title: Universal institutional delivery among mothers in a remote mountain district of Nepal: what are the challenges?
abstract: 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.
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: D
authors.initials: D
authors.lastname: Joshi
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: S C
authors.initials: SC
authors.lastname: Baral
authors.affiliation: Health Research and Social Development Forum (HERD), Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Giri
authors.affiliation: International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
keywords: access; challenges; health-care provider behaviour