Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services

Background Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In ۲۰۰۵, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In ۲۰۰۹, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (۴ ANC) visits and institutional deliveries in Nepal.   Methods Demographic and health survey data from ۱۹۹۶, ۲۰۰۱, ۲۰۰۶ and ۲۰۱۱ were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of ۴ ANC visits and institutional delivery services.   Results Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of ۴ ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in ۲۰۰۵, women were three times (adjusted odds ratio [AOR] = ۳.۰۲۰, P < .۰۰۱) more likely to attend ۴ ANC visits than when there was no FDC policy. After the implementation of Aama programme in ۲۰۰۹, the likelihood of attending ۴ ANC visits increased six-folds (AOR = ۶.۰۰۶, P < .۰۰۱) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR = ۲.۱۱۷, P < .۰۰۱) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR = ۵.۱۱۶, P < .۰۰۱) after the implementation of Aama compared to no FDC policy.   Conclusion Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of ۴ ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services without adequately considering the individual and community level factors

Keywords:

Free Delivery Policies , Institutional Delivery , ANC Visits