Page 91 - GHES-3-1

Global Health Economics and
Sustainability

ORIGINAL RESEARCH ARTICLE
“Push out” and “pull in” factors of institutional

delivery among rural women in central
Myanmar

1
Aye Sandar Mon * and Myo Kyi Phyu 2
1 Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
2 Community Health Training Center, Hlegu, Myanmar

Abstract
Myanmar continues to face the burden of maternal mortality, with most maternal
deaths occurring during or immediately after childbirth. Many women, particularly
those in rural areas, do not deliver in health institutions offering comprehensive
obstetric care. Despite the importance of institutional delivery, few studies have
examined its determinants among rural women in Myanmar. This community-based
cross-sectional study was conducted in selected villages in the Magway region,
Academic editor: located in central Myanmar, and exhibited a maternal mortality ratio higher than the
Mihajlo Jakovljevic M.D. Ph.D. MAE national average. A total of 500 married women who had delivered in the two years
*Corresponding author: before the survey were selected using multistage sampling and interviewed with a
Aye Sandar Mon semi-structured questionnaire. Independent determinants were identified using a
(ayesandarmon@uphmm.net) generalized linear mixed model under a logistic regression framework. Approximately
Citation: Mon, A.S. & Phyu, M.K. one-third (35.6%; 95% confidence interval [CI]: 31.5 – 39.9%) of the respondents
(2025). “Push out” and “pull in” delivered their last child at a health institution. The “pull in” factors of institutional
factors of institutional delivery
among rural women in central delivery included being aged 25 – 35 years (adjusted odds ratio [AOR] = 2.96; 95% CI:
Myanmar. Global Health Econ 1.21 – 7.22), having a secondary or higher education (AOR = 2.83; 95% CI: 1.50 – 5.32),
Sustain, 3(1):83-91. receiving information from health-care providers (AOR = 2.01; 95% CI: 1.11 – 3.83),
https://doi.org/10.36922/ghes.3954
recognizing high-risk pregnancies (AOR = 5.47; 95% CI: 1.42 – 21.11), and completely
Received: July 17, 2024 taking up antenatal care (AOR = 3.04; 95% CI: 1.42 – 6.49). The “push out” factors that
1st revised: July 18, 2024 deterred institutional delivery included a lack of women’s autonomy (AOR = 0.26;
95% CI: 0.14 – 0.50) and inadequate birth preparedness (AOR = 0.37; 95% CI: 0.19 –
2nd revised: August 1, 2024
0.72). The institutional delivery rate among rural women was considerably low. To
Accepted: August 5, 2024 improve it, it is crucial to provide information about high-risk pregnancies and the
Published online: September 27, importance of institutional delivery during antenatal visits, empower women, and
2024 encourage birth preparedness in rural Myanmar.
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the Keywords: Institutional delivery; Health facility delivery; Rural women; Myanmar
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium,
provided the original work is
properly cited. 1. Introduction
Publisher’s Note: AccScience Ending preventable maternal mortality is one of the most significant public health
Publishing remains neutral with challenges in the developing world. The World Health Organization (WHO)
regard to jurisdictional claims in
published maps and institutional estimates that 303,000 women worldwide die from pregnancy- or childbirth-related
affiliations. complications each year, with 99% of these deaths occurring in developing regions

Volume 3 Issue 1 (2025) 83 https://doi.org/10.36922/ghes.3954