Why women do not utilize maternity services in Nepal: a literature review
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World Health Organization. Regional Office for South-East Asia
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The structure and provision mechanism of maternity services in Nepal appearsto be good, with adequate coverage and availability. Utilization of maternityservices has also improved in the past decade. However, this progress may not beadequate to achieve the Millennium Development Goal to improve maternal health(MDG 5) in Nepal. This paper reviews the factors that impede women from utilizingmaternity services and those that encourage such use. Twenty-one articles wereexamined in-depth with results presented under four headings: (i) socioculturalfactors; (ii) perceived need/benefit of skilled attendance; (iii) physical accessibility;and (iv) economic accessibility. The majority of the studies on determinants ofservice use were cross-sectional focusing on sociocultural, economic and physicalaccessibility factors. In general, the education of couples, their economic statusand antenatal check-ups appeared to have positive influences. On the otherhand, traditional beliefs and customs, low status of women, long distance tofacilities, low level of health awareness and women’s occupation tended to impactnegatively on service uptake. More analytical studies are needed to assess theeffectiveness of the Safer Mother Programme, expansion of rural birth centres andbirth-preparedness packages on delivery-service use. Moreover, it is important toinvestigate women’s awareness of the need of facility delivery and their perceptionof the quality of health facilities in relation to actual usage
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