Over the last three decades, Nepal has made huge progress in accessing maternal and newborn health (MNH) services. Despite improvements in access, persistent challenges remain. For instance, Nepal’s maternal mortality ratio (259 per 100,000 births) and neonatal mortality rate (21 per 1,000 births) remain high, with widening equity gaps between advantaged and marginalized groups, particularly rural, ethnic minority, and socioeconomically disadvantaged populations. While uptake of the first antenatal care (ANC) visits is nearly universal, discontinuation across the MNH continuum—ANC, institutional delivery, and postnatal care—remains prevalent, driven by fragmented care quality and systemic barriers.

Key findings reveal stark disparities: marginalized groups face suboptimal service quality, influenced by ethnicity, language, birth order, and geographic remoteness. Health facilities (HFs) in peripheral areas and provinces like Karnali and Madhesh lack resources, trained staff, and infrastructure, while private HFs outperform public ones. Effective coverage, emphasizing intervention quality over mere contact, is critical. Centralizing intrapartum care in hospitals, rather than low-volume birthing centers, is urged to manage severe pregnancy and childbirth complications.

The paper calls for multisectoral policy reforms addressing macro-level corruption, meso-level decentralization, and micro-level service quality. Recommendations prioritize equity-focused strategies: targeting marginalized groups, enhancing HF capacity, improving respectful care, and integrating multisectoral actions. Strengthening political commitment, health workforce training, and infrastructure investment are vital to bridging inequities and achieving sustainable MNH improvements in Nepal.