Determinants of Delays in Receiving Labor and Delivery Care at Health Facilities: An Analysis of the 2021 Nepal Health Facility Survey.

backgroundMaternal mortality remains a significant challenge worldwide. In Nepal, although remarkable achievements have been made, maternal mortality remains high. The three-delays framework is widely acknowledged as a framework for identifying the factors contributing to maternal mortality. This study aims to assess the extent of the third delay (delay in receiving care after arriving at a health facility) in Nepal and identify client and facility characteristics associated with this delay.

methodsThis cross-sectional study utilized data from the 2021 Nepal Health Facility Survey. A total of 307 interviewed postpartum women who gave birth at a health facility were included in the study. Descriptive analysis, cross-tabulation, and multivariate regression models were used to identify variables associated with the third delay.

resultsIn total, 5.8% women experienced the third delay. A woman's education level was significantly associated with receiving timely care at a health facility. Women at hospitals had higher odds of experiencing a delay compared to women at local level health facilities. However, women at facilities with higher levels of technical quality of care had lower odds of experiencing a delay compared to women at facilities with lower levels of technical quality of care.

conclusionsThis study found that approximately 5 in 100 women experienced a delay in receiving care after arriving at the health facility. Woman's education level, the level of health facility and quality of care contributed to the experience of the third delay. The government should consider prioritizing quality improvement of maternal health care, to reduce maternal mortality and improve maternal health.