Background
The postnatal or postpartum period is the time after childbirth when a mother’s body and mind adjust from pregnancy to motherhood. Postnatal care provides essential support to both mother and baby during this transition, focusing on physical recovery, emotional well-being, and newborn health. Regular check-ups help detect and address health issues early, while midwives offer guidance on breastfeeding, bonding, and self-care. The care also includes newborn screenings, parenting education, family planning advice, and referrals to specialists if needed. Postnatal care ensures safe recovery, supports emotional adjustment, and promotes healthy growth for both mother and baby.
Nepal has recorded substantial gains in maternal and child health over the last two decades, yet the postnatal period remains a high-risk window for both mothers and newborns. The 2022 Nepal Demographic and Health Survey reports a neonatal mortality rate of about 21 deaths per 1,000 live births, and national analyses and global reviews show that a large proportion of neonatal and early infant deaths occur within the first seven days after birth often on day one primarily from preventable causes such as asphyxia, infection (neonatal sepsis), and complications related to childbirth.
Rationale
The postnatal period, defined as the first six weeks after childbirth, remains the most critical and vulnerable phase for both mothers and newborns. Globally, about 75% of neonatal deaths occur within the first week of life, and more than half of maternal deaths take place during the postnatal period, primarily due to preventable causes such as postpartum hemorrhage, sepsis, hypertensive disorders, and birth-related complications. In Nepal, despite significant progress in maternal and child health over the past two decades, mortality rates during this period remain unacceptably high. According to the Nepal Demographic and Health Survey (NDHS) 2022, the neonatal mortality rate in Nepal is 21 per 1,000 live births, while the maternal mortality ratio remains 151 per 100,000 live births, highlighting the continued need to strengthen postnatal care services care. More recent findings from the Nepal Multiple Indicator Cluster Survey 2024-2025 indicate a neonatal mortality rate of 17 per 1,000 live births. However, disparities persist between areas, with urban areas reporting 16 deaths per 1,000 live births compared to 19 per 1,000 live births in rural areas, suggesting ongoing inequities in newborn survival. Furthermore, the Annual Report 2080/81 from the Department of Health Services Nepal reports that only 37.8% of mothers completed four postnatal care (PNC) visits according to the national protocol.
Recognizing the vital importance of early and continuous postnatal care, the MoHP introduced the Postnatal Home Visit (PNC) Guideline in 2021 to ensure that trained providers, such as Auxiliary Nurse Midwives (ANMs) and nurses, deliver timely, high-quality care at the household level. This initiative aligns with the Safe Motherhood and Newborn Health Roadmap 2030, which aims to reduce maternal and neonatal morbidity and mortality through community-based, people-centered approaches. The program emphasizes identifying maternal and newborn danger signs, prompt referral, and improved counseling on essential newborn care practices, including exclusive breastfeeding, cord care, and hygiene.
Recognizing the vital importance of early and continuous postnatal care, the MoHP introduced the Postnatal Home Visit (PNC) Guideline in 2021 to ensure that trained providers, such as Auxiliary Nurse Midwives (ANMs) and nurses, deliver timely, high-quality care at the household level. This initiative aligns with the Safe Motherhood and Newborn Health Roadmap 2030, which aims to reduce maternal and neonatal morbidity and mortality through community-based, people-centered approaches. The program emphasizes identifying maternal and newborn danger signs, prompt referral, and improved counseling on essential newborn care practices, including exclusive breastfeeding, cord care, and hygiene.[1]
However, despite the strong policy commitment, there is limited empirical evidence on the effectiveness and implementation performance of the postnatal home visit program in real-world settings. Existing reports highlight significant variability in coverage, quality, and timeliness of postnatal visits across provinces and ecological regions.[2] Challenges such as under-identification of danger signs, delayed or incomplete referrals, poor documentation, and weak follow-up at facilities have been reported. Furthermore, systemic factors, including inadequate supervision, limited refresher training, increased workload, and insufficient incentives for frontline workers, may be contributing to uneven performance and low motivation among service providers.
Community-level barriers also persist. Sociocultural norms, gender dynamics, limited awareness, and geographic inaccessibility continue to hinder timely care-seeking among mothers and families, especially in remote and marginalized populations. In the context of federalization, coordination between local, provincial, and federal tiers of government remains inconsistent, affecting program implementation, budget utilization, and accountability mechanisms.[3]
Given these gaps, a comprehensive evaluation of the postnatal home visit program is crucial to generate robust evidence on its effectiveness, acceptability, and operational functionality. Specifically, the assessment will:
- Verify whether key maternal and newborn danger signs are being identified and managed appropriately;
- Examine community acceptance and satisfaction with home visits;
- Review the functionality and timeliness of the referral system;
- Understand factors influencing service providers’ motivation and performance; and
- Identify system-level barriers and enablers to inform adaptation, integration, and scale-up within Nepal’s decentralized health system (UNICEF Nepal, 2026).
The findings will provide actionable recommendations for the MoHP, provincial and local governments, and development partners to refine implementation strategies, strengthen supervision and accountability, and enhance equitable access to quality postnatal care, ultimately contributing to improved maternal and newborn survival in Nepal.
Study area: 22 districts across the seven provinces.
Team: Dr. Nish Rana, Dr. Deepebra Kaj Thapa, Prof. Madhusudan Subedi, Ms. Pabitra Balampaki and Dr. Janak Thapa
Duration: May to October 2026