Evaluation of a health promotion intervention associated with birthing centres in rural Nepal

Preeti Mahato, Edwin van Teijlingen, Padam Simkhada, Catherine Angell, Vanora Hundley

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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
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, pvalue
<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.
Original languageEnglish
Number of pages14
JournalPLoS ONE
Issue number5
Publication statusPublished - 22 May 2020


  • maternal health
  • Health promotion
  • birth centre
  • Nepal

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