Abstract
Background and purposeHome deliveries increase the risk of maternal and child mortality. To increase institutional deliveries, South Asian countries have introduced various forms of Conditional Cash Transfer (CCT) schemes that offer women cash if they come to deliver at a health facility. In 2005, Nepal introduced its Safe Delivery Incentive Programme (SDIP)—a cash incentive program nationwide to boost the rate of institutional delivery and care from health professionals at childbirth. This study asks the following research questions: How informed were Nepalese women about the cash incentive program? Does knowledge about the cash incentive program correlate with institutional delivery?MethodsData to answer these questions come from the 2011 Nepal Demographic and Health Survey (NDHS). This is a nationally representative data collected from 12,674 women between 15 and 49 years of age, of which 4,036 had given births in the past five years. Multiple logistic regression was employed to predict if knowledge about the cash incentive program increased the odds of institutional delivery controlling for sociodemographic and geographic factors.ResultsApproximately 90% of the women knew about the SDIP. About 42% of the women who knew about the SDIP and 13% of the women who did not know about the SDIP had their most recent delivery at a health institution. The odds of institutional delivery increased nearly three-fold (OR = 2.70; CI: 1.59–4.59) among women who knew about the SDIP compared to women who did not know about the SDIP. Other factors that predicted institutional delivery included education, wealth, urban status, first birth, the number of antenatal care visits, and exposure to news media.ConclusionThis study shows that there is a correlation between women’s knowledge about the SDIP and increased institutional delivery. Nepal’s health and social work professionals should inform all women of reproductive age about the program so that they can make more informed delivery decisions.
Highlights
About 5.9 million children die annually within the first five years of birth and these deaths are more concentrated during the earliest days of their lives: one million children die on the day of birth, two million die within the first week of birth, and 2.7 million die within the first four weeks of birth or neonatal period [1]
About 42% of the women who knew about the Safe Delivery Incentive Programme (SDIP) and 13% of the women who did not know about the SDIP had their most recent delivery at a health institution
The odds of institutional delivery increased nearly three-fold (OR = 2.70; CI: 1.59–4.59) among women who knew about the SDIP compared to women who did not know about the SDIP
Summary
About 5.9 million children die annually within the first five years of birth and these deaths are more concentrated during the earliest days of their lives: one million children die on the day of birth, two million die within the first week of birth, and 2.7 million die within the first four weeks of birth or neonatal period [1]. Three causes—pre-term births, infections, and asphyxia—contribute to over 80% of neonatal mortality[2] These deaths could be eliminated if the delivery occurred in a health facility where informed birth attendants attend to pregnant women and newborn babies with complications. In 2005, Nepal introduced its Safe Delivery Incentive Programme (SDIP)—a nationwide program that offers cash to women who deliver at a health facility and to health care providers who attend delivery [5,6,7]. South Asian countries have introduced various forms of Conditional Cash Transfer (CCT) schemes that offer women cash if they come to deliver at a health facility. In 2005, Nepal introduced its Safe Delivery Incentive Programme (SDIP)—a cash incentive program nationwide to boost the rate of institutional delivery and care from health professionals at childbirth. Given the prevailing custom of home delivery, the decision to spend a significant portion of the household income on hospital delivery would be extraordinary and burdensome
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