title: Paternal Factors and Inequity Associated with Access to Maternal Health Care Service Utilization in Nepal: A Community Based Cross-Sectional Study.
abstract: BACKGROUND
  The threat of maternal mortality can be reduced by increasing use of maternal health services. Maternal death and access to maternal health care services are inequitable in low and middle income countries.The aim of this study is to assess associated paternal factors and degree of inequity in access to maternal health care service utilization.
  
  
  METHODS
  Analysis illustrates on a cross-sectional household survey that followed multistage-cluster sampling. Concentration curve and indices were calculated. Binary logistic regression analysis was executed to account paternal factors associated with the utilization of maternal health services. Path model with structural equation modeling (SEM) examined the predictors of antenatal care (ANC) and institutional delivery.
  
  
  RESULTS
  The finding of this study revealed that 39.9% and 45.5% of the respondents' wives made ANC visits and utilized institutional delivery services respectively. Men with graduate and higher level of education were more likely (AOR: 5.91, 95% CI; 4.02, 8.70) to have ANC of their wives than men with no education or primary level of education. Men with higher household income (Q5) were more likely (1.99, 95% CI; 1.39, 2.86) to have ANC for their wives. Similarly, higher household income (Q5) also determined (2.74, 95% CI; 1.81, 4.15) for institutional delivery of their wives. Concentration curve and indices also favored rich than the poor. SEM revealed that ANC visit was directly associated to institutional delivery.
  
  
  CONCLUSIONS
  Paternal factors like age, household wealth, number of children, ethnicity, education, knowledge of danger sign during pregnancy, and husband's decision making for seeking maternal and child health care are crucial factors associated to maternal health service utilization. Higher ANC coverage predicts higher utilization of the institutional delivery. Wealthier population is more concentrated to maternal health services. The inequities between the poor and the rich are necessary to be addressed through effective policy and programs.
authors.affiliation: Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal; Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, HatYai, Thailand.
authors.forename: Dharma Nand
authors.initials: DN
authors.lastname: Bhatta
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
authors.forename: Umesh Raj
authors.initials: UR
authors.lastname: Aryal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000941:ethics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D000068097:Maternal Health / Q000191:economics / Q000941:ethics* / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000191:economics / Q000941:ethics* / Q000706:statistics & numerical data; D009390:Nepal; D011247:Pregnancy; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology*