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.
Highlights
Kapilvastu district had lower utilization of skilled care at birth and other maternal health care services compared with other districts of the western development region and the national average of Nepal in 2012[28] Geographically, this district is situated in Terai and Chure hills where the population comprises predominantly of the ethnic and other disadvantaged groups[19]
We interviewed 500 women from five electoral constituencies (ECs) and 10 village development committees (VDCs) of the district using a structured interview schedule and the autonomy measurement scale constructed by the authors
Even within the hospital deliveries, nearly six per cent of deliveries were handled by general health workers who were not trained for the skilled delivery care
Summary
We conducted this study in Kapilvastu district of Nepal. It is one of the districts of Western Development Region of Nepal which covers 1738 square kilometers and is situated at theWomen’s autonomy and delivery care practices height of 93 to 1491 meters from the sea level. We conducted this study in Kapilvastu district of Nepal. It is one of the districts of Western Development Region of Nepal which covers 1738 square kilometers and is situated at the. Kapilvastu district had lower utilization of skilled care at birth and other maternal health care services compared with other districts of the western development region and the national average of Nepal in 2012[28] Geographically, this district is situated in Terai and Chure hills where the population comprises predominantly of the ethnic and other disadvantaged groups[19]. We requested written permission from Public Health Offices of Rupandehi and Kapilvastu districts, the concerned local authorities of Nepal before initiating research. We took written informed consent from each respondent collecting their signatures or thumb-prints prior to participating in the study
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