Why have improvements in maternal health not translated in equitable outcomes in Madhesh Province, Nepal?

Abstract

In Madhesh Province, Nepal, deep-rooted socio-economic, cultural, and systemic barriers are interwoven to persistently exclude women from safe and quality maternal care. Despite Madhesh’s geographic accessibility, women continue to face barriers to maternal health service access exposing ingrained inequities that national progress has consistently failed to reach. These gaps are not dictated by geography, but by chronic underfunding, structural neglect, and intersecting linkage of poverty, caste, ethnicity, language, and limited autonomy. Addressing these challenges requires intersectional, equity-based strategies such as developing and scaling digital health interventions, strengthening and empowering community health cadres, engaging men/partner, and reforming resource allocation and financing. Only innovative shifts in policy, financing, and community engagement will uplift the most marginalized and drive real progress toward Universal Health Coverage and commitment to Sustainable Development Goals (SDG) 3 targets, in Nepal.