Changing trends on the place of delivery: why do Nepali women give birth at home?

Abstract

BackgroundHome delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery.MethodsA community based cross sectional study was conducted among 732 married women of reproductive age (MWRA) in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery.ResultsThe study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center.ConclusionThe trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.

Factors Associated with the Utilization of Institutional Delivery Service among Mothers

“…This finding is in line with the findings of another study 9 conducted in Nepal which revealed that respondents who visited ≥ 4 ANC were 2 times more likely to have had institutional delivery as compared to those respondents who had visited 1-3 times.…”

“…Consistently, Brahmin/Chhetri was 1.2 times more likely to utilize delivery service as compared to Tamang and Danuwar ethnicity in one of the study conducted in Kavrepalanchok district of Nepal. 9 Greater utilization of institutional delivery services among Brahmin/Chhetri might point the higher societal value given to Brahmin/Chhetri in Nepalese society because of which this particular caste group may have the greater accessibility to the services.…”

Determinants of Institutional Delivery Among Mothers Who Gave Birth in the Last One Year in Dejen Woreda, Ethiopia, 2016: A Cross Sectional Study

“…Age of the mother was an independent predictor of maternal delivery care utilization in this study; this is inconsistent with a study conducted in Nepal [13]. The possible reason for the discrepancy might be due to differences in the context and socio-culture status.…”

“…The prevalence of institutional delivery in the study area was 71.7%. This finding is lower than according to a study done in Nepal which was 77.3 [13]. The possible explanation might be the fact that mothers in these countries had better educational status (since only 17.6% was illiterate) and better ANC service utilization (since more than 95% had ANC follow up).…”

“…World Health Organizations (WHO) strongly advocates skilled care for every birth to reduce the global burden of 536, 000 maternal deaths every year [11,12]. A community-based cross-sectional study conducted in Nepal showed that out of the total participants, 77.3% had institutional delivery [13]. Another study conducted in Tanzania showed that only 74.3% of all deliveries occur in health facilities.…”