Page 94 - GHES-3-1

Global Health Economics and
Sustainability
Institutional delivery within rural Myanmar

3.2. Background characteristics associated with 3.4. “Push out” and “Pull in” factors for institutional
institutional delivery delivery
Nearly half of the respondents (48.5%) were aged 25 – According to bivariate analysis using simple logistic
35 years, with an age range of 17 – 47 years and a mean age of regression, several factors acted as “pull-in” influence
29.72 ± 6.6 years. Only one-third (27.8%) of the respondents encouraging institutional delivery. These included being
had a secondary or higher level of education. About 25% of 25 years of age or older, having secondary or higher
the women earned an income from their own businesses or education, earning a regular income (both mothers and
regular income-generating jobs. Regarding their husbands’ their husbands), having a monthly per capita income
education and occupation, 63.8% had primary or lower exceeding 50,000 MMK, a first birth, awareness of high-
education, and 57.6% were manual workers. More than risk pregnancy, receiving maternal health information
half the respondents (60.8%) had a low income, earning from skilled providers, and completing ANC. Conversely,
<50,000 Myanmar kyats (MMK). Regarding accessibility, “push-out” factors determining institutional delivery
including physical and financial issues, 15.6% of rural were financial and physical barriers to accessing health
women encountered difficulty accessing skilled care at facilities, a lack of women’s autonomy, and inadequate
health facilities. The institutional delivery rate was higher birth preparedness (Table 2).
among women aged 25 – 35 years (44.8%), those with Figure 1 presents the results of a multivariable analysis,
secondary or higher education (63.3%), those engaged in reporting AOR and 95% CI for the determinants of
their own businesses or with regular income-generating institutional delivery. After adjusting for other variables, the
jobs (53.9%), and those with per capita income of more likelihood of institutional delivery was higher among rural
than 50,000 MMK (54.1%). In addition, 39.1% of rural mothers aged 25 – 35 (AOR = 2.96; 95% CI: 1.21 – 7.22)
women who could access a health facility during the rainy and those aged over 35 (AOR = 2.10; 95% CI: 1.10 – 4.18)
season and afford the cost of transportation and health compared with mothers ages <25. Mothers with secondary
care delivered at a health facility. Nearly half (48.8%) of the or higher education (AOR = 2.83; 95% CI: 1.50 – 5.32),
participants had autonomy in deciding to seek maternal those receiving maternal health information from health-
care, and among these women, 57.8% delivered at a health care providers (AOR = 2.01; 95% CI: 1.11 – 3.83), those
facility (Table 2). knowledgeable about high-risk pregnancies and perinatal
danger signs (AOR = 5.48; 95% CI: 1.42 – 21.11), and those
3.3. Obstetric factors associated with institutional who completed antenatal uptake (AOR = 3.04; 95% CI: 1.42
delivery – 6.49) were more likely to deliver at a health institution.
On average, the participants had 2 ± 1.4 children, with 34 In contrast, mothers lacking autonomy in making
mothers (6.8%) having five children or more. For nearly decisions regarding maternal health care and choosing
half of the mothers (47.6%), their most recent delivery the delivery location or attendant (AOR = 0.26; 95%
was their first child. Only 20 respondents (4%) were aware CI: 0.14 – 0.50), as well as those without birth preparedness
of high-risk pregnancy criteria and key danger signs (AOR = 0.37; 95% CI: 0.19 – 0.72), were significantly less
during the perinatal period. Nearly half of the mothers likely to opt for institutional delivery.
(46.8%) received maternal health information (antenatal,
intranatal, and postnatal) from skilled health-care 4. Discussion
providers, including doctors, nurses, lady health visitors,
and midwives. Institutional delivery is a key strategy for reducing maternal
mortality given the unpredictable obstetric complications
Regarding birth preparedness, only 179 (35.8%) arising during home delivery; it can also prevent maternal
mothers reported saving money for delivery, identifying a deaths resulting from delays in receiving treatment due
place of delivery, choosing a skilled provider, and arranging to late referral and prolonged transit. This community-
transportation in case of an obstetric emergency. Of the based study aimed to explore the extent and determinants
500 respondents, 382 (76.4%) had at least one ANC visit influencing institutional delivery among rural women in
whereas 118 (23.6%) had none. Among those who received central Myanmar. The findings highlighted a considerably
ANC, 18.5% did not regularly take antenatal supplements, low institutional delivery rate, with only one-third of
although almost all (96.7%) received tetanus toxoid twice. rural mothers delivering their most recent children at a
More than half the participants received complete ANC, health facility. The 2015 – 2016 MDHS reported a 28%
defined as at least four antenatal visits, regular prenatal institutional delivery rate in rural areas, 7% lower than the
supplement intake, and two doses of tetanus toxoid rate observed in this study. This discrepancy may be due
(Table 2). to differences in the study periods and the recall period for

Volume 3 Issue 1 (2025) 86 https://doi.org/10.36922/ghes.3954