Increasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear.
In this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization.
Institutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors.
Comprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization.
Maternal mortality Fact sheet No. 348. http://www.who.int/mediacentre/factsheets/fs348/en/. Accessed 23 Nov 2014.
Lawn J, Lee ACC, Kinney M, Sibley L, Carlo W, Paul V, Pattinson R, Darmstadt G. Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done? Int J Gynecol Obstet vol. 2009;107:S5–19. CrossRef
Ministry of Health and Population. Nepal Demographic and Health Survey 2011. Kathmandu: New ERA, ICF International Inc; 2012.
Witter S, Khadka S, Nath H, Tiwari S. The national free delivery policy in Nepal: early evidence of its effects on health facilities. Health Policy Plan. 2011;26(suppl2):ii84–91. PubMed
Simkhada B, Van Teijlingen ER, Porter M, Simkhada P. Major problems and key issues in maternal health in Nepal. Kathmandu Univ Med J. 2006;4(14):258–63.
Lee AC, Lawn JE, Cousens S, Vishwajeet K, Osrin D, Bhutta ZA, Wall SN, Nandakumar AK, Syed U, Darmstadt G. Linking families and facilities for care at birth: What works to avert intrapartum-related deaths?(Report). Int J Gynecol Obstet. 2009;107:S65–88. CrossRef
World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva: World Health Organization; 2009.
Institute of Medicine. Study On Utilization of Emergency Obstetric Care (EmOC). Kathmandu: Selected Districts Of Nepal; 2004.
Crabtree BF, Miller William L. Doing qualitative research. Thousand Oaks: Sage Publications; 1999.
Sorensen G, Emmons K, Hunt M, Barbeau E, Goldman R, Peterson K, Kuntz K, Stoddard A, Berkman L. Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. Prev Med vol. 2003;37:188–97. CrossRef
Laurent C, Kouanfack C, Koulla-Shiro S, Nkoué N, Bourgeois A, Calmy A, Lactuock B, Nzeusseu V, Mougnutou R, Peytavin G, et al. Effectiveness and safety of a generic fixed-dose combination of nevirapine, stavudine, and lamivudine in HIV-1-infected adults in Cameroon: open-label multicentre trial. Lancet. 2004;364(9428):29–34. CrossRefPubMed
Digital Continuous Household Census. Phase One Summary of Results and Post-Mortem. Achham: Possible; 2015.
- Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal
Alex Harsha Bangura
- BioMed Central
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