Determinants and Spatial Variation of Skilled Birth Assistance in Nepal: Insights from NDHS 2022

Background : Skilled birth assistance (SBA) is one of the determinants of maternal and neonatal health. Although there has been development in Nepal, there is still imbalance in SBA coverage in socioeconomic, obstetric, and geographical dimensions. This research sought to determine the major risk factors of SBA, spatial differences in SBA, and rural and urban differences in the determinants. Methodology : This study used national representative data on Nepal Demographic and Health Survey (NDHS) 2022, which included women age 15-49 years with a last live birth within the last 5 years. The outcome variable categorized as SBA at delivery (skilled vs unskilled). Step wise survey-weighted multivariable logistic regression was used to assess the national and rural -urban determinants with fitted assessed by likelihood ratio tests, (AIC), (BIC), and result presented as adjusted odds ratios (aORs) with the 95 % confidence intervals (CI). Findings : Among 2,785 women, 72.5% of women were received skill birth assistance (SBA). The uptake of SBA was highest among women aged 20-34 years, secondary or higher education, and richer households. Multiparity (aOR :0.47 ,95% CI:0.36–0.63). The obstetric variables such as 4 or more antenatal care visits (aOR 2.30, 95% CI 1.80-2.94) and caesarean section delivery (aOR: 3.86, 95% CI: 2.42-6.16) were significant predictors of SBA. Maternal age during first birth 20 years and above, increased SBA likelihood to a moderate extent (aOR :1.23,95% CI 1.00-1.50). SBA coverage in the provinces differed significantly with the highest level in Madhesh (≈18 .19%) and the smallest in Gandaki and Bagmati (≈9.11%). Caesarean delivery, ≥4 ANC visits, and residence in Lumbini were the most significant predictors in rural areas and Gandaki residence, caesarean delivery, ≥4 ANC visits and no desire of having additional children were the most significant predictors in urban areas. Conclusion : Maternal, obstetric and socioeconomic factors have a strong impact on SBA in Nepal, and there are immense geographic and rural-urban differences. Specific actions taken against ANC uptake, parity, and provincial inequity: It is necessary to increase SBA coverage on the national level.