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BMC Pregnancy and Childbirth

Open Access 01-12-2004 | Research article

Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal

Authors: Rajendra Raj Wagle, Svend Sabroe, Birgitte Bruun Nielsen

Published in: BMC Pregnancy and Childbirth | Issue 1/2004

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Abstract

Background

Although the debate on the safety and women's right of choice to a home delivery vs. hospital delivery continues in the developed countries, an undesirable outcome of home delivery, such as high maternal and perinatal mortality, is documented in developing countries. The objective was to study whether socio-economic factors, distance to maternity hospital, ethnicity, type and size of family, obstetric history and antenatal care received in present pregnancy affected the choice between home and hospital delivery in a developing country.

Methods

This cross-sectional study was done during June, 2001 to January 2002 in an administratively and geographically well-defined territory with a population of 88,547, stretching from urban to adjacent rural part of Kathmandu and Dhading Districts of Nepal with maximum of 5 hrs of distance from Maternity hospital. There were no intermediate level of private or government hospital or maternity homes in the study area. Interviews were carried out on 308 women who delivered within 45 days of the date of the interview with a pre-tested structured questionnaire.

Results

A distance of more than one hour to the maternity hospital (OR = 7.9), low amenity score status (OR = 4.4), low education (OR = 2.9), multi-parity (OR = 2.4), and not seeking antenatal care in the present pregnancy (OR = 4.6) were statistically significantly associated with an increased risk of home delivery. Ethnicity, obstetric history, age of mother, ritual observance of menarche, type and size of family and who is head of household were not statistically significantly associated with the place of delivery.

Conclusions

The socio-economic standing of the household was a stronger predictor of place of delivery compared to ethnicity, the internal family structure such as type and size of family, head of household, or observation of ritual days by the mother of an important event like menarche. The results suggested that mothers, who were in the low-socio-economic scale, delivered at home more frequently in a developing country like Nepal.
Literature
1.
Figa'-Talamanca I: Maternal mortality and the problem of accessibility to obstetric care; the strategy of maternity waiting homes. Soc Sci Med. 1996, 42: 1381-1390. 10.1016/0277-9536(95)00286-3.CrossRef
2.
Faundes A, Rosenfield A, Pinotti JA: Maternity care in developing countries: relevance of new technological advances. Int J Gynecol Obstet. 1988, 24: 103-109.
3.
Kaunitz AM, Spence C, Danielson TS, Rochat RW, Grimes DA: Perinatal and maternal mortality in a religious group avoiding obstetric care. Am J Obstet Gynecol. 1984, 150: 826-831.CrossRefPubMed
4.
Resource centre for Primary Health Care: Health in Nepal realities and challenges. Kathmandu. 1997
5.
Ministry of Health, Family Health Division: Maternal mortality and morbidity study. Kathmandu. 1998
6.
Bolam A, Manandhar DS, Shrestha P, Ellis M, Malla K, Costello AM: Factors affecting home delivery in the Kathmandu valley. Health Policy Plann. 1998, 13: 152-158. 10.1093/heapol/13.2.152.CrossRef
7.
Bolam A, Manandhar DS, Shrestha P, Manandhar B, Ellis M, Costello AM: Maternity care utilization in Kathmandu valley. The Journal of Nepal Medical Association. 1997, 35: 122-129.
8.
De Brouwere V, Tonglet R, Van Lerberghe W: Strategies for reducing maternal mortality in developing countries: what can we learn fromthe history of the industrialized West?. Trop Med Int Health. 1998, 3: 771-782. 10.1046/j.1365-3156.1998.00310.x.CrossRefPubMed
9.
Family Health Division, Department of Health Services, Ministry of Health, Nepal: HMG's Safe Mothterhood Policy. Kathmandu. 1998
10.
Ackermann-Liebrich U, Vogeli T, Gunter-Witt K, Kunz I, Zullig M, Schindler C, Maurer M, Zurich Study Team: Home versus-hospital deliveries: follow up study of matched pairs for procedures and outcomes. BMJ. 1996, 313: 1313-1318.CrossRefPubMedPubMedCentral
11.
Sorensen HT, Steffensen FH, Rothman KJ, Gillman MW, Fischer P, Sabroe S, Olsen J: Effect of home and hospital delivery on longterm cognitive function. Epidemiology. 2000, 11: 706-708. 10.1097/00001648-200011000-00016.CrossRefPubMed
12.
Walraven GEL, Mkanje RJB, Roosemalen J, Van Dongen PWJ, Dolmans WMV: Perinatal mortality on homebirths in rural Tanzania. Eur J Obstet Gynecol Reprod Biol. 1995, 58: 131-134. 10.1016/0028-2243(94)01989-4.CrossRefPubMed
13.
Garber P, Lai D, Baea M: Childbirth in rural area: maternal death, village deliveries and obstetric service use. PNG Med J. 1994, 37: 166-172.
14.
Wiegers TA, Keirse MJNC, Van Der Jee J, Berghs GAH: Outcome of planned home and planned hospital births in low risk pregnancies: prospective studies in the midwife practices in the Netherlands. BMJ. 1996, 313: 309-313.CrossRef
15.
Mckay S: Models of midwifery care. Denmark, Sweden and the Netherlands. J Nurse Midwifery. 1993, 38: 114-120.CrossRefPubMed
16.
Schmidt N, Abelsen B, Oian P: Deliveries in maternity homes in Norway: results from a 2-year prospective study. Acta Obstet Gynecol Scand. 2000, 81: 731-737. 10.1034/j.1600-0412.2002.810808.x.CrossRef
17.
Nesbitt TS, Connell FA, Hart LG, Rosenblatt RA: Access to Obstetric care in rural areas: Effect on birth outcomes. Am J Public Health. 1990, 80: 814-818.CrossRefPubMedPubMedCentral
18.
Macintyre S, Ellaway A, Cummins S: Place effects on health: how can we conceptualise, operationalise and measure them?. Soc Sci Med. 2002, 55: 125-139. 10.1016/S0277-9536(01)00214-3.CrossRefPubMed
19.
Campbell R, MacFarlane A: Place of delivery: a review. BJOG. 1986, 93: 675-683.CrossRef
20.
Hodgkin D: Household characteristics affecting where mothers deliver in Rural Kenya. Health Econ. 1996, 5: 333-340. 10.1002/(SICI)1099-1050(199607)5:4<333::AID-HEC202>3.0.CO;2-K.CrossRefPubMed
21.
Elo IT: Utilization of maternal health-care services in Peru: the role of womens's education. Health Transit Rev. 1992, 2: 49-69.PubMed
22.
23.
Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med. 2000, 50: 203-213. 10.1016/S0277-9536(99)00275-0.CrossRefPubMed
24.
Liberatos P, Link BG, Kelsey JL: The measurement of social class in Epidemiology. Epidemiol Rev. 1988, 10: 87-121.PubMed
25.
Zurayk H, Halabi S, Deeb M: Measures of social class based on education for use in developing countries. J Epidemiol Community Health. 1987, 41: 173-179.CrossRefPubMedPubMedCentral
26.
Krieger N, Williams DR, Moss NE: Measuring social class in U.S. public health research: concepts, methodologies and guidelines. Annu Rev Public Health. 1997, 18: 341-378. 10.1146/annurev.publhealth.18.1.341.CrossRefPubMed
27.
Krieger N: Women and social class: a methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health. 1991, 45: 35-42.CrossRefPubMedPubMedCentral
28.
Central Bureau of Statistics: Population of Nepal, Population Census 2001- Selected Tables. Kathmandu. 2002
29.
Fajemilehin BR: Factors influencing high rate of 'born before arrival' babies in Nigeria-a case control study in Ogbomsho. Int J Nurs Stud. 1991, 28: 13-18. 10.1016/0020-7489(91)90045-5.CrossRefPubMed
30.
Schwartz JB, Akin JS, Popkin BM: Price and income elasticities of demand for modern health care: the case of infant delivery in the Philippines. World Bank Econ Rev. 1988, 2: 49-76.CrossRefPubMed
31.
Illsley R, Baker D: Contextual variations in the meaning of health inequality. Soc Sci Med. 1991, 32: 359-365. 10.1016/0277-9536(91)90336-B.CrossRefPubMed
32.
Lundberg O: Causal explanations for class inequality in health – an empirical analysis. Soc Sci Med. 1991, 32: 385-393. 10.1016/0277-9536(91)90339-E.CrossRefPubMed
33.
Le Bacq F, Rietsema A: High maternal mortality levels and Additional risk from poor accessibility in two districts of Northern Province, Zambia. Int J Epidemiol. 1997, 26: 357-363. 10.1093/ije/26.2.357.CrossRefPubMed
34.
Yantzi N, Rosenberg MW, Burke SO, Harrison MB: The impact of distance to hospital on families with a child with chronic condition. Soc Sci Med. 2001, 52: 1777-1791. 10.1016/S0277-9536(00)00297-5.CrossRefPubMed
35.
Noorali R, Luby S, Rahbar MH: Does use of governmenthealth services depend on distance from the health facility?. Health Policy Plann. 1999, 14: 191-197. 10.1093/heapol/14.2.191.CrossRef
36.
Stone L: Primary Health Care for whom? Village perspectives from Nepal. Soc Sci Med. 1986, 22: 293-302. 10.1016/0277-9536(86)90125-5.CrossRefPubMed
37.
Jewkes R, Abrahams N, Mvo Z: Why do nurses abuse patients? Reflections from South African obstetric services. Soc Sci Med. 1998, 47: 1781-1795. 10.1016/S0277-9536(98)00240-8.CrossRefPubMed
38.
Herngreen WP, Reerink JD, van Noord-Zaadstra BM, Verloove-Vanhoric SP, Ruys JHR: Relationship between socio-economic status and differences in health care utilization in pregnancy, delivery and puerpe rium. (Article in Dutch with English Abstract). Ned Tijdschr Genneskd. 1993, 137: 1007-1012.
39.
Abel S, Kearns RA: Birth places: a geographical perspective on planned home birth in New Zealand. Soc Sci Med. 1991, 33: 825-834. 10.1016/0277-9536(91)90387-R.CrossRefPubMed
40.
Donovan L, Blake DR: Patient non-compliance: Deviance or reasoned decision-making ?. Soc Sci Med. 1992, 34: 507-513. 10.1016/0277-9536(92)90206-6.CrossRefPubMed
Metadata
Title
Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal
Authors
Rajendra Raj Wagle
Svend Sabroe
Birgitte Bruun Nielsen
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2004
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-4-8