Spousal violence and receipt of skilled maternity care during and after pregnancy in Nepal.
OBJECTIVE
a substantial number of Nepali women experience spousal violence, which affects their health in many ways, including during and after pregnancy. This study aimed to examine associations between women's experiences of spousal violence and their receipt of skilled maternity care, using two indicators: (1) receiving skilled maternity care across a continuum from pregnancy to the early postnatal period and (2) receiving any skilled maternity care in pregnancy, childbirth, or postpartum.


METHODS
data were analysed for married women aged 15-49 from the 2011 Nepal Demographic and Health Survey. Data were included on women who completed an interview on spousal violence as part of the survey and had given birth within the five years preceding the survey (weighted n=1375). Logistic regression models were developed for analyses.


RESULTS
the proportion of women who received skilled maternity care across the pregnancy continuum and those who received any skilled maternity care was 24.1% and 53.7%, respectively. Logistic regression analyses showed that spousal violence was statistically significantly associated with receiving low levels of skilled maternity care, after adjusting for accessibility of health care. However, after controlling for women's sociodemographic backgrounds (age, number of children born, educational level, husband's education level, husband's occupation, region of residence, urban/rural residence, wealth index), these significant associations disappeared. Better-educated women, women whose husbands were professionals or skilled workers and women from well-off households were more likely to receive skilled maternity care either across the pregnancy continuum or at recommended points during or after pregnancy.


CONCLUSIONS
spousal violence and low uptake of skilled maternity care are deeply embedded in a society in which gender inequality prevails. Factors affecting the receipt of skilled maternity care are multidimensional; simply expanding geographical access to maternity services may not be sufficient to ensure that all women receive skilled maternity care.
Kyoto University, Department of Human Health Sciences, Graduate School of Medicine, 53 Kawara-cho, Shogo-in, Sakyo-ku, Kyoto 606-8507, Japan. Electronic address: marie.furuta@kcl.ac.uk.
Marie
M
Furuta
Kings College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE18WA, UK.
Debra
D
Bick
Cardiff University, School of Medicine, UHW Main Building, Heath Park, Cardiff, UK.
Hiromi
H
Matsufuji
Kings College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE18WA, UK.
Kirstie
K
Coxon
D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009390:Nepal; D011247:Pregnancy; D011364:Professional Practice / Q000592:standards*; D012424:Rural Population / Q000639:trends; D013179:Spouse Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data; D000078329:Workforce
Continuum of care; Gender inequality; Nepal; Skilled maternity care; Spousal violence