Factors affecting utilisation of skilled birth attendants in a western hill district of rural Nepal - A mixed method study

Authors: Baral, Y.B., Skinner, J., van Teijlingen, E. and Lyons, K.

Conference: 1st National Health Promotion Conference in Nepal

Dates: 30 March-1 April 2013


Background: The proportion of deliveries where skilled attendance care is used is one of the indicators of the progress of Millennium Development Goal 5 (MDG5) to improve maternal morbidity and mortality. All women need skilled maternity care in pregnancy, childbirth and after delivery. Worldwide, however, one third of births take place without the assistance of a skilled birth attendant (SBA). In developed countries the majority of births are assisted by skilled attendants, but in Nepal it is only 36%; and this rate is much higher in rural areas. The aim of the study was to explore the women’s experiences and perceptions of using skilled birth attendants for delivery in a western hill district of Nepal. This study was designed: (a) to explore the factors affecting the use of skilled birth attendants for delivery in a western hill district of Nepal; (b) to explore women’s perceptions in the use of skilled birth attendants during the labour and delivery and (c) to explore the women’s experiences and choice of skilled birth attendants services during pregnancy, labour and delivery.

Methods: A mixed methods design was utilised to address the research aim with a case study approach. The quantitative information was collected using self-administered structured survey questionnaires to the doctor, nurse and midwives in a private and a public hospital. Qualitative data were collected using semi-structure face-to-face interviews with women aged 18-49 years who had given birth within three years at the time of interview. Study site was a rural area in the western hill district of Nepal. All interviews were undertaken in Nepali and digital recorded with confidentiality ensured.

Results: This study explores the different factors influencing SBA use, they are: (1) women’s individual characteristics, perceptions and experiences, (2) economic, family and community influence in service use, (3) attitudes for and nature and quality of service, (4) Gender roles and cultural aspects of services, (5) access to SBA services relative to women’s socio-economic positions and, political situation, (6) changing society views through traditional to modern e. g. living in nuclear family system, modern views in the younger generation on health services, and inequalities in health service distribution. Moreover, women’s individual characteristics such as age of the mother, parity, and number of living children, women’s previous pregnancy history, women’s educational and employment status, caste/ethnicity including costs of service and health service delivery system are factors influenced SBA use during pregnancy and childbirth.

Conclusions: The findings of the study show that different factors namely: individual characteristics such as age, education, employment, household position, knowledge and attitude; interpersonal relationships, family, friends, neighbours, co-workers, and their links; and organisational factors, the role of different organisations, school, university, different groups of people, community and professional groups affect service use. Furthermore, community factors such as family, relationships between community groups and social networks and wider public health policies, and procedures, such as transportation policy, economic policy and incentive policy, influence maternal health service use.


Source: Manual

Preferred by: Edwin van Teijlingen