Page 92 - GHES-3-1

Global Health Economics and
Sustainability
Institutional delivery within rural Myanmar

and under-resourced settings (WHO, 2015). Myanmar, quarters (77.4%) of maternal deaths in Myanmar occurred
a developing country, ranks high in maternal mortality among rural women (MOH, 2013). Among rural women,
compared with its neighboring countries in Southeast Asia. nearly 80% deliver at home, with the majority attended
The 2014 Myanmar census reported a maternal mortality by unskilled providers. The Myanmar Demographic
ratio (MMR) of 282/100,000 live births (LBs), higher than and Health Survey (MDHS) reported that 52% of rural
the regional average of 140/100,000 LBs (Department of women delivered with a skilled provider, and only 28%
Population, 2016). More than 70% of maternal deaths in delivered in a health facility (MOHS & ICF International,
Myanmar occur among rural women (MOHS, 2018). 2016). Furthermore, an estimated 15 – 20% of pregnancies
encounter unpredictable complications, and most deaths
Despite the occurrence of millions of uncomplicated from these complications occur at home or during transit
childbirths, the majority of adverse pregnancy outcomes (Oo et al., 2012). Although institutional delivery in a well-
occur around the time of delivery, with most intrapartum functioning health facility is critical for reducing maternal
complications being unpredictable. More than 70% mortality, many rural women face significant barriers in
of maternal deaths happen during or immediately deciding to seek, access, and receive skilled care in health
after childbirth (UNICEF, 2018). This period, which facilities.
includes childbirth and the first few hours postpartum,
is recognized as the period with the highest risk of Internationally, a number of studies have been conducted
mortality for mothers and newborns (The Partnership for to determine the factors associated with institutional
Maternal, Newborn, & Child Health, 2006; WHO, 2005). delivery, with education of women, socioeconomic status,
Most postpartum deaths arise from complications during women’s autonomy, accessibility, antenatal visits, birth
childbirth (WHO, 2005). The absence of skilled care at this order, and awareness of maternal danger signs and high-
critical time can lead to life-threatening consequences for risk pregnancies identified as key determinants (Anyait
mothers and their newborns. Therefore, skilled attendance et al., 2012; Darega et al., 2016; Gabrysch & Campbell, 2009;
at birth is considered the most important factor in Gudu & Addo, 2017; Hagos et al., 2014; Kamal et al., 2015;
preventing maternal deaths. According to the WHO, a Khanal et al., 2014). However, most studies have focused
skilled attendant is a licensed health-care provider, such on birth attendants rather than place of delivery, and few
as a medical doctor, nurse, or midwife who is trained studies explore the determinants of institutional delivery.
in managing uncomplicated pregnancies, deliveries, A study conducted in Myanmar found that the main
and postpartum care, as well as detecting, treating, and reason for home deliveries was financial difficulty (51.9%).
referring complications in mothers and newborns (WHO Other factors included a desire for social support during
labor (from family members, relatives, and friends), fear of
et al., 2004). While skilled attendants can conduct deliveries the childbirth position used in health facilities (lithotomy
either at home, health centers, or hospitals, delivering position), and negative attitudes toward health staff (Sein,
in health facilities with referral capacity is considered 2012). This study aims to explore the proportion of rural
the most effective strategy in low-income countries for women who deliver in health facilities and the push and
reducing maternal and newborn mortality (Gabrysch pull factors influencing institutional delivery among rural
& Campbell, 2009). It is recommended that childbirths women in central Myanmar.
take place in environments equipped with the necessary
resources, including medicines, well-functioning health 2. Data and methods
systems, and emergency referral services (The Partnership
for Maternal, Newborn, & Child Health, 2006; WHO, This community-based cross-sectional study was
2005; WHO et al., 2004) Therefore, delivering in a health conducted in selected villages in the Magway region, one
institution under the supervision of skilled attendants of the central regions of Myanmar, which has an MMR of
promotes child survival and reduces the risk of maternal 343.6/100,000 LBs, higher than the national average. More
than three-quarters of the population in this region reside
mortality (WHO et al., 2004; WHO, 2015; UNICEF, 2018).
in rural areas (Department of Population, 2016). The data
In Myanmar, skilled birth attendants (SBAs) include were collected between November 2016 and January 2017.
obstetricians, doctors, nurses, lady health visitors, and A sample size of 500 participants was estimated using the
midwives. Approximately 1.3 million women give birth multiple logistic regression formula (Hsieh et al., 1998).
annually, with an average of 2.3 children per woman; Eligible participants were currently married women
this rate is notably higher in rural areas (MOHS & ICF who had delivered children within 2 years before the
International, 2016). The lifetime risk of maternal death survey. In Myanmar, especially in rural areas, considering
is 1 in 250 (Requejo et al., 2015). The 2013 Myanmar cultural factors and traditional customs, the proportion
Maternal Death Review revealed that more than three- of women who deliver children without being married is

Volume 3 Issue 1 (2025) 84 https://doi.org/10.36922/ghes.3954