Nepal made impressive progress in reducing maternal mortality until 2015. Since then, progress has stagnated, coinciding with Nepal's transition to a federation with significant devolution in health management. In this context, we conducted key informant interviews (KII) to solicit perspectives on policies responsible for the reduction in maternal mortality, reasons for the stagnation in maternal mortality, and interventions needed for a faster decline in maternal mortality. We conducted 36 KIIs and analysed transcripts using standard framework analysis methods. The key informants identified three policies as the most important for maternal mortality reduction in Nepal: the Safe Motherhood Policy, Skilled Birth Attendant Policy, and Safe Abortion Policy. They opined that policies were adequate, but implementation was weak and ineffective, and strategies needed to be tailored to the local context. A range of health system factors, including poor quality of care, were identified by key informants as underlying the stagnation in Nepal's maternal mortality ratio, as well as a few demand-side aspects. According to key informants, to reduce maternal deaths further Nepal needs to ensure that the current family planning, birth preparedness, financial incentives, free delivery services, abortion care, and community post-partum care programmes reach marginalised and vulnerable communities. Facilities offering comprehensive emergency obstetric care need to be accessible, and in hill and mountain areas, access could be supported by establishing maternity waiting homes. Social accountability can be strengthened through social audits, role models, and empowerment of health and management committees.

中文翻译：

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降低尼泊尔孕产妇死亡率的政策和行动：关键人物的观点。

尼泊尔在降低孕产妇死亡率方面一直取得令人瞩目的进展，直到2015年。此后，进展一直停滞不前，这与尼泊尔过渡到健康管理水平显着下降的联邦有关。在这种情况下，我们进行了重要的线人访谈（KII），以征求有关降低孕产妇死亡率的政策，孕产妇死亡率停滞的原因以及加快孕产妇死亡率下降的干预措施的观点。我们进行了36个KII，并使用标准框架分析方法分析了成绩单。主要信息提供者确定了尼泊尔降低孕产妇死亡最重要的三项政策：安全孕产政策，熟练分娩服务员政策和安全堕胎政策。他们认为政策是适当的，但执行力很弱且效果不佳，需要根据当地情况量身定制策略。关键的线人认为，一系列卫生系统因素，包括较差的护理质量，是尼泊尔孕产妇死亡率停滞以及某些需求方面的基础。据重要的信息提供者称，为进一步减少孕产妇死亡，尼泊尔需要确保当前的计划生育，生育准备，经济激励措施，免费分娩服务，堕胎护理和社区产后护理计划惠及边缘化和脆弱的社区。需要提供提供全面紧急产科护理的设施，并且在丘陵和山区，可以通过建立产妇候诊室来支持出入。可以通过社会审计，榜样，