Inequalities in utilization of maternal health care services in Nepal

Abstract

Purpose – The purpose of this paper is to quantify inequalities in utilization of maternal health care services and measure the relative contribution of different factors affecting it in the context of Nepal. Design/methodology/approach – The paper uses data from the latest round of the Nepal Demographic and Health Survey. Two stages of stratified cluster samplings were used. A total of 13,200 women aged 15-49 were interviewed. Findings – Results of concentration index estimates in three selected indicators suggest considerable inequalities in maternal health care utilization. The decomposition analyses indicate that the critical factors contributing to inequalities in <3 antenatal care visits are poor economic status of households (32 percent) and women (23 percent) and their partners’ illiteracy (23 percent). However, in case of no institutional delivery, apart from the poor economic status of household (51 percent) and women's illiteracy (16 percent), the rural place of residence (21 percent) has emerged as critical factors contributing to inequalities. In case of no postnatal care within a day, birth order (21 percent) becomes a significant factor, next to the poor economic status of the household (41 percent) in terms of the relative contribution to total inequalities. Practical implications – Policies and program targeting maternal health interventions need to consider equity with efficiency in utilization of maternal health care services, and further to achieve the targets of millennium development goal 5 in Nepal. Originality/value – This study is an innovative effort to estimate inequalities in maternal health care services in the context of Nepal by using inequality decomposition model. For the first time, this study estimates the relative contribution of different socioeconomic factors contributing to inequalities in maternal health care services in Nepal.