ArticleBMC pregnancy and childbirth2017
Impact of the roll out of comprehensive emergency obstetric care on institutional birth rate in rural Nepal.
Article in BMC pregnancy and childbirth, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Reducing Neonatal Mortality in Nepal's Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB).Pediatric reports · 2025Review
- Implementation of antepartum preterm birth interventions: A scoping review.European journal of obstetrics & gynecology and reproductive biology: X · 2025Review
- Successful task shifting: a mixed-methods cross-sectional evaluation of an emergency obstetric care program to increase access to cesarean sections in rural Nepal.Global health action · 2024Article
- Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal.Reproductive health · 2020Article
- The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal.Reproductive health · 2019Article
- Role of the general practitioner in improving rural healthcare access: a case from Nepal.Human resources for health · 2018Article
- An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol.Implementation science : IS · 2018Article
- Accountable Care Reforms Improve Women's And Children's Health In Nepal.Health affairs (Project Hope) · 2017Article
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Authors and funding
10 authors.
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Abstract
backgroundIncreasing institutional births rates and improving access to comprehensive emergency obstetric care are central strategies for reducing maternal and neonatal deaths globally. While some studies show women consider service availability when determining where to deliver, the dynamics of how and why institutional birth rates change as comprehensive emergency obstetric care availability increases are unclear.
methodsIn this pre-post intervention study, we surveyed two exhaustive samples of postpartum women before and after comprehensive emergency obstetric care implementation at a hospital in rural Nepal. We developed a logistic regression model of institutional birth factors through manual backward selection of all significant covariates within and across periods. Qualitatively, we analyzed birth stories through immersion crystallization.
resultsInstitutional birth rates increased after comprehensive emergency obstetric care implementation (from 30 to 77%, OR 7.7) at both hospital (OR 2.5) and low-level facilities (OR 4.6, p < 0.01 for all). The logistic regression indicated that comprehensive emergency obstetric care availability (OR 5.6), belief that the hospital is the safest birth location (OR 44.8), safety prioritization in decision-making (OR 7.7), and higher income (OR 1.1) predict institutional birth (p ≤ 0.01 for all). Qualitative analysis revealed comprehensive emergency obstetric care awareness, increased social expectation for institutional birth, and birth planning as important factors.
conclusionComprehensive emergency obstetric care expansion appears to have generated significant demand for institutional births through increased safety perceptions and birth planning. Increasing comprehensive emergency obstetric care availability increases birth safety, but it may also be a mechanism for increasing the institutional birth rate in areas of under-utilization.
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