Women's empowerment for abortion and family planning decision making among marginalized women in Nepal: a mixed method study.

BACKGROUND: Women's empowerment is multidimensional. Women's education, employment, income, reproductive healthcare decision making, household level decision making and social status are vital for women's empowerment. Nepal is committed to achieving women empowerment and gender equality, which directly affects the reproductive health issues. This can be achieved by addressing the issues of the poor and marginalized communities. In this context, we aimed to find the association of women's empowerment with abortion and family planning decision making among marginalized women in Nepal. METHODS: A cross sectional study was conducted at selected municipalities of Morang district of Nepal from February 2017 to March 2018. A mixed method approach was used, where 316 married marginalized women of reproductive age (15-49 years) and 15 key informant interviews from representative healthcare providers and local leaders were taken. From key informants, data were analysed using the thematic framework method. Findings obtained from two separate analyses were drawn together and meta inferences were made. RESULTS: Women's empowerment was above average, at 50.6%. Current use of modern contraceptives were more among below average empowerment groups (p 0.041, OR 0.593 C.I. 0.36-0.98). We could not find any statistically significant differences among levels of women's empowerment, including those women with abortion knowledge (p 0.549); family planning knowledge (p 0.495) and women's decision for future use of modern contraceptives (p 0.977). Most key informants reported that unsafe abortion was practiced. CONCLUSIONS: Women's empowerment has no direct role for family planning and abortion decision making at marginalized communities of Morang district of Nepal. However, different governmental and non-governmental organizations influence woman for seeking health care services and family planning in rural community of Nepal irrespective of empowerment status.

Factors Affecting the Place of Delivery among Mothers Residing in Jhorahat VDC, Morang, Nepal.

BACKGROUND: In Nepal, the maternal mortality ratio is 281 per thousand live births, among which 40% mortality occurs during home delivery. Home delivery increases the risk of maternal and neonatal mortality and morbidity due to the birth not assisted by skilled attendant. This study was carried out to determine the factors affecting the place of delivery among the mothers residing in Jhorahat VDC, Morang district, Nepal. METHODS: A mixed method study using interviews based on semi-structured questionnaire (n=93) among mothers and two focus group discussion among decision makers of the house and female community health volunteers was conducted between November to December 2012. For quantitative data, Chi-square test and Fischer's Exact test were used to examine the association between the selected variables and place of delivery. RESULTS: More than half (58.1%) of the mothers had institutional delivery and 41.9% of them had home delivery. The most common reason for home delivery was easy and convenient environment (66.7%) and that for institutional delivery was safety (77.8%). There was a significant association between caste, education of mothers, education of spouse, occupation of spouse, per capita income, time to reach the nearest health center, parity, previous place of delivery, number of antenatal visit, knowledge about place of delivery, planned place of delivery, and place of delivery. CONCLUSION: Maternal health services, such as prenatal care, skilled assistance during delivery and post-natal care, along with adequately equipped health institutions, play a major role in the reduction of maternal morbidity and mortality. Concerted efforts should be made both at community and government levels to increase institutional delivery.

Quality of care provided to newborns by nursing personnel at BP Koirala Institute of Health Sciences.

BACKGROUND: Birth is a major challenge for the newborn to negotiate successfully from intrauterine to extra uterine life. The first few hours since birth is the most crucial period in the life of an infant for further growth and development, which is largely determined by the quality of care that the newborn receives. OBJECTIVE: The aim of this study is to assess the quality of care provided by nursing personnel to newborn in the labour room. MATERIALS AND METHODS: This study was conducted in BP Koirala Institute of Health Science. Cross sectional, non participatory observational research design was adopted for the study. Care provided by nursing personnel to 814 normal newborns was observed. Samples were chosen by non probability purposive sampling technique. Data was collected through observational method by trained nursing personnel, using 46 items pre-tested, validated and self developed observational checklist. Care provided to newborns was observed from birth to two hours and categorised as good, average and poor based on scores obtained. Data was entered and analysed using SPSS-10. Descriptive statistics- [Mean, percentage, frequencies and standard deviation] was used to describe the quality of care provided to the newborn babies. RESULTS: Overall quality of care was good in 42.36%, average in 57.64% and none of them received poor care. Overall mean score for quality of care was 34.75/46 (75.54 %). Regarding subscales quality of care was good in majority of newborns in areas such as Preparation to receive the baby (76.1%), Initiation of breathing (100%), Maintaining thermoregulation (77.3%), Physical assessment (90.9%), and other aspects of care (95.2%). However the quality of care was poor in majority of newborns in establishment of breast feeding (58.23%) and average in prevention of infection(76.9%). CONCLUSION: Study findings highlight the need for focus in establishment of breast feeding and prevention of infection.