Reducing Neonatal Mortality in Nepal’s Remote Regions: Challenges, Disparities, and the Role of Helping Babies Breathe

Background: Nepal’s diverse geography creates significant challenges for healthcare accessibility, particularly for neonatal care. Rural areas, especially in the mountainous regions, face severe healthcare gaps due to isolation, inadequate infrastructure, and a shortage of skilled staff. Strengthening healthcare in these underserved regions is essential to reducing neonatal mortality. Methods: A comprehensive literature search identified studies on neonatal mortality and interventions, particularly Helping Babies Breathe (HBB), analyzed using a narrative synthesis approach. The review examined disparities in neonatal health outcomes, regional differences, and barriers to healthcare access. Findings: The review identified key themes related to healthcare disparities, neonatal mortality, and birth outcomes in Nepal's remote regions. Geographical isolation, inadequate healthcare infrastructure, and cultural barriers contribute to persistently high neonatal mortality, particularly in mountainous areas such as Jumla and Dolpa, where rates exceed 60 per 1,000 live births. HBB has shown a significant impact, reducing neonatal mortality by up to 60% when effectively implemented. However, infrastructural gaps, lack of emergency transport, and the uneven distribution of skilled birth attendants (SBAs) remain critical challenges. Addressing these disparities requires expanded training, increased availability of neonatal resuscitation equipment, and culturally sensitive healthcare strategies. Recommendations: Future research should explore sustainable neonatal resuscitation training, telemedicine support, and emergency referral systems to improve neonatal survival in remote Nepal. Further studies on healthcare infrastructure gaps and policy-driven interventions are needed to enhance maternal and newborn care. Conclusions: While HBB and other neonatal interventions have demonstrated success in reducing neonatal mortality, their impact is limited by persistent disparities in healthcare infrastructure, workforce availability, and geographic inaccessibility. To achieve sustainable reductions in neonatal mortality, a multi-faceted approach combining expanded SBA training, improved emergency healthcare infrastructure, and community-based interventions is essential.