Setting: Eight village development committees of Mugu
District, a remote mountainous district of Nepal that has
poor maternal health indicators.
Objectives: 1) To assess the proportion of mothers who
delivered in health facilities (institutional delivery); 2)
among mothers who delivered at home, to understand
their reasons for doing so; and 3) among mothers who
delivered in health facilities, to understand their
challenges.
Design: Cross-sectional study involving semi-structured
interviews with mothers conducted in 2015.
Results: Of 275 mothers, 97 (35%) had an institutional
delivery. Multivariate logistic regression analysis showed
that women who resided within 1 h distance from the
birthing centre, had adequate mass media exposure or
had only one child were more likely to deliver in hospital.
Reasons for non-institutional delivery (n = 178) were related
to geographical access (49%), personal preferences
(18%) and perceived poor quality care (4%). Mothers
who accessed institutional delivery (n = 97) also reported
difficulties related to travel (60%), costs (28%), dysfunctional
health system (18%) and unfriendly attitudes of
the health-care providers (7%).
Conclusion: To improve access to institutional delivery,
the government should establish a 24/7 emergency ambulance
network, including air ambulance. Health system
issues, including unfriendly staff attitudes, urgently need
to be addressed to gain the trust of the mothers.