Determinants of Maternal Health and Family Planning Service Coverage in Nepal

Determinants of Maternal Health and Family Planning Service Coverage in Nepal report has been released.The risk of obstetric complications during pregnancy and unwanted pregnancies are linked to higher maternal deaths. Increasing availability and the use of modern contraceptives and providing high-quality pregnancy and childbirth care can reduce the number of maternal deaths. However, service utilization and coverage are influenced by multiple other factors like the poverty gap, literacy rates, overall human development index, and other external factors. Expansion of the coverage of maternal health and family planning (FP) services has been a priority for the health sector in Nepal, and the Government of Nepal is working to ensure that all citizen have access to such services through a series of policy initiatives. It is often critical to evaluate whether these public health initiatives have been effective. In this context, this analysis used statistical models to identify the factors that determine the coverage of maternal and FP services.

The analysis used the service coverage data from the Health Management Information System, and district characteristics data from ‘Population Atlas of Nepal 2014’ published by Central Bureau of Statistics. The district is the unit of analysis. Eight statistical models were used to identify district characteristics associated with coverage of maternal health and FP services. Coverage of first antenatal care(ANC) visit, four ANC visits, intake of iron and folic acid for 180 days (IFA coverage), institutional delivery, postnatal care (PNC) visit within 24 hours, three PNC visits, and composite coverage of maternal health services were the dependent variables used to assess determinants of maternal health service coverage. Similarly, the modern contraceptive prevalence rate (mCPR) was used as a dependent variable for FP service coverage. A log-transformed linear regression model was used for statistical analysis. All statistical analyses were performed in R software.

The analysis revealed that the coverage of institutional delivery increases with increase in the proportion of female household heads in the districts. Of the 77 districts, 31 districts had higher than average and 30 districts had lower than average composite coverage of maternal health services. Compared to districts with Brahmin as the predominant caste, districts with Magar as predominant caste had 17% higher composite coverage of maternal health services. Similarly, compared to districts in Province 1, Gandaki Province, Province 2 and Bagmati province had 27%, 26% and 15% lower composite coverage of maternal health services. With one unit increase in female mean age at marriage in the district, the composite coverage of maternal health services decreased by approximately 10%.

Key Findings of Determinants of Maternal Health and Family Planning Service Coverage in Nepal

Determinants of first ANC visit coverage

Determinants of institutional delivery coverage

Conclusion of Determinants of Maternal Health and Family Planning Service Coverage in Nepal

This analysis aimed to identify the determinants of maternal health and FP service coverage linking
routine data with characteristics of the district like proportion of absentee population, literacy rates,
mean age at marriage, HDI, poverty gap, population per HF, the proportion of female household
head, predominant caste, year and province. The analysis revealed that districts with a higher
proportion of female household heads had higher coverage of institutional delivery. The potential
reason could be that the women who were household head were more able to make independent
decision relating to service utilization.

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Nirdesh Baral

Hey there, I am Nirdesh Baral, founder of Nepal Health Magazine. I am a Tech geek by passion , Public health practitioner by profession and an Ailurophile by heart and a patriot by birth

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