Nepal does not win a Millennium Development Goal (MDG) award every day. Yet its decline in maternal mortality reported from demographic health surveys in 1996 and 2006, with the ratio falling from 539 to 281 deaths per 100 000 live births (LBs) over 10 years,1,2 earned the country international accolades in September 2010.3 The decline was cautiously corroborated by a point estimate of 229 per 100 000 LBs from a subnational maternal morbidity and mortality study carried out in 2009 in eight districts.4

Nepal still experiences around 2000 maternal deaths per year among 690 000 births.5 To reach Nepal’s MDG 5 target of 134 per 100 000 LBs by 2015, the maternal mortality ratio (MMR) must continue to decline by 13% per year, particularly amongst poor and marginalised women who bear a disproportionate share of deaths—including undereducated, Muslims, Dalits, rural dwellers and those from mid- and far- western hills and mountains.

Neonatal deaths have declined from 39 per 1000 LBs (1996–2000)6 to 33 (2001–5), two-thirds of which occur in the first week of life.2 Reaching the MDG 4 target of 15 per 1000 LBs is considered likely. Even so, neonatal deaths are 54% of under-5 deaths versus 41% in 2001, and 69% of infants who die are neonates.