{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:49:24Z","timestamp":1792550964899,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Maternal mortality continues to be a pressing concern in global health, presenting an enduring and unmet challenge for healthcare systems worldwide. Utilization of institutional delivery services has been established as a proven intervention to mitigate life-threatening risks for both mothers and newborns. Exploring the determinants of institutional delivery is crucial to improve and enhance maternal and newborn safety. This study aimed to assess the contextual and individual factors associated with institutional delivery in Nepal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This study utilized that data form Nepal Multiple Indicator Survey 2019, which included a sample of 1,932 women who had given birth within the two years prior to the survey. A multilevel logistic regression analysis was performed to determine the significant external environment, contextual and individual predictors of institutional delivery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The women from Madhesh province [Adjusted Odds Ratio (aOR): 0.32, 95% Confidence Interval (CI): 0.17\u20130.61], as compared to Bagmati province, women from rural areas (aOR: 0.55, 95% CI: 0.39\u20130.78) as compared to urban areas, and women from a relatively less-advantaged ethnic groups (aOR: 0.52, 95% CI: 0.35\u20130.76) as compared to the relatively advantaged ethnic groups were less likely to deliver in health institutions. Similarly, women from the poorest (aOR: 0.09, 95% CI: 0.04\u20130.22) and second wealth groups (aOR: 0.29, 95% CI: 0.13\u20130.64) were less likely to attend institute for delivery compared to women from the richest household. Women with formal education (aOR: 1.65, 95% CI: 1.16\u20132.35) were more likely to deliver in an institution over uneducated women. Moreover, the uptake of institutional delivery increased by 59% (aOR: 1.59, 95% CI: 1.43\u20131.75) for each additional ANC visit.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The findings highlight the importance of stepping up efforts to achieve universal health care from the standpoint of long-term government investment, focusing particularly on illiterate women in rural areas, poorer households, and socially disadvantaged groups. Expanding the benefits of maternal benefit schemes targeting the women from the poorest households in the communities is recommended.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292054","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T17:45:14Z","timestamp":1695318314000},"page":"e0292054","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Determinants of institutional delivery service utilization in Nepal"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6667-0619","authenticated-orcid":true,"given":"Bipin","family":"Thapa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Karki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4115-5765","authenticated-orcid":true,"given":"Suman","family":"Sapkota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4611-2206","authenticated-orcid":true,"given":"Yifei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"pone.0292054.ref001","unstructured":"WHO, UNICEF, UNFPA WBG and the UPD. Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Population Division. 2019. Available: http:\/\/apps.who.int\/bookorders."},{"key":"pone.0292054.ref002","author":"World Health Organization","year":"2018","journal-title":"Defining competent maternal and newborn health professionals"},{"key":"pone.0292054.ref003","author":"UNICEF","year":"2018","journal-title":"UNICEF Global Databases"},{"key":"pone.0292054.ref004","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/S0140-6736(15)00838-7","article-title":"Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group","volume":"387","author":"L Alkema","year":"2016","journal-title":"Lancet (London, England)."},{"key":"pone.0292054.ref005","author":"K Kumar Aryal","year":"2019","journal-title":"Maternal Health Care in Nepal: Trends and Determinants"},{"key":"pone.0292054.ref006","article-title":"Nepal and the Millennium Development Goals Final Status Report 2000\u20132015 Government of Nepal National Planning Commission","author":"S Durbar","year":"2016"},{"key":"pone.0292054.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-698X-13-49","article-title":"Barriers to using skilled birth attendants\u2019 services in mid- and far-western Nepal: A cross-sectional study","volume":"13","author":"B Choulagai","year":"2013","journal-title":"BMC Int Health Hum Rights"},{"key":"pone.0292054.ref008","article-title":"Nepal Demographic and Health Survey","author":"Ministry of Health and Population (MOHP)","year":"2011"},{"key":"pone.0292054.ref009","article-title":"Nepal Multiple Indicator Cluster Survey 2019, Survey Findings Report.","author":"Central Bureau of Statistics","year":"2020"},{"key":"pone.0292054.ref010","volume-title":"National Population and Housing Census 2021","author":"Ministry of Health and Population (MOHP)","year":"2022"},{"key":"pone.0292054.ref011","author":"Ministry of Health Nepal; New ERA; ICF","year":"2012","journal-title":"Nepal Demographic and Health Survey 2011"},{"key":"pone.0292054.ref012","first-page":"14","article-title":"A Multilevel Analysis to Determine the Factors Associated with Institutional Delivery in Nepal: Further Analysis of Nepal Demographic and Health Survey 2016","author":"B Neupane","year":"2021","journal-title":"Heal Serv Insights"},{"key":"pone.0292054.ref013","unstructured":"UNICEF. Surveys\u2014UNICEF MICS. [cited 22 Jun 2021]. Available: https:\/\/mics.unicef.org\/surveys"},{"key":"pone.0292054.ref014","doi-asserted-by":"crossref","first-page":"301","DOI":"10.33314\/jnhrc.v17i3.1525","article-title":"Factors Associated with Use of Maternal Health Services in Nepal: Analysis of the 2016 Nepal Demographic and Health Survey","volume":"17","author":"P. Bhattarai","year":"2019","journal-title":"J Nepal Health Res Counc"},{"key":"pone.0292054.ref015","doi-asserted-by":"crossref","first-page":"e0228440","DOI":"10.1371\/journal.pone.0228440","article-title":"Determinants of home delivery in Nepal\u2013A disaggregated analysis of marginalised and non-marginalised women from the 2016 Nepal Demographic and Health Survey","volume":"15","author":"B Devkota","year":"2020","journal-title":"PLoS One"},{"key":"pone.0292054.ref016","doi-asserted-by":"crossref","first-page":"e0211113","DOI":"10.1371\/journal.pone.0211113","article-title":"Individual and community level factors associated with health facility delivery: A cross sectional multilevel analysis in Bangladesh","volume":"14","author":"TM Huda","year":"2019","journal-title":"PLoS One"},{"key":"pone.0292054.ref017","doi-asserted-by":"crossref","article-title":"Decision-making for birth location among women in Pakistan: evidence from national survey","author":"M Iftikhar ul Husnain","DOI":"10.1186\/s12884-018-1844-8"},{"key":"pone.0292054.ref018","first-page":"12","article-title":"The association between institutional delivery and neonatal mortality based on the quality of maternal and newborn health system in India","author":"HY Lee","year":"2022","journal-title":"Sci Rep"},{"key":"pone.0292054.ref019","first-page":"20","volume-title":"2016 Nepal Demographic and Health Survey Key Findings.","author":"Ministry of Health Nepal, ICF, New ERA.","year":"2017"},{"key":"pone.0292054.ref020","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/1742-4755-11-71","article-title":"Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis","volume":"11","author":"MA Bohren","year":"2014","journal-title":"Reprod Health."},{"key":"pone.0292054.ref021","first-page":"21","article-title":"Factors associated with diarrhoea and acute respiratory infection in children under-5 years old in Ghana: an analysis of a national cross-sectional survey","author":"PA Apanga","year":"2021","journal-title":"BMC Pediatr"},{"key":"pone.0292054.ref022","doi-asserted-by":"crossref","first-page":"e0242242","DOI":"10.1371\/journal.pone.0242242","article-title":"Individual and community-level determinants, and spatial distribution of institutional delivery in Ethiopia, 2016: Spatial and multilevel analysis","volume":"15","author":"GA Tesema","year":"2020","journal-title":"PLoS One"},{"key":"pone.0292054.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-018-0553-0","article-title":"Barriers and facilitators to institutional delivery in rural areas of Chitwan district, Nepal: A qualitative study","volume":"15","author":"R Shah","year":"2018","journal-title":"Reprod Health"},{"key":"pone.0292054.ref024","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12913-019-4871-x","article-title":"Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal","volume":"20","author":"TP Lama","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0292054.ref025","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3126\/medphoenix.v3i1.20755","article-title":"Determinants of Utilization of Institutional Delivery Services in East Nepal: A Community-Based Cross- Sectional Study","volume":"3","author":"BR Kumar","year":"2018","journal-title":"Med Phoenix"},{"key":"pone.0292054.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-015-0454-y","article-title":"Factors affecting institutional delivery in rural Chitwan district of Nepal: A community-based cross-sectional study","volume":"15","author":"R Shah","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0292054.ref027","first-page":"2017","article-title":"Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements","author":"S Mehata","year":"2017","journal-title":"Biomed Res Int"},{"key":"pone.0292054.ref028","first-page":"18","article-title":"Women\u2019s experience of disrespect and abuse during institutional delivery in biratnagar, nepal","author":"NP Ghimire","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0292054.ref029","article-title":"Inequalities in Health Outcomes and Access to Services by Caste\/ Ethnicity, Province, and Wealth Quintile in Nepal","author":"U Ghimire","year":"2019"},{"key":"pone.0292054.ref030","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1093\/inthealth\/ihab002","article-title":"Institutional delivery and associated factors among women in Ghana: findings from a 2017\u20132018 multiple indicator cluster survey","volume":"13","author":"MT Kumbeni","year":"2021","journal-title":"Int Health"},{"key":"pone.0292054.ref031","first-page":"1","article-title":"Institutional delivery in public and private sectors in South Asia: A comparative analysis of prospective data from four demographic surveillance sites.","volume":"16","author":"S Das","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0292054.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-015-1343-1","article-title":"Multilevel analysis of individual and community level factors associated with institutional delivery in Ethiopia.","volume":"8","author":"ZA Mekonnen","year":"2015","journal-title":"BMC Res Notes"},{"key":"pone.0292054.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-021-12287-2","article-title":"Predictors of wealth-related inequality in institutional delivery: a decomposition analysis using Nepal multiple Indicator cluster survey (MICS) 2019","volume":"21","author":"UP Bhusal","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0292054.ref034","first-page":"1","volume":"300","author":"Family Health Division.","year":"2009","journal-title":"Aama Surakshya Programme Policy Guideline"},{"key":"pone.0292054.ref035","doi-asserted-by":"crossref","first-page":"645","DOI":"10.15171\/ijhpm.2018.01","article-title":"Contribution of Nepal\u2019s free delivery care policies in improving utilisation of maternal health services","volume":"7","author":"H Bhatt","year":"2018","journal-title":"Int J Heal Policy Manag"},{"key":"pone.0292054.ref036","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1093\/heapol\/czx070","article-title":"Incentivizing universal safe delivery in Nepal: 10\u2009years of experience.","volume":"32","author":"T Ensor","year":"2017","journal-title":"Health Policy Plan"},{"key":"pone.0292054.ref037","article-title":"JNMA I VOL 58 I ISSUE 232 I","author":"P Gartaula","year":"2020"},{"key":"pone.0292054.ref038","article-title":"Distance to Health Facilities as A Factor in The Uptake of Institutional Delivery Services in Nepal","author":"Nepal Health Sector Support Programme","year":"2020"},{"key":"pone.0292054.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-020-10066-z","article-title":"Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001\u20132016).","volume":"21","author":"VP Sapkota","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0292054.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0181793","article-title":"Dimensions of antenatal care service and the alacrity of mothers towards institutional delivery in South and South East Asia","author":"P Dixit","year":"2017"},{"key":"pone.0292054.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0257782","article-title":"Determinants of utilization of antenatal and delivery care at the community level in rural Bangladesh","author":"JI Pervin","year":"2021"},{"key":"pone.0292054.ref042","doi-asserted-by":"crossref","first-page":"e0250012","DOI":"10.1371\/journal.pone.0250012","article-title":"Factors influencing place of delivery: Evidence from three south-Asian countries.","volume":"16","author":"MA Rahman","year":"2021","journal-title":"PLoS One"},{"key":"pone.0292054.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-14-94","article-title":"Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data","volume":"14","author":"C Joshi","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0292054.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-015-0599-8","article-title":"The role of husbands in maternal health and safe childbirth in rural Nepal: A qualitative study.","volume":"15","author":"S Lewis","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0292054.ref045","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/inthealth\/ihac034","article-title":"Women\u2019s involvement in decision-making and receiving husbands\u2019 support for their reproductive healthcare: a cross-sectional study in Lalitpur, Nepal.","volume":"15","author":"A Pokharel","year":"2023","journal-title":"Int Health"},{"key":"pone.0292054.ref046","first-page":"11","article-title":"Mass media exposure and maternal healthcare utilization in South Asia.","author":"K Fatema","year":"2020","journal-title":"SSM\u2014Popul Heal"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T17:46:00Z","timestamp":1695318360000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292054"}},"subtitle":[],"editor":[{"given":"Kanchan","family":"Thapa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0292054","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,21]]}}}