Factors influencing the utilization of health facilities for childbirth in a disadvantaged community of Lalitpur, Nepal

Background: In Nepal, half of deliveries take place at home (HMIS 2014), while institutional birth assisted by skilled birth attendants (SBAs) are still infrequent.

Objectives: This study explores factors influencing the utilization of health facilities for childbirth in a disadvantaged community of rural Nepal.

Method: A qualitative study with two focus groups: mothers-in-law and husbands, and female community health volunteers. 28 semi-structured in-depth interviews were conducted with selected participants 20 mothers and 8 grass-root and policy level stakeholders. Data were analysed by three delays model of conceptual framework.

Results: The main reasons for giving birth at home included cultural tradition, lack of awareness about danger signs during pregnancy and childbirth, about importance of skilled birth attendants and lack of knowledge about availability of free 24-hours delivery sites/birthing centers, inability to afford two way transportation costs despite transport incentives provided by government for institutional delivery, fear of episiotomy/surgery/physical abuse and health service provider’s attitude for home delivery. Health facilities were mostly used by women who experienced complications during childbirth

Policy Implications: Significant gaps from policy to grass root levels were identified which -suggests that dissemination of information about free delivery must be more effective. The health workers should convincingly inform families about benefits of institutional delivery, especially in marginalized/disadvantaged communities.