Introduction

In Nepal, despite the decade-long internal conflict and unstable governments during the Millennium Development Goal (MDG) period, the progress in reducing maternal and child deaths has been praiseworthy. The under-five mortality reduced from 146 per 1000 live births to 42 per 1000 live births, and the maternal mortality ratio reduced by more than half between 1990 and 2015.1 More than 85% of the children were fully vaccinated as per national schedule in 2015.2 However, the progress was not uniform and disparities were considerable across different social, economic and geographical population groups. A large inequity gap was witnessed in skilled attendance at birth between the wealthiest and poorest families in 20162 (figure 1). The coverage of skilled attendance at birth was more than 90% among the women from the wealthiest families, but less than 40% among the women from the poorest families. Similarly, the wealthiest families have achieved neonatal mortality rate target for SDG, 12 per 1000 live births in 2017, while the poorest families will take an estimated further 40 years to achieve it.1

Nepal has …