Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, Bournemouth, United Kingdom.
Manmohan Memorial Institute of Health Sciences, Tribhuvan University, Kirtipur, Nepal.
PLoS One. 2020 May 22;15(5):e0233607. doi: 10.1371/journal.pone.0233607. eCollection 2020.
Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings.
This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014-2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys.
The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value <0.001) than prior to the intervention. Similarly, the likelihood of giving birth at a health facility increased if decision for birthplace was made jointly by women and family members for primary care facilities (OR 1.76, p-value 0.023) and hospitals/tertiary care facilities (OR 1.78, p-value 0.020. If women had less than four ANC visits, then they were less likely to give birth at primary care facilities (OR 0.39, p-value <0.001) or hospitals/tertiary care facilities (OR 0.63, p-value 0.014). Finally, women were less likely to give birth at primary care facilities if they had only primary level of education (OR 0.49, p-value 0.014).
BCs have the potential to increase the births at health facilities and decrease home births if their services are promoted by the local health promoters. In addition, socio-economic factors including women's education, the level of women's autonomy and having four or more ANC visits affect the utilisation of perinatal services at the health facility.
尼泊尔的生育中心（BC）大多位于农村地区，为没有并发症的妇女提供护理。然而，这些中心经常被妇女忽视，其提供高质量产妇服务的作用也被忽视。本研究评估了一项增加社区围产期保健设施的获得和利用的干预措施。
本研究为一项为期五年的纵向横断研究，在尼泊尔的四个村庄进行，包括两个生育中心。2014 年至 2016 年期间进行了一项干预措施，包括支持生育中心和与当地妇女开展一项健康促进方案。采用多阶段整群抽样方法对有 24 个月以下儿童的育龄妇女进行人口抽样。由经过培训的普查员进行家庭调查，并使用结构化的经过验证的问卷。收集的数据输入 SPSS 进行分析，比较干预前后的调查结果。
干预措施与增加设施分娩的比例增加有关，也增加了生育中心提供的围产期服务的利用率。干预后调查提供的证据表明，妇女更有可能在初级保健设施分娩（比值比 5.60，p 值 <0.001），而不是干预前。同样，如果妇女和家庭成员共同决定分娩地点，则妇女选择在初级保健设施（比值比 1.76，p 值 0.023）和医院/三级保健设施（比值比 1.78，p 值 0.020）分娩的可能性增加。如果妇女的产前护理次数少于 4 次，则她们在初级保健设施（比值比 0.39，p 值 <0.001）或医院/三级保健设施（比值比 0.63，p 值 0.014）分娩的可能性较小。最后，如果妇女只有小学教育程度，则她们在初级保健设施分娩的可能性较小（比值比 0.49，p 值 0.014）。
如果当地卫生促进者宣传生育中心的服务，生育中心有潜力增加在保健设施分娩的比例，并减少在家分娩的比例。此外，社会经济因素，包括妇女的教育程度、妇女自主权的程度以及有 4 次或更多次产前护理就诊，会影响在保健设施使用围产期服务的情况。
