Background characteristics
The total number of women aged 15-49 years who had a live birth in the five years preceding the survey was alike in all three surveys,which was 4066, 4148 and 3998 in the survey of 2006, 2011 and 2016 respectively.Nearly half of the women were aged between 25-34 years (45%, 48% and 51% in 2006, 2011 and 2016 respectively).More than two-fifths (43%) women were married at the age of 15-17 years followed by 18-20 years (30%) in the year 2016.The proportion of women such womenwas higher among Brahmin/Chhetri (50%) in the year 2006 while among Janajatis in the year 2011 (37%) and 2016 (33%). Similarly, higher proportion of uneducated women had a live birth in the survey of the year 2006 (58%) and 2011 (44%)than their counterparts while the proportion was higher among women having secondary or above education in the survey of the year 2016 (49%). More than four out of five women were Hindus in all three surveys. Likewise, in regards to place of residence,87% and 90% of such women resided in rural area in the survey of 2006 and 2011 respectively. In contrast, more than half (56%) women resided in urban area in the survey of 2016. The proportion of currently working women who had a live birth in the preceding five years of the survey decreased gradually with time; 70%, 56% and 51% in the survey of 2006, 2011 and 2016 respectively. The proportion of such women was homogeneous among all level of wealth quintiles in all surveys. More than a third of all women had no autonomy (36%) and moderate autonomy (34%). Similarly, in regards to exposure to mass media, three-fourth (75%) of all women had no exposure to newspaper, nearly two-fifths each had high exposure to radio (39%) and television (38%).
(Table 1 is about here)
Bivariate analysis
The utilization of health services during delivery among women aged 15-49 years who had a live birth in the five years preceding the survey for most recent live birthwas assessed and bi-variate analysis was done to find the statistical significance with socio-demographic variables. The utilization of health service during delivery increased from 21% in 2006 to 40% in 2010 and 62% in 2016.Although the proportion of delivery in health facilityincreased among poorest over the period of 10 years, the disparity between richest and poorest still persisted from 2006 to 2016 and the association was highly significant in all the surveys.The proportion of poorest women utilizing health services during delivery increased from 8% to 39% over the period of 10 years (2006 to 2016). But there's still huge gap between rich and poor with 92% richest and 39% poorest women utilizing the services in 2016.
(Figure 1 is about here)
In regards to age, significantly, higher proportion of women aged less than 25 years utilized health service during delivery in the year 2006 (24%), 2011 (46%) and 2016 (67%).In regards to ethnicity, significantly higher proportion of Brahmin/Chhetri (p>0.001) had their recent delivery in health facility than their counterparts in all three surveys (25% in 2006, 49% in 2011 and 74% in 2016).Similarly, proportion of delivery in health facility increased with increase in education of women and the relation was statistically significant (p>0.001) in all three surveys. Health service delivery among women having secondary or above education increased from 47% in 2006 to 79% in 2016.Although decreasing, the urban rural difference in health service delivery continued from 2006 to 2016. Higher proportion of women in urban area had their most recent birth in health facility and the difference was statistically significant in all the surveys. In the similar manner, significantly higher proportion of women who were currently working had their most recent birth in health facility in all the surveys. Number of ANC visits completed was highly statistically significant with place of delivery in all three surveys. 43% of women who had four or more ANC visits had their most recent delivery in health facility in the survey of 2006, which increased to 74% in 2016. Exposure to mass media (newspaper, radio and TV) was also directly proportional to delivery in health facility as significantly higher proportions of women who had high exposure to mass media had their delivery in health facility than those with low exposure in all three surveys.
(Table 2 is about here)
Multivariate analysis
The predictors of institutional delivery among women aged 15-49 years were investigated through multivariate logistic regression analysis.At first, while calculating unadjusted odds ratio, wealth status was a significant predictor of institutional delivery in which poorest were 92 percent (OR=0.075, 95% CI=0.065-0.086) times less likely to deliver their recent child in health facility than the richest.
Although attenuated, wealth status still remained significant predictor of institutional delivery after adjusting all other variables where poorest were almost 78 percent (aOR=0.218, CI=0.174-0.272) less likely to practice institutional delivery than richest. Adjusted odd's ratio was calculated for all other remaining variables. Time period was another significant predictor of institutional delivery as women in the survey of 2016 and 2011 were almost 6 and 3 times respectively more likely to deliver their child in health facility than in the year 2006. Similarly, women married at an age of 21 and above were significantly more likely to have institutional delivery than women married at an age of less than 15 years. Number of children was also significant predictor of institutional delivery in which women having two or more children were significantly less likely to deliver their child in health facility. In regards to ethnicity, women who belonged to Janajati(aOR=0.732, CI=0.641-0.837) and other castes (aOR=0.749, CI=0.636-0.881) were less likely to practice institutional delivery.
Secondary level education had significant positive impact on institutional delivery as women having secondary and above education were more likely to deliver their child in health facility than women having no education. Compared to Hindu women, Muslim women were more likely to practice institutional delivery although this was only marginally significant (aOR=1.291, CI=1.043-1.599). Likewise, women living in rural areas and currently working women were significantly less likely to deliver their most recent child in health facility. Women with moderate and high autonomy were also significantly more likely to deliver their child in health facility than women with no autonomy. Number of ANC visits was also a significant predictor of institutional delivery in whichwomen completing four or more ANC visits (aOR=2.739, CI=2.472-3.035) were nearly three times more likely to practice institutional delivery than their counterparts. Similarly, exposure to mass media like newspaper and television had significant positive influence on institutional delivery.
(Table 3 is about here)