Maternal Mortality in Nepal: Addressing the Issue
In the NDHS database, mother’s highest educational level is categorized into four categories: No education, Primary, Secondary and Higher. Chi-square analyses showed a significant association between mother’s highest educational level and PC status in pf women (χ2 = 398.20, p = <.001). Furthermore, the percentage of mothers who received PC showed an increasing trend with increasing level of education. In the four education groups – no education, primary, secondary and higher – the percentage of mothers who received PC were 61.2%, 80.5%, 92.5% and 100% respectively. Hence, only 5.5% of women with higher than secondary level of schooling did not receive PC, in comparison to 82% of women with no education.
Ecological zone (Mountain, Hill, Terai) was also significantly associated with whether or not the women received PC (χ2 = 117.015, p = <.001). Mothers who were living in the Mountain region were least likely to receive PC, and those who were living in the Terai Region were most likely to receive PC, with mothers who were living in the Hill region falling in between. 39.2% of women in the Mountain region reported having received no PC in comparison to 32.7% and 20.1% of mothers living in the Hill and Terai region respectively. Similar relation was seen between women living in different development regions of Nepal (Eastern, Central, Western, Mid-Western, Far-western) (χ2 = 45.58, p = <.001). Analysis showed Eastern Region had the largest proportion of women (78.7%) who reported having received PC. The Mid-western Region showed the lowest proportion of women (64.4%) who reported having received PC. There were no considerable differences in the proportions of two PC status groups between Western and Far-western groups. There was a stronger significant association between the type of place of residence (urban vs. rural) and PC status (χ2 = 114.98, p = <.001). Consistent with what we would expect, a greater proportion (85.5%) of women who lived in the urban region reported having received PC in comparison to 68.1% of women who lived in the rural region.
DHS wealth index quintile distribution (poorest, poorer, middle, richer, richest) was significantly associated with PC status (χ2 = 494.85, p = <.001). As we expected, there was perfect linear trend in the proportion of ‘received PC’ group among the increasing quintiles of wealth index. The ‘Richest’ group, had the highest proportion (93.5%) of women who reported received PC, followed by the ‘Richer’ group (84.9%) of women who reported having received PC. The percentage of women who reported having received PC in the first three quintiles (Poorest, Poorer, Middle) was 50.2%, 68.9% and 76.3% respectively.
Religion (Hindu, Buddhist, Muslim, Kirat, Christian or other) was also found to be associated with PC status (χ2 = 30.56, p = <.001). Christian women were most likely to seek PC (81.1%) whereas Buddhist women were less likely to have received PC (59%). Similarly, survival status of last child was significantly associated with the status of PC among women (χ2 =16.18, p = 0.<.001). Interestingly, the percentage of women having received PC was greater among those who had the last child alive (88%) than those whose last child were dead (72.8%). Also, the type of native language spoken by the women was significantly associated with their PC status (χ2 =145.02, p = 0.<.001). In contrast to our hypothesis, women speaking Maithili were more likely to have received PC (85.8%) than women speaking Nepali, national language (76.7%).
Three groups of variables related to Knowledge, Attitude and Practice were analyzed to investigate whether or not these variables have any association with Nepalese women receiving PC. The first group included variables that measured knowledge status of women, including heard about family planning (through radio, TV or newspaper) and whether or not women know where to get abortion. Opinion of women in terms of desire for more children and whether or not wanted last child were included in the ‘attitude’ group. Sm