The authors aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal. Findings suggest that institutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period.


  1. Kc A, Ewald U, Basnet O, Gurung A, Pyakuryal SN, Jha BK, Bergström A, Eriksson L, Paudel P, Karki S, Gajurel S, Brunell O, Wrammert J, Litorp H, Målqvist M. Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial. PLoS Med. 2019 Sep 9;16(9):e1002900. doi: 10.1371/journal.pmed.1002900. eCollection 2019 Sep. PMID: 31498784

  2. Kc A, Berkelhamer S, Gurung R, Hong Z, Wang H, Sunny AK, Bhattarai P, Poudel PG, Litorp H. The burden of and factors associated with misclassification of intrapartum stillbirth: Evidence from a large scale multicentric observational study. Acta Obstet Gynecol Scand. 2020 Mar;99(3):303-311. doi: 10.1111/aogs.13746. Epub 2019 Nov 10.
    PMID: 31600823

  3. Kozuki N, Katz J, Khatry SK, Tielsch JM, LeClerq SC, Mullany LC. Risk and burden of adverse intrapartum-related outcomes associated with non-cephalic and multiple birth in rural Nepal: a prospective cohort study. BMJ Open. 2017 Apr 20;7(4):e013099. doi: 10.1136/bmjopen-2016-013099. PMID: 28428183


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