Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017:2017:5079234.
doi: 10.1155/2017/5079234. Epub 2017 Jul 20.

Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements

Suresh Mehata  1 , Yuba Raj Paudel  2 , Maureen Dariang  2 , Krishna Kumar Aryal  3 , Bibek Kumar Lal  4 , Mukti Nath Khanal  4 , Deborah Thomas  2
Affiliations

Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements

Suresh Mehata et al. Biomed Res Int. 2017.

Abstract

Background: Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines.

Methods: Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3-5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities.

Findings: The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82-6.76), 9.00 (95% CI: 6.55-12.37), and 9.37 (95% CI: 4.22-20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56-0.64) in 1994-1996 to 0.31 (95% CI: 0.29-0.33) in 2009-2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62-0.70) to 0.40 (95% CI: 0.38-0.40) between 1994-1996 and 2009-2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51-0.77); 0.76 (95% CI: 0.64-0.88); 0.77 (95% CI: 0.71-0.84); and 0.66 (95% CI: 0.60-0.72) in the periods 1994-1996, 1999-2001, 2004-2006, and 2009-2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful.

Conclusion: To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trend in use of four ANC, institutional delivery, and C-section  1994–2011.
Figure 2
Figure 2
Distribution of place of delivery over time.
Figure 3
Figure 3
Income inequality in use of four antenatal care visits over time.
Figure 4
Figure 4
Income inequality in use of facility delivery over time.
Figure 5
Figure 5
Income inequality in use of C-section over time.
See this image and copyright information in PMC

References

    1. Goland E., Hoa D. T. P., Målqvist M. Inequity in maternal health care utilization in Vietnam. International Journal for Equity in Health. 2012;11(1, article no. 24) doi: 10.1186/1475-9276-11-24. - DOI - PMC - PubMed
    1. Zere E., Tumusiime P., Walker O., Kirigia J., Mwikisa C., Mbeeli T. Inequities in utilization of maternal health interventions in Namibia: Implications for progress towards MDG 5 targets. International Journal for Equity in Health. 2010;9, article no. 16 doi: 10.1186/1475-9276-9-16. - DOI - PMC - PubMed
    1. Phiri J., Ataguba J. E. Inequalities in public health care delivery in Zambia. International Journal for Equity in Health. 2014;13(1, article no. 24) doi: 10.1186/1475-9276-13-24. - DOI - PMC - PubMed
    1. Zere E., Suehiro Y., Arifeen A., Moonesinghe L., Chanda S. K., Kirigia J. M. Equity in reproductive and maternal health services in Bangladesh. International Journal for Equity in Health. 2013;12(1, article no. 90) doi: 10.1186/1475-9276-12-90. - DOI - PMC - PubMed
    1. Zere E., Moeti M., Kirigia J., Mwase T., Kataika E. Equity in health and healthcare in Malawi: Analysis of trends. BMC Public Health. 2007;7, article no. 78 doi: 10.1186/1471-2458-7-78. - DOI - PMC - PubMed

LinkOut - more resources