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

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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.
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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

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  • 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.

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