Determinants of Maternal Health Service Utilization and Continuum of Care in Nepal: An Analysis from Demographic and Health Survey 2022

BackgroundContinuum of care for maternal health services is essential in minimizing preventable fatalities linked to pregnancy and childbirth. The study focuses on assessing determinants of maternal health service utilization i.e., four or more antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visit within the first 2 days of delivery and the continuum of care. MethodsWe performed weighted analysis of Nepal Demographic and Health Survey 2022 accounting for complex survey design. Categorical variables are presented using frequency, percentage, and 95% confidence intervals (CI), while numerical variables were represented as mean and a 95% CI. We performed bivariable and multivariable binary logistic regression and the results are odds ratios presented with 95%. ResultsAmong total participants, 80.5% (95% CI: 77.9, 82.8) had four or more antenatal care (ANC) visits, 79.4% (95% CI: 76.8, 81.9) had institutional delivery and 70.2% (95% CI:67.5, 72.9 postnatal care (PNC) visit within 2 days of delivery. The proportion of participants having both four or more ANC visits and institutional delivery was 67.6% (95% CI: 64.7, 70.4) those completing all three components of care (4 or more ANC visits, delivering in health facility and having PNC visit for mother within 2 days of delivery) was 51.2% (95% CI: 48.3, 54.0). Compared to participants in poorest wealth quintile, participants in wealthiest quintile had 12 folds higher odds (AOR: 11.96, 95% CI: 14.36, 32.79) of having both four or more ANC visits and institutional delivery. Residents of the Madhesh had lower odds (AOR: 0.47, 95% CI: 0.23, 0.99), Sudurpaschim had higher odds (AOR: 2.37, 95% CI: 1.17, 4.82) of having 4 or more ANC visits and institutional delivery compared to Koshi Province. Residents of Bagmati Province had lower odds (AOR:0.49, 95% CI: 0.28, 0.87) of having all three components of care: 4 or more ANC visits, institutional delivery and PNC visit within 2 days of delivery for mother. ConclusionThere are notable differences in coverage of maternal health services based on education, wealth quintile, province and place of residence. Addressing economic inequalities and provincial differences and harnessing technology to provide and equitable access to vital maternal and newborn health initiatives.