Persistent Inequalities in Antenatal Care, Institutional Delivery, and Caesarean Section Use in Nepal
1
District Hospital Taplejung, Government of Nepal, Ministry of Health, Phungling, Nepal
2
Ministry of Health, Government of Nepal, Biratnagar, Nepal
Popul. Med. 2026;8(Supplement Supplement 1):A1228
ABSTRACT
INTRODUCTION:
To improve maternal health and reduce preventable deaths, Nepal introduced financial incentives for facility-based deliveries in 2005 and eliminated user fees for delivery services in public facilities in 2009. Against this policy context, this study assesses utilization and inequalities in antenatal care, institutional delivery, and caesarean section services, focusing on underserved populations.
METHODS:
This study analyzed data from the 2022 Nepal Demographic and Health Survey, a cross-sectional survey. Using a two-stage sampling, 476 primary units and 14,280 households were selected. Interviews with 3,071 mothers who delivered in the past three years assessed ANC, institutional delivery, and caesarean use. Bivariate and multivariate logistic regression was used considering the cluster design.
RESULTS:
Only 5.8% of women completed eight or more antenatal care (ANC) visits. Utilization was markedly lower among women with no formal education (1.6%) compared to those with the higher education (AOR:3.69(95%CI:1.12–12.16)) and the lower use was observed among women in the poorest wealth quintile (1.5%) versus the richest (AOR:5.91(95%CI:2.60–13.43)). Institutional delivery coverage was higher at 78.3%, yet women with no education (58.9%). The higher use was observed among the women with higher education (AOR: 30.6(95%CI:4.33–215.95). Those in the poorest quintile (62.8%) versus the richest (AOR:11.73(95%CI:5.45–25.23)). The national caesarean section rate was 18.6%, but use was substantially lower among women with no education (8.4%), the higher used observed among those who had higher education (AOR:2.05(95%CI:1.05–4.02)). The lowest used was observed among the poorest households (6.1%) versus the richest (AOR:4.86(95%CI:2.92–8.09)).
CONCLUSIONS:
Despite national safe motherhood incentives and free delivery policies, socioeconomic inequalities persist in maternal health service utilization in Nepal. Use of recommended antenatal care, institutional delivery, and caesarean section services remains disproportionately low among women with no education and the poorest households. These gaps underscore the need for targeted, equity-focused strategies to achieve maternal health–related Sustainable Development Goals.
To improve maternal health and reduce preventable deaths, Nepal introduced financial incentives for facility-based deliveries in 2005 and eliminated user fees for delivery services in public facilities in 2009. Against this policy context, this study assesses utilization and inequalities in antenatal care, institutional delivery, and caesarean section services, focusing on underserved populations.
METHODS:
This study analyzed data from the 2022 Nepal Demographic and Health Survey, a cross-sectional survey. Using a two-stage sampling, 476 primary units and 14,280 households were selected. Interviews with 3,071 mothers who delivered in the past three years assessed ANC, institutional delivery, and caesarean use. Bivariate and multivariate logistic regression was used considering the cluster design.
RESULTS:
Only 5.8% of women completed eight or more antenatal care (ANC) visits. Utilization was markedly lower among women with no formal education (1.6%) compared to those with the higher education (AOR:3.69(95%CI:1.12–12.16)) and the lower use was observed among women in the poorest wealth quintile (1.5%) versus the richest (AOR:5.91(95%CI:2.60–13.43)). Institutional delivery coverage was higher at 78.3%, yet women with no education (58.9%). The higher use was observed among the women with higher education (AOR: 30.6(95%CI:4.33–215.95). Those in the poorest quintile (62.8%) versus the richest (AOR:11.73(95%CI:5.45–25.23)). The national caesarean section rate was 18.6%, but use was substantially lower among women with no education (8.4%), the higher used observed among those who had higher education (AOR:2.05(95%CI:1.05–4.02)). The lowest used was observed among the poorest households (6.1%) versus the richest (AOR:4.86(95%CI:2.92–8.09)).
CONCLUSIONS:
Despite national safe motherhood incentives and free delivery policies, socioeconomic inequalities persist in maternal health service utilization in Nepal. Use of recommended antenatal care, institutional delivery, and caesarean section services remains disproportionately low among women with no education and the poorest households. These gaps underscore the need for targeted, equity-focused strategies to achieve maternal health–related Sustainable Development Goals.
| eISSN: | 2654-1459 |
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