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Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?

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  • Tulsi Ram Bhandari
  • V Raman Kutty
  • P Sankara Sarma
  • Ganesh Dangal

Abstract

Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives—women’s autonomy—plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women’s autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women’s autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women’s education had a strong positive association (odds ratio = 24.11, CI = 9.43–61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women’s education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband’s education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women’s autonomy may be an important mediating factor in this pathway.

Suggested Citation

  • Tulsi Ram Bhandari & V Raman Kutty & P Sankara Sarma & Ganesh Dangal, 2017. "Safe delivery care practices in western Nepal: Does women’s autonomy influence the utilization of skilled care at birth?," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-10, August.
    • Handle: RePEc:plo:pone00:0182485
    DOI: 10.1371/journal.pone.0182485
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    References listed on IDEAS

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    1. Kruk, M.E. & Prescott, M.R., 2012. "The role of health systems and policies in promoting safe delivery in low-and middle-income countries: A multilevel analysis," American Journal of Public Health, American Public Health Association, vol. 102(4), pages 645-650.
    2. Ensor, Tim & Clapham, Susan & Prasai, Devi Prasad, 2009. "What drives health policy formulation: Insights from the Nepal maternity incentive scheme?," Health Policy, Elsevier, vol. 90(2-3), pages 247-253, May.
    3. Jeroen Smits & Roel Steendijk, 2015. "The International Wealth Index (IWI)," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 122(1), pages 65-85, May.
    4. Powell-Jackson, Timothy & Hanson, Kara, 2012. "Financial incentives for maternal health: Impact of a national programme in Nepal," Journal of Health Economics, Elsevier, vol. 31(1), pages 271-284.
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    1. Habtamu Tolera & Tegegne Gebre-Egziabher & Helmut Kloos, 2019. "Utilization of decentralized health facilities and factors influencing women’s choice of a delivery site in Gida Ayana Woreda, western Ethiopia," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-16, May.
    2. Maryam Vizheh & Frances Rapport & Jeffrey Braithwaite & Yvonne Zurynski, 2023. "The Impact of Women’s Agency on Accessing and Using Maternal Healthcare Services: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 20(5), pages 1-17, February.

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