Lama, Claire
(2024)
Factors in Seeking Skilled Care During the Perinatal Period: An Exploratory Study from Golche, Nepal.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
In 2010, Nepal won a Millenium Development Goal Award from the United Nations for its exceptional achievement in reducing maternal mortality. Nepal had one of the highest maternal mortality ratios (MMR) of 990 deaths per 100,000 live births in 1990 and has brought it down to 115 deaths per 100,000 live births. This dramatic drop can be primarily attributed to the robust policies that the government has implemented to increase prenatal care, skilled birth attendance, facility-based deliveries, and postpartum care. Despite the drop in maternal mortality ratio, significant disparities persist. District-level maternal mortality ranges from 66 deaths per 100,000 live births to 478 deaths per 100,000 live births.
Further, people who live in urban areas are significantly more likely than those in rural areas to deliver in a health facility. Birthing parents in the highest wealth quintile are seven times more likely to have professional assistance at their delivery than those in the lowest wealth quintile. Janajati, Nepal’s indigenous population, are the least likely to deliver in a health facility.
This thesis describes a qualitative study using semi-structured interviews with ten birthing parents and two informal key informant interviews in Sindhupalchowk, a district north of Kathmandu. The interviews examined decisions and considerations in seeking skilled care during the perinatal period and cultural norms surrounding the perinatal period. Interviews were supplemented with a short household demographic survey. Content and thematic analysis was conducted to synthesize latent and semantic themes. Additional descriptive quantitative analysis was conducted for the household demographic survey.
Participants identified barriers, including distance, lack of transportation, and poor road conditions, as significant in their decision to give birth at home. They also described spouses and traditional healers as essential collaborators in their decision-making process. This small exploratory study’s findings are consistent with other work from Nepal and shed light on barriers that persist in accessing care for Tamang women in Sindhupalchowk. It demonstrates the need for further research among rural dwellers and minority ethnic groups, policies such as increasing transportation reimbursement, and collaborators, including spouses and traditional healers, for future programs.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
26 June 2024 |
| Date Type: |
Publication |
| Defense Date: |
20 June 2024 |
| Approval Date: |
26 June 2024 |
| Submission Date: |
20 June 2024 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
62 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Behavioral and Community Health Sciences |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Nepal, Birth, Three Delays, Tamang |
| Date Deposited: |
27 Jun 2024 01:31 |
| Last Modified: |
27 Jun 2024 01:31 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46593 |
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