Background: Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal
is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This
study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional
delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant
proportion of home deliveries.
Methods: This community-based cross-sectional study was conducted in six rural Village Development Committees of
Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres.
The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a
one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis
using stepwise backward elimination was performed to identify key factors affecting institutional delivery.
Results: Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support
for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by
women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth
preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI:
1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility
located within one hour’s travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of
institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the
likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41].
Conclusion: With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay
of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband’s
support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized
in the health policy as well as development and implementation of maternal health programmes in Nepal.