Background characteristics of the respondents
Table 2 shows the background characteristics of women aged 15-49 years. Majority of the women (68%) are aged 20-29 years. About two third of women resided in urban area and one fifth of women in Province 2. About 21% of women had no education, 31% received basic education, and 40% received secondary education. Sixty-two percent of women reported having access to media and 44 % of women use internet. Eighty-four percent women have mobile phones. Forty-four percent women belonged to first parity.
Similarly, 78% of women had their recent birth at age 20-34 years. Ninety-five percent women have no health insurance. Considering migration status, 71% of women are rural migrants. About 64% of women are below the middle household wealth index quintile. Seventy-eight percent of women attended at least four ANC visits for the most recent birth within the survey's last two years.
Table 2. Background characteristics of the respondents, Nepal MICS 2019
Characteristics
|
Percent
|
Total (N)
|
Age of women
|
|
|
15-19
|
10.3
|
201
|
20-29
|
67.6
|
1318
|
30-49
|
22.1
|
431
|
Residence
|
|
|
Urban
|
65.5
|
1277
|
Rural
|
34.5
|
673
|
Province
|
|
|
Province 1
|
15.7
|
306
|
Province 2
|
21.4
|
417
|
Bagmati
|
19.7
|
384
|
Gandaki
|
7.9
|
153
|
Lumbini
|
19.0
|
371
|
Karnali
|
6.8
|
132
|
Sudurpaschim
|
9.6
|
187
|
Women's education
|
|
|
No
|
20.7
|
405
|
Basic
|
30.7
|
600
|
Secondary
|
39.7
|
775
|
Higher
|
8.8
|
171
|
Access to media (at least once a week)
|
|
|
Not exposed
|
38.1
|
743
|
Exposed
|
61.9
|
1207
|
Internet use
|
|
|
No
|
56.0
|
1093
|
Yes
|
44.0
|
858
|
Having own mobile phone
|
|
|
No
|
16.0
|
312
|
Yes
|
84.0
|
1638
|
Parity
|
|
|
One
|
43.7
|
851
|
Two
|
33.0
|
644
|
Three
|
12.8
|
250
|
Four or above
|
10.5
|
205
|
Age of women at most recent live birth
|
|
|
<20
|
17.0
|
331
|
20-34
|
77.8
|
1517
|
35-49
|
5.3
|
103
|
Health insurance
|
|
|
No
|
95.2
|
1856
|
Yes
|
4.8
|
94
|
Migration status
|
|
|
Urban migrants
|
19.5
|
381
|
Rural migrants
|
71.0
|
1385
|
Urban non-migrants
|
5.7
|
111
|
Rural non-migrants
|
3.8
|
73
|
Wealth index quintile
|
|
|
Poorest
|
22.7
|
442
|
Poor
|
21.2
|
414
|
Middle
|
19.7
|
384
|
Rich
|
19.7
|
384
|
Richest
|
16.7
|
327
|
ANC Visits
|
|
|
No
|
4.5
|
87
|
1-3 visits
|
17.7
|
346
|
4+ visits
|
77.8
|
1517
|
Total
|
100.0
|
1950
|
Association between background characteristics and place of delivery
Table 3 shows that among 1950 women of reproductive age, 78% delivered at a health facility. Delivery in a health facility was higher among women aged 15-19 years (80%) and women in urban areas (84%). Regarding provinces, the percentage of women delivering in a health facility was more than 78% in Gandaki, Bagmati, Sudurpaschim, Province 1 and Lumbini province. Similarly, the proportion of health facility delivery was higher among women with secondary and higher education, who were exposed to media, who used information and communication technology (internet and mobile phone), who had lower parity, with age of women at most recent birth was less than 20 years, who had health insurance, who were urban migrants, in highest wealth index quintile, and who attended ANC at least four visits. The percentage of delivery in a health facility increased with the level of education of women and with the level of household wealth index quintiles, frequency of mass media use, and the increase in ANC visits.
Table 3. Percent distribution of married women aged 15-49 years with a live birth in the last two years by place of delivery of most recent live birth, Nepal MICS 2019
|
Place of delivery
|
|
|
|
Background characteristics
|
Home
|
Health facility
|
Total
|
|
|
%
|
N
|
%
|
N
|
%
|
N
|
c2
p-value
|
Age of women
|
|
|
|
|
|
|
|
15-19
|
19.9
|
40
|
80.1
|
161
|
100.0
|
201
|
0.118
|
20-29
|
21.6
|
285
|
78.4
|
1033
|
100.0
|
1318
|
|
30-39
|
26.1
|
113
|
73.9
|
319
|
100.0
|
431
|
|
Place of residence
|
|
|
|
|
|
|
|
Urban
|
16.4
|
209
|
83.6
|
1068
|
100.0
|
1277
|
0.000
|
Rural
|
34.0
|
229
|
66.0
|
445
|
100.0
|
673
|
|
Province
|
|
|
|
|
|
|
|
Province 1
|
21.2
|
65
|
78.8
|
241
|
100.0
|
306
|
0.000
|
Province 2
|
36.2
|
151
|
63.8
|
266
|
100.0
|
417
|
|
Bagmati
|
11.3
|
43
|
88.7
|
341
|
100.0
|
384
|
|
Gandaki
|
10.8
|
16
|
89.2
|
137
|
100.0
|
153
|
|
Lumbini
|
21.9
|
81
|
78.1
|
289
|
100.0
|
371
|
|
Karnali
|
38.0
|
50
|
62.0
|
82
|
100.0
|
132
|
|
Sudurpaschim
|
16.5
|
31
|
83.5
|
156
|
100.0
|
187
|
|
Women's education
|
|
|
|
|
|
|
|
No
|
45.8
|
185
|
54.2
|
219
|
100.0
|
405
|
0.000
|
Basic
|
25.5
|
153
|
74.5
|
447
|
100.0
|
600
|
|
Secondary
|
12.5
|
97
|
87.5
|
679
|
100.0
|
775
|
|
Higher
|
1.8
|
3
|
98.2
|
168
|
100.0
|
171
|
|
Access to media
|
|
|
|
|
|
|
|
Not exposed
|
34.6
|
258
|
65.4
|
486
|
100.0
|
743
|
0.000
|
Exposed
|
15.0
|
180
|
85.0
|
1027
|
100.0
|
1207
|
|
Internet use
|
|
|
|
|
|
|
|
No
|
32.8
|
359
|
67.2
|
734
|
100.0
|
1093
|
0.000
|
Yes
|
9.2
|
79
|
90.8
|
779
|
100.0
|
858
|
|
Having own mobile
|
|
|
|
|
|
|
|
No
|
40.7
|
127
|
59.3
|
185
|
100.0
|
312
|
0.000
|
Yes
|
19.0
|
311
|
81.0
|
1327
|
100.0
|
1638
|
|
Parity
|
|
|
|
|
|
|
|
One
|
11.7
|
100
|
88.3
|
752
|
100.0
|
851
|
0.000
|
Two
|
21.1
|
136
|
78.9
|
508
|
100.0
|
644
|
|
Three
|
43.2
|
108
|
56.8
|
142
|
100.0
|
250
|
|
Four or above
|
46.1
|
95
|
53.9
|
111
|
100.0
|
205
|
|
Age of women at most recent live birth
|
|
|
|
|
|
|
|
<20
|
18.7
|
62
|
81.3
|
269
|
100.0
|
331
|
0.028
|
20-34
|
22.7
|
345
|
77.3
|
1172
|
100.0
|
1517
|
|
35-49
|
30.5
|
31
|
69.5
|
71
|
100.0
|
103
|
|
Health insurance
|
|
|
|
|
|
|
|
No
|
23.3
|
432
|
76.7
|
1424
|
100.0
|
1856
|
0.000
|
Yes
|
6.3
|
6
|
93.7
|
88
|
100.0
|
94
|
|
Migration status
|
|
|
|
|
|
|
|
Urban migrants
|
8.9
|
34
|
91.1
|
347
|
100.0
|
381
|
0.000
|
Rural migrants
|
25.6
|
354
|
74.4
|
1031
|
100.0
|
1385
|
|
Urban non-migrants
|
21.5
|
24
|
78.5
|
87
|
100.0
|
111
|
|
Rural non-migrants
|
36.0
|
26
|
64.0
|
47
|
100.0
|
73
|
|
Wealth index quintile
|
|
|
|
|
|
|
|
Poorest
|
42.9
|
190
|
57.1
|
252
|
100.0
|
442
|
0.000
|
Poor
|
27.2
|
112
|
72.8
|
301
|
100.0
|
414
|
|
Middle
|
19.5
|
75
|
80.5
|
309
|
100.0
|
384
|
|
Rich
|
12.4
|
48
|
87.6
|
336
|
100.0
|
384
|
|
Richest
|
4.1
|
13
|
95.9
|
313
|
100.0
|
327
|
|
ANC visits
|
|
|
|
|
|
|
|
No
|
84.0
|
73
|
16.0
|
14
|
100.0
|
87
|
0.000
|
1-3 visits
|
42.7
|
148
|
57.3
|
198
|
100.0
|
346
|
|
4+ visits
|
14.3
|
217
|
85.7
|
1300
|
100.0
|
1517
|
|
Total
|
22.5
|
438
|
77.5
|
1512
|
100.0
|
1950
|
|
The results of bivariate analysis showed that place of residence, province, women's education, exposure to media, use of the internet, having own mobile, parity, health insurance, migration status, household wealth quintile, and ANC visits were significantly associated with place of delivery at 95% confidence level (p<0.001). Age of women's most recent birth less than 20 was strongly associated with place of delivery at 95 % confidence level (p<0.05). Age of women was not found to have a significant association with place of delivery.
Factors associated with health facility delivery
The results of bivariate logistic regression analysis are presented in Table 4. Place of residence, province, women's education, access to media, internet use, having own mobile, parity, age of women at most recent live birth, health insurance, migration status, wealth index and ANC visits were significantly associated with health facility delivery. After adjusting the effects of other variables, place of residence, province, internet use, parity, household wealth index, and ANC visits remain significantly associated with health facility delivery. The adjusted odds ratio indicated that women living in urban areas were 1.64 times [AOR: 1.64, 95% CI: 1.17-2.30] more likely to deliver at health facility than women living in rural areas. The odds of delivering in a health facility were 5.86 [AOR:5.86, 95% CI: 3.15-10.90] times higher among women from Sudurpaschim, 3.06 times [AOR: 3.06, 95% 1.70-5.50] higher among women form Gandaki, 2.98 times [AOR: 2.98, 95% 1.55-5.74] higher among women form Karnali, 2.64 times [AOR: 2.64, 95% CI: 1.55-4.50] higher among women from Bagmati, 2.44 times [AOR: 2.44, 95% CI: 1.41-4.20] higher among women from Province 1 and 2.09 times [AOR: 2.09, 95% CI: 1.30-3.36] higher among women from Lumbini Province compared with women from Province 2. Women who used the internet were 1.53 times [AOR:1.53, 95% CI:1.09-2.14] more likely to deliver at health facility compared with women who did not use the internet. Parity was also significantly associated with delivering at health facility in adjusted odds ratio. The odds of delivering at health facility was 2.79 times [AOR:2.79, 95% CI:1.63-4.76] higher for women of one parity than women of four or more parities. The odds of delivering in a health facility increases as the level of household wealth index quintile increases. Women who attended at least four ANC visits had 12.77 times [AOR:12.77, 95% CI:6.69-2439] higher odds of delivering in a health facility than women who had no ANC visits.
Table 4. Logistic regression analysis of health facility delivery for the most recent live birth in the last 2 years preceding the survey, Nepal MICS 2019
Variables
|
COR
|
95% CI
|
AOR
|
95% CI
|
Place of residence
|
|
|
|
|
Rural
|
1.00
|
|
1.00
|
|
Urban
|
2.62***
|
1.92 - 3.59
|
1.64**
|
1.17 - 2.30
|
Province
|
|
|
|
|
Province 2
|
1.00
|
|
1.00
|
|
Province 1
|
2.12*
|
1.19 - 3.76
|
2.44**
|
1.41 - 4.20
|
Bagmati
|
4.46***
|
2.44 - 8.16
|
2.64***
|
1.55 - 4.50
|
Gandaki
|
4.72***
|
2.63 - 8.46
|
3.06***
|
1.70 - 5.50
|
Lumbini
|
2.02**
|
1.25 - 3.29
|
2.09**
|
1.30 - 3.36
|
Karnali
|
0.93
|
0.54 - 1.58
|
2.98**
|
1.55 - 5.74
|
Sudurpaschim
|
2.88***
|
1.64 - 5.08
|
5.86***
|
3.15 - 10.90
|
Women's education
|
|
|
|
|
No
|
1.00
|
|
1.00
|
|
Basic
|
2.46***
|
1.85 - 3.28
|
1.05
|
0.71 - 1.53
|
Secondary
|
5.93***
|
4.26 - 8.25
|
1.36
|
0.90 - 2.05
|
Higher
|
44.89***
|
9.25 - 217.74
|
3.74
|
0.75 - 18.72
|
Access to media
|
|
|
|
|
No exposed
|
1.00
|
|
1.00
|
|
Exposed
|
3.02***
|
2.33 - 3.90
|
0.96
|
0.70 - 1.32
|
Internet use
|
|
|
|
|
No
|
1.00
|
|
1.00
|
|
Yes
|
4.80***
|
3.63 - 6.34
|
1.53*
|
1.09 - 2.14
|
Having own mobile
|
|
|
|
|
No
|
1.00
|
|
1.00
|
|
Yes
|
2.94***
|
2.21 - 3.91
|
0.90
|
0.64 - 1.26
|
Parity
|
|
|
|
|
Four or above
|
1.00
|
|
1.00
|
|
One
|
6.47***
|
4.39 - 9.53
|
2.79***
|
1.63 - 4.76
|
Two
|
3.21***
|
2.30 - 4.49
|
1.31
|
0.83 - 2.07
|
Three
|
1.12
|
0.76 - 1.66
|
0.74
|
0.47 - 1.14
|
Age of women at most recent live birth
|
|
|
|
|
<20
|
1.00
|
|
1.00
|
|
20-34
|
0.78
|
0.60 - 1.03
|
1.16
|
0.81 - 1.66
|
35-49
|
0.52*
|
0.32 - 0.87
|
1.56
|
0.74 - 3.29
|
Health insurance
|
|
|
|
|
No
|
1.00
|
|
1.00
|
|
Yes
|
4.50***
|
2.09 - 9.66
|
2.22
|
0.92 - 5.35
|
Migration status
|
|
|
|
|
Rural non-migrants
|
1.00
|
|
1.00
|
|
Urban migrants
|
5.78***
|
3.13 - 10.69
|
1.48
|
0.75 - 2.90
|
Rural migrants
|
1.64*
|
1.02 - 2.62
|
1.11
|
0.65 - 1.88
|
Urban non-migrants
|
2.06
|
0.90 - 4.72
|
0.91
|
0.37 - 2.24
|
Wealth index quintile
|
|
|
|
|
Poorest
|
1.00
|
|
1.00
|
|
Poor
|
2.02***
|
1.46 - 2.78
|
2.52***
|
1.59 - 4.00
|
Middle
|
3.11***
|
2.13 - 4.56
|
4.30***
|
2.58 - 7.18
|
Rich
|
5.31***
|
3.45 - 8.19
|
5.50***
|
3.15 - 9.60
|
Richest
|
17.65***
|
8.52 - 36.56
|
6.10***
|
2.69 - 13.82
|
ANC visits
|
|
|
|
|
No
|
1.00
|
|
1.00
|
|
1-3 visits
|
7.07***
|
3.76 - 13.27
|
4.90***
|
2.53 - 9.49
|
4+ visits
|
31.57***
|
16.94 - 58.84
|
12.77***
|
6.69 - 24.39
|
*** p<0.001, ** p<0.01, * p<0.05
Note: COR = Crude odds ratio (unadjusted), AOR = Adjusted odds ratio