High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

Abstract

Plain Language summary Utilisation of essential maternity and newborn health (MNH) interventions during pregnancy, childbirth, and the postnatal period can improve the health of mothers and newborns. There are increasing access trends for routine MNH visits in Nepal, such as at least four (4+) antenatal care (ANC) visits, institutional delivery, and postnatal care (PNC) visits. Little is known, however, about the utilisation of recommended MNH interventions, or who is benefitting or being left behind in relation to better quality MNH services. This study examined different types of health service coverage cascades across routine MNH services and associated determinants using Nepal Demographic and Health Survey 2016 data. A total of 1978 women aged 15–49 years who had live-births 2 years preceding the survey were included in the analysis. Despite improved access to routine visits during the pregnancy-postnatal period, some women had not received all recommended interventions, and had low-quality-adjusted coverage of MNH services. Women with advantaged ethnicities or financial assets received optimal quality MNH services, while Maithili-speaking women or those with high birth order received poor quality ANC services. Women from Karnali province or women who preferred to be seen by a female healthcare provider experienced poor quality PNC service. Demographic and health survey data can be used to assess the population-level coverage of quality health services. Policy and program efforts require better quality MNH services that employ female health providers.

Keywords

• Antenatal care
• Institutional delivery
• Postnatal care
• Coverage cascade
• Determinants
• Quality