Assessment of maternal healthcare services among the women of reproductive age in the rural municipality of Nepal: a cross-sectional study.

Background: Maternal Mortality Ratio is one of the crucial indicators of the Sustainable Development Goal-3, which is to be achieved below 70 per 100 000 live births by 2030. It is essential to assess the current status of antenatal care (ANC), uptake of skilled birth attendants (SBAs), and postnatal care (PNC) to improve the health of a mother and child in developing countries like Nepal. This study assesses the utilisation and factors associated with maternal healthcare services among reproductive-aged women in the Shubhakalika Rural municipality of Nepal.

Methods: A cross-sectional study using proportionate simple random sampling was performed to select 180 participants. A Nepali-translated tool based on Andersen's Behaviour Model of healthcare service utilisation was used to collect the data. ANC services, SBAs, PNC services and continuum of care were dependent variables while independent variables were categorised into predisposing, enabling and need factors. Bivariate and multivariable regression analysis was performed using the Statistical Package of Social Sciences V.20 to determine the association between dependent and independent variables. All the tests were set at a CI of 95%.

Results: This study included 180 participants with a mean (±SD) age of 24.3±4.9 years. Women whose husbands completed formal schooling were more likely to have four ANC visits (adjusted OR (AOR)=3.2, CI=1.0-10.3). Women with a planned pregnancy were significantly associated with the use of four ANC visits (AOR=10.3, CI=3.5-30.3), institutional delivery (AOR=3.2, CI=1.1-9.3) and continuum of care (AOR=7.4, CI=1.4-37.8). Ethnicity (AOR=2.4, CI=1.1-5.4), education of women (AOR=2.7, CI=1.0-7.7), having problems in receiving maternal healthcare services (AOR=4.5, CI=1.5-15.2) and distance to the nearest health facilities of less than 30 minutes (AOR=2.4, CI=1.0-5.7) were significantly associated with the use of institutional delivery. Similarly, women who were 18 years or above at the time of marriage were more likely to attend at least one PNC (AOR=3.2, CI=1.5-6.5) than women who were under 18. Meanwhile, women with health insurance were less likely to attend at least one PNC visit (AOR=0.3, CI=0.1-0.6) compared with those without health insurance.

Conclusion: Women with planned pregnancies, higher education and husbands who completed formal schooling were more likely to access comprehensive maternal healthcare services, including ANC, institutional delivery and PNC. This study demonstrated proximity to health facilities, and lower ethnic groups were deprived of maternal healthcare services. These results emphasise the need to address socio-demographic disparities and improve healthcare accessibility. Since, health insurance programmes facilitate the utilisation of maternal healthcare services, efforts should focus on expanding coverage to reach the target population effectively, such as newly married couples.