Challenging Global Advocacy of Biomedical Institution-Based Birth in Nepal: A Review with Reference to Nepal and South Asia

Based on findings from public health, demographic, and anthropological research, this review discusses biomedical institution-based birth in Nepal, in the process asserting that better understanding of maternal health determinants requires biomedical strategies be balanced with greater attention to local social realities and approaches. The paper begins with a summary of evolving international maternal health policies and their manifestations in Nepal, then discusses how recent public health research there indicates existing community support structures, including women’s groups, to have had demonstrably positive impacts on maternal health. The subject of women’s reproductive agency is subsequently considered. While public health and development-based research often equates this to women’s decision-making ability, I draw here upon anthropological examples from the broader South Asian context to reveal a more nuanced appreciation of agency, illuminating the many shifting forces influencing women’s use of available maternal health resources. A case study based on a short piece of ethnographic research I carried out in Nepal in 2011 follows. Findings from this provide further evidence of the significance and positive effects of community networks and groups in maternal health outcomes; they also reflect aspects of the foregoing discussion of agency. Overall, the case made here is that an important and growing body of research exists, which challenges dominant views within international public health—and actively promoted by the Nepali state—that biomedically-managed, institution-based births are the most effective means to reduce maternal mortality. Thus suggest further research, that incorporates ethnographic explorations of Nepali women’s agency in maternal health matters (including impact upon birth outcomes) is needed if more appropriate pregnancy and childbirth-related measures are to be enacted going forwards