Factors Associated with Choice of Home, Public or Private Sector Delivery in Eastern Nepal

Background and Objectives:  Safe delivery location is an important factor to reduce the maternal mortality. As there are several barriers for women to deliver in a health facility, the reasons for choosing a place for childbirth have to be elicited. This study assessed the factors that are associated with the choice of delivery location from a client's perspective in Eastern Nepal.

Materials and Methods: A community based comparative cross-sectional study was conducted among 420 ever- married females between ages of 15 to 49 years. Data were abstracted from the most recent delivery from 140 mothers in each wing using a validated questionnaire. Anderson's Behavior Model for health service utilization was the conceptual framework used. Multinomial logistic regression was conducted to determine the association of predisposing, enabling and need factors for use of home, public or private sector delivery.

Results: Out of the total 420 women, prior planning (73.6%) and prior arrangements (83.6%) to delivery location was seen the most in Public sector delivery. The odds for delivering in a public facility was higher (OR 4.5, 95% CI 1.97-10.43) than home delivery in terms of prior arrangements to delivery. Women with birth order 2 or less were more likely to deliver in private institution (OR 9.040, 95% CI 2.293- 35.634) and with the literacy of the spouse (OR 6.709, 95% CI 1.808- 24.892) compared to public. Decision making for site made by the husband alone had higher odds in delivering in public (OR 17.17, 95% CI 5.604-52.603) compared to the respondent herself and other members of the family.

Conclusion: Literacy, parity, prior arrangements and decision making are factors that play an important role in choice of safe delivery site. Attention to these aspects is therefore needed.