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Open Access Highly Accessed Research

Changing trends on the place of delivery: why do Nepali women give birth at home?

Saraswoti Kumari Shrestha1*, Bilkis Banu1, Khursida Khanom1, Liaquat Ali1, Narbada Thapa2, Babill Stray-Pedersen3 and Bhimsen Devkota4

Author Affiliations

1 Department of Health Promotion and Health Education, Public Health, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh

2 Department of Community Medicine, Nepal Army Institute of Health Sciences, Kathmandu, Nepal

3 Division of Women and Children, Oslo University Hospital Riks hospital and University of Oslo, Oslo, Norway

4 Department of Health Educations, Faculty of Education, Tribhuvan University, Kathmandu, Nepal

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Reproductive Health 2012, 9:25  doi:10.1186/1742-4755-9-25

Published: 10 October 2012

Abstract

Background

Home delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery.

Methods

A community based cross sectional study was conducted among 732 married women of reproductive age (MWRA) in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery.

Results

The study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center.

Conclusion

The trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.

Keywords:
Home delivery; Institutional delivery; Changing trends; Nepal