Although this national estimate has fallen over the last decade, the rural maternal mortality rate is, at least, double the national average (Vanwinge et al. 1994). This disparity between urban and rural maternal health poses a significant challenge to meet the Millennium Development Goal- 5, (134 per100, 000 live births) in Nepal.
Targeted social issues: Most of the maternal deaths in Nepal take place at home and remain unrecorded (Campbell, Graham et al., 2006). Many factors influence maternal mortality. Factors include maternal age, early marriage, parity, birth spacing, malnutrition, poverty and poor literacy (Joshi and Kushwah 2011). Currently, health care and information are far beyond the reach of rural women (Yadamsuren et al. 2010). In Nepal, it is mothers-in-law who take final decisions about pregnancy related issues (Simkhada et al. 2011), however, they do not have the power to authorize decisions associated with the cost, as the men make financial decisions. Men are usually uninvolved and most of the time they work away from their homes (Nwakwuo et al. 2013). For these reasons, pregnant women have no control over their care. Lack of awareness of the importance of antenatal examinations and delivery by skilled attendants are the two main reasons for poor maternal outcomes (Sharma, S.R., et al 2014). Lack of awareness about the importance of antenatal care and skilled delivery is one of the leading causes of maternal death. The deficiency of health care systems and an unsupportive sociocultural environment combine to create poor outcomes in maternal care for pregnant women in Nepal.
Intervention: Singing is a prominent feature of everyday rural life in Nepal. We aim to engage female community health workers and school students in developing health messages using traditional songs to transmit knowledge through the community and change attitudes surrounding pregnancy to improve maternal outcomes. This research will develop an awareness program owned by the community. It is expected that this program will lead to improved community knowledge concerning the key health messages needed to improve maternal mortality in rural Nepal and increase the number of women accessing health care prenatally and at the time of delivery. Our project seeks to change maternal mortality from the grass roots level using health messages transmitted to the whole community through songs created within the community. The project will be evaluated at the conclusion and results in our intervention communities compared with those in control communities to determine its effectiveness. Results will be published and used to influence National Policy.