Skip to main content
padlock icon - secure page this page is secure

Open Access Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?

Download Article:
(PDF 126.9 kb)
Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators.

Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) 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.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Keywords: access; challenges; health-care provider behaviour

Document Type: Research Article

Affiliations: 1: Health Research and Social Development Forum (HERD), Kathmandu, Nepal 2: International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India

Publication date: December 21, 2016

More about this publication?
  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

  • Editorial Board
  • Information for Authors
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more