Page 96 - GHES-3-1

Global Health Economics and
Sustainability
Institutional delivery within rural Myanmar

Figure 1. Factors associated with institutional delivery in multivariable analysis
Abbreviation: CI: Confidence interval.

obstetric history (5 years preceding the MDHS). In addition, institutional delivery. These results aligned with the findings
the MDHS may have been affected by extremely low rates of two literature reviews (Gabrysch & Campbell, 2009; Tey
in some regions (MOHS & ICF International, 2016). & Lai, 2013). Studies conducted in Ethiopia and Myanmar
Mothers aged 25 – 35 years were approximately 3 times further support the significant association between maternal
more likely than those under 25 years to deliver at a health education and institutional delivery (Berelie et al., 2020;
institution. Older women may have stronger decision- Lwin & Punpuing, 2022). Similarly, another Ethiopian study
making power when choosing maternal care providers found that good maternal health knowledge influenced
and delivery locations and may be less influenced by facility-based deliveries (Zenbaba et al., 2021). Education
older female relatives in making decisions about their level, knowledge, awareness of pregnancy risks, and access
maternal health care compared with younger women. to health information were intertwined determinants of
Although women over 35 years had a lower proportion the utilization of health facilities for delivery. Mothers
of institutional deliveries than those aged 25 – 35, the with higher education attainment are more likely to seek
difference was not statistically significant. Women in maternal health information about safe motherhood and
this age group may have previous delivery experience the availability and accessibility of health-care services from
and feel more confident, perceiving less need for health reliable sources.
facility deliveries. In addition, older women may be more As expected, institutional delivery was significantly
inclined to follow traditional beliefs, making them less influenced by the frequency and receipt of ANC services.
likely to utilize institutional delivery than young women Complete antenatal uptake tripled the odds of institutional
(Gabrysch & Campbell, 2009). Unlike other studies, this delivery, consistent with international studies conducted
research found that physical accessibility to health facilities in Ethiopia, Bangladesh, Timor-Leste, and rural Ghana
was not related to the choice of delivery location. In many (Berelie et al., 2020; Gudu & Addo, 2017; Kamal et al.,
rural areas, despite them being near health centers, the 2015; Khanal et al., 2014; Zenbaba et al., 2021). Frequent
unavailability of health staff outside office hours often leads antenatal visits can lead to the timely detection of obstetric
women to deliver at home. A perception of pregnancy as abnormalities, encouraging institutional delivery. In
normal, social pressure (advice from older female relatives, addition, repeated exposure to skilled health personnel
husbands, and peers), previous home delivery experience, and valuable maternal health information may positively
and a desire for family support during labor was identified influence the choice of delivery location.
as the most common reasons for home delivery. These In this study, a lack of women’s autonomy in deciding on
factors explain the discrepancies between the findings of birth location and attendant was identified as a deterrent
this study and those of others. to health facility delivery, as previously documented in
Furthermore, the likelihood of institutional delivery a study in Bangladesh (Kamal et al., 2015), although
increased with education levels and awareness of high- this finding contradicts results from Uganda (Anyait
risk pregnancies and perinatal danger signs. Mothers who et al., 2012). A possible explanation is that women with
received maternal health education from skilled providers, higher autonomy are less influenced by older female
including through media, were more likely to choose family members, such as mothers-in-law or mothers,

Volume 3 Issue 1 (2025) 88 https://doi.org/10.36922/ghes.3954