Neonatal Mortality

Dalits: Down but not out

Mesoprostol Use

Mother in Laws

What is CRADLE?


CRADLE, Community Responsive Antenatal, Delivery, and Life Essential support, is a CARE
and USAID Child Survival program that is for mothers and newborns in Nepal, locally known as
MANASHI Project. CARE implemented this program in the Kailali and Doti districts of Far Western Region
due to a high level of unmet needs and limited external agency support. Both districts rank in or
near the bottom third of all 75 Nepali districts. This program lasts for duration of 4 years, beginning
October 1, 2007 and concluding September 30, 2011.

The need for CARE

Over the last decade, CARE has focused its efforts (via two previous Child Survival Health Grants Program (CSHGP) grants) on addressing the high child mortality rates in some of the poorest and most isolated districts in the country by changing attitudes, behaviors, services and systems that have helped to bring about dramatic improvements in child health indicators. Through a collective effort, between CARE and the Nepal Government, communities, CBOs and INGOs, to reduce child mortality in Nepal through the support and application of Community based Integrated Management of Childhood Illnesses. As a result of the collaborative effort, child mortality has dropped from 118/1,000 live births to 65/1,000 in just ten years (NDHS 2006).

However, statistical data reveal little improvement in the chances of survival for newborns. Five years prior to the start
of the CRADLE project, neonatal mortality only dropped slightly from 39 to 34 per 1,000 live births, while infant and
child mortality rates, in comparison, were cut in half. In 2006, neonatal mortality made up 66% of all infant deaths and
results in 26,000 newborn deaths each year. Maternal mortality did not fare any better, with one in every 24 women in Nepal dying prematurely – primarily as a result of complications during and after delivery like post partum hemorrhage. The Human Development Index’s adjusted MMR (740/100,000) placed Nepal as one of the worst ten countries in the world for maternal survival. Perhaps the single greatest contributing factor to the high maternal and neonatal mortality rates are the facts that 86% of women give birth at home, 81% have no trained assistance (2006 NDHS), and mother-in-laws are traditionally the main decision makers regarding child birth. Others include woman’s status, costs, distance to facilities, difficulty of terrain, and the unavailability of appropriate, quality care at the nearest health facility.

CARE’s Response

In response to this crucial problem, the CRADLE. program will support the government’s Community Based Newborn Care Program by applying, adapting, and building upon new and promising approaches from Nepal and India for reducing newborn mortality.CARE’s program focuses specifically on sustainable and equitable improvements in maternal and neonatal care. The strategic objective/goal and results for the CRADLE program are as follows:

Strategic Objective:Sustained improvements in maternal & neonatal health in the districts of Doti and Kailali
IR1: Improved maternal and neonatal outcomes
IR2: Improved maternal and neonatal services
IR3: Improved capacity of MOH and stakeholders for maternal and neonatal services
IR4: Improved viability for maternal and neonatal services
IR5: Improved community commitment for maternal and neonatal care
IR6: Improved environment for maternal and neonatal care

Care applied the Child Survival Sustainability Assessment Framework (CSSA) methodology as the central planning and design tool for this program. It will help ensure that during implementation, the project pays the requisite amount of attention to the three interrelated dimensions of the framework:

Dimension I: Improved maternal and neonatal health and health services
Comprising of developing and adapting training and resource materials on maternal and neonatal health issues, capacity building of health workers, training on logistics and supervision techniques, training of health workers and volunteers on MNH case identification, management and referral, and activities for behavior change.

Dimension II: Organizational development through strengthened capacity and viability of DPHOs MOH and other stakeholders for MNH care and services
Includes training for health workers, health facility management committee and district level reproductive health coordination committee members on effective program planning focusing on MNH, periodic review and reflection workshops, community campaigns for sensitization on health and reproductive rights, advocacy efforts, and activities to improve community based recording and reporting systems.

Dimension III: Improved community competency and environment for MNH care and services
Developing of a district based human resource pool of MNH volunteers, interaction workshops with mother in laws, pregnant women and their husbands on gender equity issues that affects MN health, mobilization of mothers groups targeted to poor, vulnerable and socially excluded communities, mobilization of school teachers and students on behavior change and creating a supportive environment for MN health, formation and mobilization of local resource persons, mobilization of community based organizations, social mapping and analysis for ensuring equity in health services, scale-up activities and advocacy efforts at the local and national level, and activities to facilitate cross-learning and sharing of ideas and experiences in the project.

In addition to the overall CSSA framework, the project will support the following three framework/packages to support the national health strategy:
  1. Community based newborn care Package (Doti); Safe motherhood in Nepal (Kailali)
  2. Community Based Integrated Management of Childhood Illnesses
  3. Focused attention to marginalized populations

CARE’s Project Activities


  1. Behavior change communication (BCC) for newborn care
  2. Promotion of institutional delivery & clean delivery practices in case of home deliveries
  3. Post natal care
  4. Community case management of pneumonia/ Possible Severe Bacterial Infection (PSBI)
  5. Care of Low Birth Weight newborns
  6. Prevention and management of Hypothermia
  7. Recognition of asphyxia, initial stimulation and resuscitation of newborn baby