Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?
Cross-sectional study involving semi-structured interviews with mothers conducted in 2015
Abstract
Setting
8 village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators.
Objectives
- To assess the proportion of mothers who delivered in health facilities (institutional delivery)
- among mothers who delivered at home, to understand their reasons for doing so
- among mothers who delivered in health facilities, to understand their challenges.
Design
Cross-sectional study involving semi-structured interviews with mothers conducted in 2015.
Results
Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%).
Conclusion
To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
The costs for open access publication were supported by the Department for International Development’s COMDIS–HSD Programme which is led by the University of Leeds
Citation
D. Joshi, S. C. Baral, S. Giri, A. M. V. Kumar (2016) Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?
Public Health Action. 2016 Dec 21; 6(4): 267–272. doi: 10.5588/pha.16.0025