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

BMC Pregnancy and Childbirth

Birgitte Bruun Nielsen¹  Svend Sabroe²  Rajendra Raj Wagle² 

[1] Perinatal Epidemiological Research Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8200 Aarhus N, Denmark;Department of Epidemiology and Social Medicine, University of Aarhus, 8000 Aarhus C, Denmark

关键词: place of delivery;    distance;    socio-economic status;   

Others  :  1165786
DOI  :  10.1186/1471-2393-4-8

 received in 2003-05-28, accepted in 2004-05-22,  发布年份 2004

【 摘 要 】

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.

【 授权许可】

   
2004 Wagle et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [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.
• [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.
• [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.
• [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.
• [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.
• [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.
• [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.
• [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.
• [15]Mckay S: Models of midwifery care. Denmark, Sweden and the Netherlands. J Nurse Midwifery 1993, 38:114-120.
• [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.
• [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.
• [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.
• [19]Campbell R, MacFarlane A: Place of delivery: a review. BJOG 1986, 93:675-683.
• [20]Hodgkin D: Household characteristics affecting where mothers deliver in Rural Kenya. Health Econ 1996, 5:333-340.
• [21]Elo IT: Utilization of maternal health-care services in Peru: the role of womens's education. Health Transit Rev 1992, 2:49-69.
• [22]Nwakoby BN: Use of obstetric services in rural Nigeria. J R Soc Health 1994, 114:132-136.
• [23]Amooti-Kaguna B, Nuwaha F: Factors influencing choice of delivery sites in Rakai district of Uganda. Soc Sci Med 2000, 50:203-213.
• [24]Liberatos P, Link BG, Kelsey JL: The measurement of social class in Epidemiology. Epidemiol Rev 1988, 10:87-121.
• [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.
• [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.
• [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.
• [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.
• [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.
• [31]Illsley R, Baker D: Contextual variations in the meaning of health inequality. Soc Sci Med 1991, 32:359-365.
• [32]Lundberg O: Causal explanations for class inequality in health – an empirical analysis. Soc Sci Med 1991, 32:385-393.
• [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.
• [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.
• [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.
• [36]Stone L: Primary Health Care for whom? Village perspectives from Nepal. Soc Sci Med 1986, 22:293-302.
• [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.
• [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.
• [40]Donovan L, Blake DR: Patient non-compliance: Deviance or reasoned decision-making ? Soc Sci Med 1992, 34:507-513.