Nepal Maternal & Child Health Indicators (NDHS 2022)

The Nepal Demographic and Health Survey (NDHS) 2022 is the sixth nationally representative DHS conducted in Nepal since 1996. Fieldwork ran from 5 January to 22 June 2022 (2078-2079 BS), covering a national sample of roughly 35,000 households and interviews with about 28,000 women aged 15-49. It was implemented by New ERA under the Ministry of Health and Population (MoHP), with technical support from ICF through The DHS Program and funding from USAID.

The survey is the single most cited source for Nepal's maternal and child health statistics. It measures fertility, childhood mortality, nutrition, immunisation, family planning, antenatal and delivery care, and a range of other indicators using standardised, internationally comparable methods. Because the same methodology is repeated across survey rounds, NDHS data allow reliable comparison over nearly three decades.

One important caveat sits at the top of this dashboard: the headline maternal mortality ratio of 151 per 100,000 live births does not come from the household survey itself. NDHS 2022 reports it from the Nepal Maternal Mortality Study (NMMS) 2021, which was linked to the National Population and Housing Census 2021 (2078 BS). All the child mortality and nutrition figures below, however, are direct NDHS 2022 estimates.

The maternal mortality ratio (MMR) is the number of women who die from pregnancy-related causes during pregnancy, childbirth or within 42 days of delivery, expressed per 100,000 live births. For 2021-2022, Nepal's national MMR is 151 per 100,000 live births. This figure is drawn from the Nepal Maternal Mortality Study 2021, the first joint undertaking of the MoHP, the National Statistics Office (NSO), the Nepal Health Research Council and development partners.

The NMMS used census enumerators to identify deaths of women of reproductive age (15-49) in the 12 months preceding the 2021 census. Of 12,976 such deaths, 653 were pregnancy-related, and 622 (about 95%) were classified as maternal deaths. Because it was tied to a full population census rather than a sample survey, the 2021 study also produced provincial-level MMR estimates for the first time, revealing wide geographic disparities.

Nepal's MMR has fallen sharply over the long run - from an estimated 539 per 100,000 in 1996 and 281 in 2006 to 151 in 2021 - but the pace of decline has slowed, and independent experts have urged caution in reading the newest figure as a settled number. The government aims to cut MMR to 70 per 100,000 by 2030 in line with the Sustainable Development Goals (SDGs), which remains a substantial gap.

NDHS 2022 reports three standard childhood mortality measures for the five years before the survey. The neonatal mortality rate (deaths in the first 28 days of life) is 21 per 1,000 live births. The infant mortality rate (IMR, deaths before the first birthday) is 28 per 1,000. The under-5 mortality rate (U5MR, deaths before the fifth birthday) is 33 per 1,000 live births.

The striking feature of these numbers is how concentrated child deaths are in the earliest days of life. About 85% of all under-5 deaths in Nepal occur before the first birthday, and roughly 64% occur within the first month. This is why the neonatal figure is now the central challenge for child survival in Nepal.

Neonatal mortality has effectively stalled. It stood at 21 per 1,000 in the 2016 NDHS and remained at 21 in 2022 - no measurable improvement over six years - even as infant and under-5 rates continued to edge down. Analysts attribute the plateau to gaps in quality of care around birth, preterm birth and birth asphyxia, and unequal access to newborn care, rather than to a shortage of facility deliveries alone.

Nepal measures child undernutrition using three anthropometric indices based on WHO growth standards. Stunting (low height-for-age) reflects chronic undernutrition and affects 25% of children under five. Wasting (low weight-for-height), a sign of acute undernutrition, affects 8%. Underweight (low weight-for-age), a composite measure, affects 19% of children under five. A child is classified as affected when the relevant measurement falls more than two standard deviations below the reference median.

Chronic undernutrition has fallen dramatically over the survey series: stunting dropped from 57% in 1996 to 25% in 2022, and wasting from about 15% to 8% over the same period. This makes stunting one of Nepal's clearest public-health success stories, driven by better maternal nutrition, feeding practices, sanitation and household living standards - though a quarter of children stunted still signals a heavy remaining burden.

The nutrition picture is now double-sided. While a large share of children remain undernourished, the survey also flags rising overnutrition among adults: about 35% of women aged 20-49 are overweight or obese, against 10% who are too thin. This coexistence of under- and over-nutrition - the 'double burden' of malnutrition - is an emerging concern for Nepal's health system.

The mortality and nutrition outcomes are shaped by large gains in service coverage. In NDHS 2022, 81% of women aged 15-49 who had a recent live birth received four or more antenatal care (ANC) visits, and 73% had their first ANC visit in the first trimester - both up strongly from earlier surveys. Wider and earlier antenatal contact is closely tied to safer pregnancies.

Institutional delivery has risen faster than almost any other indicator. The share of live births delivered in a health facility jumped from 57% in 2016 to 79% in 2022, while home deliveries fell to about 19%. Family planning has expanded more modestly: the contraceptive prevalence rate among currently married women aged 15-49 is 57% (43% using modern methods), but unmet need for family planning remains high at around 21%.

On the child side, 80% of children aged 12-23 months are fully vaccinated under the national immunisation schedule, and the total fertility rate has settled at 2.1 children per woman - essentially replacement level, down from 2.3 in 2016. Together these service indicators explain both the progress reflected in falling child mortality and the bottlenecks - especially around newborn care - that keep neonatal deaths stubbornly high.

Placed against Nepal's earlier surveys, the 2022 figures show one of the strongest child-survival and nutrition improvements in South Asia. Under-5 mortality fell from 118 per 1,000 in 1996 to 33 in 2022; infant mortality from 78 to 28; and neonatal mortality from 50 to 21. In parallel, stunting was more than halved and institutional delivery rose from single digits in the mid-1990s to nearly four in five births.

Not every indicator has kept moving. Neonatal mortality has been flat since 2016, wasting has proven hard to shift below roughly 8-10%, and the maternal mortality decline has decelerated. These plateaus define Nepal's current health agenda: the 'easy' gains from expanding basic coverage have largely been captured, and further progress depends on quality of care, equity and reaching the most disadvantaged groups.

The comparison also illustrates why dates and sources matter when quoting these statistics. Older MMR figures (539 in 1996, 281 in 2006) came from survey sisterhood methods, whereas the 151 figure comes from a census-linked mortality study - so the numbers are directionally comparable but not measured identically. Always cite the indicator with its year and its source study.

Precise definitions matter because these figures are quoted so widely. The neonatal mortality rate counts deaths in the first 28 completed days per 1,000 live births; the infant mortality rate counts deaths before age one; and the under-5 mortality rate counts deaths before the fifth birthday. NDHS calculates these from full birth histories reported by interviewed women, typically for the five-year period preceding the survey, which smooths year-to-year noise.

Nutrition indicators are anthropometric. Children's height and weight were measured in the field and compared against the WHO Child Growth Standards: stunting is height-for-age below minus two standard deviations, wasting is weight-for-height below minus two standard deviations, and underweight is weight-for-age below minus two standard deviations. The maternal mortality ratio expresses maternal deaths per 100,000 live births and, for 2021, was estimated from census-linked death records rather than the DHS sample.

As a sample survey, NDHS estimates carry sampling error, so small differences between rounds may not be statistically significant - the neonatal plateau is a case in point. The 2022 sample of about 35,000 households and 28,000 women supports reliable national and provincial estimates, and the full report publishes confidence intervals. For citation, the primary references are the NDHS 2022 Key Indicators Report and Final Report, and (for MMR) the Nepal Maternal Mortality Study 2021.