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.
Highlights
Home delivery in unhygienic environment is common in Nepal
In Nepal, Maternal mortality rate (MMR) reported as 281 deaths per 100,000 live births [7]
A retrospective study done in Nepal has mentioned the major complications were retained placenta 84.1%, postpartum hemorrhage 17%, shock 10.2% and third degree perineal tear, the study revealed that home deliveries are associated with increased maternal morbidity related to the third stage complications [12]
Summary
Home 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. A report published by UN agency had mentioned an estimated 358,000 maternal deaths occurred worldwide in 2008 [1], this figure showed 34% decline from the level of 1990 [2]. Despite this decline low income countries continue to account for 99% of maternal deaths primarily in Africa and South Asia [3]. Nepal had made an effort to achieve the Millennium Development Goal (MDG-5) targeted for reducing MMR by three quarter to 134 per 100,000 live births by 2015 [13]. Proper medical attention and hygienic condition during delivery can reduce the risk of complications of mother and baby
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