Page 93 - GHES-3-1

Global Health Economics and
Sustainability
Institutional delivery within rural Myanmar

infinitesimally small. Therefore, married and reproductive- with 95% CIs, estimated through a generalized linear mixed
aged women were considered appropriate sampling units model (GLMM) within a logistic regression framework.
for this study. The eligible participants were drawn from 21 GLMM was applied to account for the correlation of
selected villages using multistage cluster sampling. events within the same village when estimating standard
The respondents were interviewed face-to-face using errors. Variables with p < 0.25 in bivariate analysis were
a semi-structured questionnaire, collecting information included in the GLMM. Two-tailed tests were used for all
statistical tests, and a p < 0.05 was considered statistically
about their obstetric history and recent childbirth significant. Statistical analysis was performed using STATA
practices. Before data collection, the researcher trained version 13.1.
ten enumerators, explaining the study’s objectives and the
appropriate protocol for administering the questionnaire. 3. Results
Subsequently, data were collected after explaining the
purpose of the study to eligible participants and ensuring 3.1. Choice of delivery place
their confidentiality. Data quality was ensured by checking Among 500 rural women in Myanmar, 35.6% (95% CI:
for consistency and completeness immediately after each 31.5%, 39.9%) delivered at a health facility. Of the 322
interview. women who delivered at home, only 29.5% were attended
The outcome variable was whether participants by an SBA. The most common reason for delivering at a
had delivered their most recent child in a health health facility was to ensure safe delivery (84.2%), followed
institution or facility. The independent variables included by the adequacy of medical resources (48.6%) and referrals
sociodemographic variables such as the respondent’s age, due to high-risk pregnancies (31.1%) (Table 1).
education level, occupation of the couple and their per
capita income; accessibility to maternal care, women’s Table 1. Distribution of delivery place and reasons for choice
of delivery place
autonomy, awareness of high-risk pregnancies, and
sources of health information. In addition, obstetric- Characteristics Frequency Percentage
related factors such as birth order, birth preparedness, and Place of delivery (n=500)
complete antenatal care (ANC) uptake were considered Institutional delivery 178 35.6
important independent variables. Several independent
variables were operationalized as follows: (1) accessibility Home delivery 322 64.4
to maternal care was defined as a combination of physical Types of birth attendants for home delivery (n=322)
and financial accessibility. This variable had two categories: SBA 95 29.5
“easy access to health facilities,” indicating if a woman Non-SBA/TBA 227 70.5
could reach the nearest health facility even during the Reasons for institutional delivery* (n=178)
monsoons and afford transportation and health-care Safe delivery 149 84.2
costs, and “difficulty accessing health facilities” otherwise. Availability and adequacy of medical 86 48.6
(2) Women’s autonomy was defined as their ability to make resources
independent decisions regarding seeking maternal care, Referral due to high-risk pregnancy 55 31.1
selecting care providers, and choosing the site of delivery. Economic accessibility 34 19.2
(3) Complete ANC uptake was defined as having at least
four ANC visits, regularly taking antenatal supplements, Advice from others 29 16.4
and receiving two tetanus toxoid injections during the Physical accessibility 25 14.1
most recent pregnancy. The outcome variable and most Reasons for home delivery* (n=322)
independent variables, except for age, per capita income Perceived that pregnancy was normal 241 74.8
birth order, and the number of ANC visits, were assessed Others (social pressure, previous 172 53.4
as categorical. To improve interpretation, all numerical experience)
independent variables were categorized. Family’s support 150 46.6
The sociodemographic characteristics of the Practice on traditional beliefs 143 44.4
respondents were presented as frequencies and percentages Financial difficulty 108 33.5
for categorical variables and as summary statistics (mean Fear of health facility 58 18.0
and standard deviation) for continuous variables. The Difficulty in transportation 34 10.6
institutional delivery rate was reported with a 95% *The findings were calculated as multiple responses.
confidence interval (CI). The determinants of institutional Abbreviations: SBA: Skilled birth attendant; TBA: Traditional birth
delivery were analyzed using adjusted odds ratios (AOR) attendant.

Volume 3 Issue 1 (2025) 85 https://doi.org/10.36922/ghes.3954