 

310 

310 







Doctor…………………………….1 

Staff Nurse . . . ………....………...2 

ANM….…………...…………....... 3 

MCHW………………………....…4 

HA ………………………………..5 

AHW/ CMA …………...….. ……6 

VHW........…………………………7 

Trained TBA……………………....8 

Untrained TBA……………………9 

FCHV……………………..………10 

Friends/Neighbors......…………….11 

Family member ………………….. 12 

Other (specify)_________________13 

Don’t know.........................….........98 

224


313 Please tell me the name and training 

background of a trained health provider that you 

know who will attend a delivery in your home. 

Please tell me the name and location of the 

health facility where s/he works. 



___________________________________ 


___________________________________ 

Location 


provider 


Doctor………………………….……..1 

Staff Nurse . . . ………....……….…….2 

ANM….…………...…………..…..…. 3 

MCHW……………………….…….…4 

HA …………………………………....5 

AHW/ CMA …………...……… ….…6 

VHW........………………………….…7 



FCHV…………………………….…10 

Other (specify)__________________11 


facility in your community where your DIL can 

go to deliver her child as well as its location. 

Location: 

_______________________________ 

____________________________________ 


facility in your community where your DIL can 

go to receive emergency services if she has a 

problem during delivery at home. 

Location: 

_______________________________ 

_____________________________________ 




your DIL’s delivery to be attended by one of 

these types of health workers? Is it very 

important, somewhat important or not 

important? 


DIL’s delivery should be attended by one of 

these health personnel? 

(Ask: “Any other reasons?” Continue until 

no further responses.) 


225 


Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Pvt. Clinic/n. Home …………………... 6 

Other (specify) ___________________ 7 

Don’t know ………………………..… 98 


Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 



Pvt. Clinic/n. Home ………………….. 6 

Other (specify) ___________________ 7 

Don’t know ………………………..… 98 




Not important ......................................... 3 

Don’t know............................................. 8 


and child…………..........…......…...….1 








delivery ……………………………..... 8 


Other (specify)……………….….…... 10 

Don’t know ……………………….….98 

320 

320


318 What was the respondent’s response to 

Question 306? 


DIL’s delivery to be attended by a health 

worker who is specially trained in how to 

deliver babies. However, this type of specially 

trained health worker did not attend your DIL’s 

delivery. Can you please tell me why a 

specially trained health worker did not attend 

your DIL’s delivery? 





321 Do you think that any of these problems can kill 

a woman? 

PROBE: “Could a woman die from any of 

these problems?” 



hours? Is it not dangerous, somewhat 



women when the baby does not come out headfirst 

during delivery? Is it not dangerous, 

somewhat dangerous, dangerous, or very 

dangerous? 



bleeding during or after delivery? Is it not 

dangerous, somewhat dangerous, dangerous, or 

very dangerous? 



1, 2, 3 or 4 …………………………..1 320 

5 to 13 or 98 …………….………….2 

She didn’t have a problem and therefore it 



No service available nearby……………3 


Family members do not allow..………...5 


Another type of health worker attended .7 

Other (specify) __________________ 8 

Don’t know ………………………… 98 






delivery ................................................... 5 

Convulsion.............................................. 6 

Other (specify)____________________ 7 

Don’t know........................................... 98 

Yes………………………………….1 

No………………………….………..2 

Don’t know………………….……..8 



Dangerous …………………………….. 3 


Don’t know …………………….…….. 8 



Dangerous …………………………….. 3 


Don’t know ……………………….….. 8 



Dangerous …………………………….. 3 


Don’t know ……………………….….. 8 

1. Liters: ______ ______ 

2. Manas: ______ ______ 

3. Cloths: ______ ______ 

5. Other (specify): _________________ 

Don’t know …………………………. 98 


326 When your DIL was pregnant prior to her last 

delivery, did you receive any information 

about bleeding after childbirth? 






Yes ...……………………………...… 1 

No …...………………………….…... 2 

Don’t know/don’t remember ………. 8 

Can cause death ………………….… 1 

Go to health facility promptly ……... 2 

Get help from health worker ….…… 3 

Other (specify) _________________ 4 

329 

329 

226




(Prompt: “Did you receive information from 

any other source?”) 


329 When your DIL was pregnant prior to her last 

delivery, did you receive any information 

about a medicine that can be taken to reduce 


330 Please tell me if you agree or disagree with the 

following statements. Answer in the way that 

most closely represents your opinion. 

It is safer for women to deliver with the 

assistance of a doctor, nurse, or midwife than 

with a TBA or a relative. 

331 Any woman can develop a serious health 

problem related to pregnancy or childbirth. 

332 After a normal delivery, a woman needs a 

check-up. 

333 Matters related to childbirth are mostly 

women’s domain. Men are not supposed to be 

very involved. 

334 It is okay for a woman and her newborn baby 

to leave the house for medical care before the 

nwaran (i.e., naming and purification 

ceremony). 

335 A woman should plan ahead of time where she 

will deliver her baby and how she will get 

there. 

336 A woman should plan ahead of time what she 

will do if she has a serious health problem 

related to pregnancy or childbirth. 

Radio … ........................................... 1 

Television … ………………..……. 2 

Pamphlet/flyer … …………..…….. 3 

Poster … ………………..…..…….. 4 

FCHV… ........................................... 5 

Women’s group … ………………... 6 

Health worker… .............................. 7 

Health facility … …………..……... 8 

Neighbor/family/friend/ relative…... 9 

Other (specify) ________________ 10 

Yes ...………………………….….… 1 

No …...…………………………....... 2 

Don’t know/don’t remember ….…... 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Agree ………………………………….. 1 

Disagree ………………………………. 2 

Don’t know …………………………… 8 

Interviewer: “Now, I would like to ask you some questions about the health of your DIL during the month 

after her most recent delivery.” 



health care during the first four weeks after 

delivery? 




High Fever…………………………….. 1 

Pain in lower abdomen or smelly vaginal 

discharge …………….………………... 2 





Do not know……………………….…. 98 

227


338 Please tell me where your DIL can go or who 

she can see for health services if she has danger 

signs during the six weeks after she has 

delivered. 



___________________________________ 

location 


responses.) 










Hospital................................................... 1 

PHCC...................................................... 2 

Health post.............................................. 3 




Other(specify)____________________ 7 

Don’t know ………………………….. 98 


Days: _____ _____ 

Don't know.........…………............98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 











Other (specify) __________________ 5 





birth.” 




Don’t know……………..……………..98 





Other (specify) __________________ 5 

Don’t know……………..……………..98 

From FCHV ….......................................1 


From friends...........................................3 


Other (specify) ___________________ 5 

228


404 What are the symptoms of the infant within 7 

days after delivery indicating the need to seek 

immediate health care? 





child / grandchild has danger signs. 



___________________________________ 

location 

229 






small ones……………………………..5 

Severe umbilical infection redness of skin 

around the cord/ foul smelling discharge 

OR bleeding from the cord……………6 

Other (specify) __________________ 7 

Don’t know…………………………..98 

Hospital ...................................................1 

PHCC ......................................................2 

Health post ..............................................3 

Sub-health post........................................4 

PHC/OR clinic ........................................5 

Pvt. Clinic/n. Home.................................6 

Other(specify)_____________________ 7 

Don’t know ………………………….. 98 




Interviewer: “Now, I would like to ask you some questions about how you prepared for the arrival 

of your child.” 

501 During your DIL’s last pregnancy did you Yes …………………………..…………1 

make any preparations for her delivery? No …………………………………….. 2 504 

502 What preparations did you make for her 

delivery? 

503 


prepare?”) 


503 How did you prepare financially for the 

delivery? 


prepare financially?”) 



emergencies during her pregnancy, delivery, 

or after delivery? 



prepare?”) 


Financial ………………………………. 1 

Transport ……………………………… 2 

Food …………………………………… 3 

Identification of birth attendant …..…… 4 

Identification of facility ….…….……… 5 

Blood …………….……………………. 6 

Materials for clean delivery ……………. 7 

Other (specify) ___________________ 8 

Saved little by little …............................. 1 

Took loan or arranged for loan ….....….. 2 

Sold livestock …...............…….…........ 3 

Sold milk …............................................. 4 

Performed labor …..........………............. 5 

Member of saving and credit scheme … 6 

Other (specify) ___________________ 7 

504 

if “1” is 

not circled 

Yes …………………………..………… 1 

No …………………………………….. 2 506 

Financial ………………………………. 1 

Transport ……………………………… 2 

Identification of health worker …..…….. 3 

Identification of facility ….…….……… 4 

Blood …………….……………………. 5 

Other (specify) ___________________ 6

506 Which member(s) of your family are 

involved in making the decision regarding 

financial and transportation issues if your 

DIL needs emergency care during her 



PROMPT FOR ADDITIONAL RESPONSES 

MULTIPLE RESPONSE POSSIBLE – 

CIRCLE ALL RESPONSES 

507 In your family, who is the one family 

member who is most responsible for making 

the final decision regarding financial and 

transportation issues with regard to 

emergency care during your DIL’s pregnancy 

or delivery? 


ONLY ONE RESPONSE POSSIBLE 

DIL ………….………………………….1 

Her husband………………………..…..2 

Her mother-in-law………………..……3 

Her father-in-law………………..………4 

Other (specify) ___________________5 

DIL ………….……..…………………1 

Her husband…………………………..2 

Her mother-in-law……………………3 

Her father-in-law……………………..4 

Other (specify) __________________5 

Section 6: Emergency Funding and Transport 


Interviewer: “Now, I would like to ask you some questions about emergency fund schemes and transport in 

your community.” 




Yes …………………………...……….. 1 

No ………………………..…………… 2 








groups or individuals for an emergency 

during your DIL’s most recent pregnancy or 

delivery? 

605 What types of transportation are available in 

your area for women who have an emergency 

during pregnancy or delivery? 



Yes …………………………...……….. 1 

No ………………………..…………… 2 604 



Bank ………………………………...… 3 


Other (specify) ___________________ 5 

Yes …………………………...……….. 1 

No ………………………..…………… 2 

Private car ……………………………. 1 

Taxi …………………………………... 2 

Ambulance …………………………… 3 

Bus …………………………………… 4 

Rickshaw …………………………….. 5 

Ox cart ……………………………….. 6 

Tractor ………………………………... 7 

Tempo ………………………………... 8 

Carried ……………………………….. 9 

Other (specify) __________________ 10 



230

Baseline Survey for CB-MNC Program in Jhapa District

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