Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal

Abstract

BackgroundAlthough the debate on the safety and women's right of choice to a home delivery vs. hospital delivery continues in the developed countries, an undesirable outcome of home delivery, such as high maternal and perinatal mortality, is documented in developing countries. The objective was to study whether socio-economic factors, distance to maternity hospital, ethnicity, type and size of family, obstetric history and antenatal care received in present pregnancy affected the choice between home and hospital delivery in a developing country.MethodsThis cross-sectional study was done during June, 2001 to January 2002 in an administratively and geographically well-defined territory with a population of 88,547, stretching from urban to adjacent rural part of Kathmandu and Dhading Districts of Nepal with maximum of 5 hrs of distance from Maternity hospital. There were no intermediate level of private or government hospital or maternity homes in the study area. Interviews were carried out on 308 women who delivered within 45 days of the date of the interview with a pre-tested structured questionnaire.ResultsA distance of more than one hour to the maternity hospital (OR = 7.9), low amenity score status (OR = 4.4), low education (OR = 2.9), multi-parity (OR = 2.4), and not seeking antenatal care in the present pregnancy (OR = 4.6) were statistically significantly associated with an increased risk of home delivery. Ethnicity, obstetric history, age of mother, ritual observance of menarche, type and size of family and who is head of household were not statistically significantly associated with the place of delivery.ConclusionsThe socio-economic standing of the household was a stronger predictor of place of delivery compared to ethnicity, the internal family structure such as type and size of family, head of household, or observation of ritual days by the mother of an important event like menarche. The results suggested that mothers, who were in the low-socio-economic scale, delivered at home more frequently in a developing country like Nepal.

A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context

“…We located few studies of high or moderate quality, and eight studies 19,35,36,41,43,45,48,49 had sample sizes of less than 500 women, restricting the ability to draw conclusions. In some instances, the population in need of health care was not identified accurately because data were collected for other purposes, such as the evaluation of child health; for example, in one study, the population was restricted to married women younger than 35 years with at least one child younger than 5 years.…”

“…In some instances, the population in need of health care was not identified accurately because data were collected for other purposes, such as the evaluation of child health; for example, in one study, the population was restricted to married women younger than 35 years with at least one child younger than 5 years. 37 The definition of need for maternal health care was also inconsistent: eligible groups included women who had given birth ever, 29,46 in the past 45 days 43 and in the past 5 years. 12,32,33,[38][39][40]47 The choice of potential confounders was another important reason for the difference in findings.…”

“…44,47 Those that did used a wide range of confounders in different combinations. Variables included user-related items such as education, religion, ethnicity, marital status, age, women's or partners' education and number of children, 28,[38][39][40]43 and supply-related items including distance to care and characteristics of health carefacility. 12,27,29,38 However, other variables of probable importance, such as obstetric risk and users' beliefs and preferences, were often not mentioned.…”

“…12,29 Instead, determinants of delivering in a medical setting included education, age, obstetric risk measures, medical insurance, time to travel to site of care and openness to the outside world in Guatemala; 12 and education, region, availability of polyclinic in the community and timing of the birth in Tajikistan. 29 The low-quality studies tended to report either an association between higher economic status and increased use, 27,32,[42][43][44][45] or no difference with increasing wealth. 19,[46][47][48][49] Antenatal care in the first trimester Urban-rural differences Five studies, one of high quality and three of moderate quality, examined the effect of urban-rural residence on antenatal care during the first trimester of pregnancy (Table 3, available at: http://www.who.int/bulletin/volumes/ 85/10/06-035659/en/index.html).…”

The Experience of Ghana in Implementing a User Fee Exemption Policy to Provide Free Delivery Care

“…1,2 Financial barriers have also been important, but there have been relatively few studies of whether and how changing fees influences women's uptake of maternity services and at what cost.…”