Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?

Abstract

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway.

Women autonomy and maternal healthcare services utilization among young ever-married women in Nigeria

“…This study found significant relationships between women autonomy, antenatal care visits and health facility delivery. The findings of this study are consistent with the findings of (Asweto et al, 2014;Baral et al, 2010;Bhandari et al, 2017;Deo et al, 2015;Fawole and Adeoye, 2015;Woldemicael, 2007b), who found that maternal healthcare utilisation is influenced by women autonomy. Also, the findings of this study are in agreement with the findings of Sharma et al, (2007) where it was stated that women with greater autonomy irrespective of physical and financial resources are able to manage their own children's health care and make fertility decisions too.…”

“…Education was also found to be significantly associated with the use of maternal healthcare services and this is consistent with the findings of Furuta and Salway (2006), Sipsma et al (2014), Adeoye (2015), Bhandari et al (2017), Fawole and Tiruneh et al (2017), Duah and Adisah-Atta (2017). This finding can be explained by the Awoleye et al 71 fact that better educated women have access to more information either through the mass media or social media compared to less educated women.…”

“…These has also been established in other studies as Okeshola and Sadiq (2013) stated that there is a close relationship between household wealth index and maternal healthcare utilisation among young women in Nigeria; that is, the richer the family, the higher the likelihood of a young woman using maternal healthcare services. Also, in Kenya, Ochako et al (2011) established that household wealth is significantly associated with the use of maternal healthcare services among young women as also highlighted by the studies of Bhandari et al (2017), Fawole and Adeoye (2015), Hagos et al (2014) and Tarekegn et al (2014) and summarised that households with more financial strength have more access to healthcare generally and not just maternal healthcare, hence, women in these households should ordinarily attend maternal healthcare services more than women from households in the lower wealth quintiles.…”

“…Another study showed that most of these young women due to their uniqueness (Banke- Thomas et al, 2017), neither benefited from these services nor derive any joy of motherhood, as a result of their young age, lack of autonomy and inexperience (Baral et al, 2010). Studies have examined the relationship between women's autonomy and utilisation of any or all of the maternal health care services, and have found association between them (Asweto et al, 2014;Baral et al, 2010;Bhandari et al, 2017;Hagos et al, 2014;Lowe et al, 2016;Speizer et al, 2014;Thapa, 2012;Tiruneh et al, 2017). Other factors such as age, education, employment or labour force participation and wealth quintile have also been found to be associated with maternal healthcare utilisation (Acharya et al, 2017;Adhikari, 2016;Asweto et al, 2014;Banke-Thomas et al, 2017;Baral et al, 2010;Dahiru and Oche, 2015;Deo et al, 2015;Fawole and Adeoye, 2015;Kamiya, 2010;Okeshola and Sadiq, 2013;Sebayang et al, 2017;Sharma et al, 2007;Situ, 2013;Tarekegn et al, 2014;Teklehaymanot et al, 2017;Tiruneh et al, 2017;Urbaeva, 2015;Woldemicael, 2007aWoldemicael, , 2007bWorkineh and Hailu, 2014;Yaya et al, 2017).…”

A Study on Utilisation of Maternal Health Care Services in Haryana

“…A study by Pulok et al (2016) based on Bangladesh Demographic and Health Survey found that women from the richest households were about 3 times more likely to have more than four Ante Natal Care visits, delivery at a health facility and skilled attendants at birth compared to women from the poorest households. Bhandari et al (2017) conducted a community-based cross-sectional study for assessing women"s autonomy and utilisation of safe delivery care service in Kapilvastu district of Nepal. The analysis suggested that economic status of household and husband"s education are other dominant predictors of the utilisation of safe delivery care services.…”