Institutional delivery is considered when pregnant women give births to their newborn at health institution with the help of skilled birth attendant.It ensures safe delivery.The study aimed to assess the utilization of institutional delivery services and associated factors among mothers who gave birth in the last 12 months. A community-based cross-sectional study was conducted among mothers in Phedikhola rural municipality of Syangja district, Nepal. A total of 133 mothers who gave birth in last twelve months were interviewed using structured questionnaire. Descriptive and analytical statistics use based on the objective of the study. Associations were tested using Pearson’s Chi-Square test and Binary logistic regression taking 95% confidence interval.

Out of the total respondents (n=133), more than three-quarter (77.4%) of mothers gave birth in health institution. Mother and her husband education status, ethnicity, mother and her husband occupation status, birth order, wealth status, number of antenatal care visits, experience of complications during last pregnancy, birth preparation activities and distance to reach the health facility with the available means of transportation were significantly associated with the utilization of institutional delivery.However, mother age, history of complications was not significantly associated with the utilization of institutional delivery.

The utilization of institutional delivery was higher compared to the national coverage but many factors influence the institutional delivery practices. Safe motherhood programs should be strengthened and health programs should be targeted at poor, less educated, labor, non-privileged ethnic groups, etc. to increase the use of institutional delivery practices.

Keywords: Institutional Delivery, Services, Utilization, Maternal Health, Nepal

Introduction

Institutional delivery is considered when pregnant women give births to their newborn at health institution with the help of skilled birth attendant such as doctor, nurse and midwife who has been educated and trained to provide delivery care.(Hagos et al., 2014) Institutional delivery also reduces pregnancy and delivery related complications, maternal and newborn death as well as improve maternal health.(Abeje et al., 2014; Amentie et al., 2016; Demilew et al., 2016; Zepro & Ahmed, 2016) Institutional delivery ensures safe environment for mothers and their baby. Sustainable development goal (SDG3) target is “Reduction of maternal mortality ratio less than 70 per 100,000 live births and increase institutional deliveries to 90% by 2030.”(National PlanningCommission, 2015)Globally, maternal mortality ratio is 216 per 100,000 live births in the year 2015 accounting 99% (302 000) of the global maternal deaths in developing countries.(World Health Organization, 2015) In Nepal, maternal mortality ratio is 239 per lakh live births in 2016. (Nepal Demographic Health Survey, 2016) In south Asian countries institutional delivery is only 52%, 75% in urban, 42% in rural. (Millennium Development Goals 2015, n.d.)Poor and low utilization of institutional delivery is a major factor that contributes high level of maternal death in developing countries. (Teferra et al., 2012; Tulsi Ram, 2015)Nepal Demographic Health Survey 2016 shows that national institutional delivery has only 57%; 69% in urban and 44% in rural area.There has been no proportional utilization of institutional delivery practice in Nepal. (Nepal Demographic Health Survey, 2016)

In Nepal, most of the studies revealed that utilization of institutional delivery is influenced by various factors such as maternal education, household wealth, occupation of family member as well as geographical location and urban/rural disparities. Similarly ANC visit, transportation facility, money, decision making power, normal home delivery, proper information and other sociocultural practice plays a significant role in utilization of institutional delivery. (Karkee et al., 2014; Poudel & Pitamanaket, 2010; Shah et al., 2015)

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