“Push out” and “pull in” factors of institutional delivery among rural women in central Myanmar

Abstract

Myanmar continues to face the burden of maternal mortality, with most maternal deaths occurring during or immediately after childbirth. Many women, particularly those in rural areas, do not deliver in health institutions offering comprehensive obstetric care. Despite the importance of institutional delivery, few studies have examined its determinants among rural women in Myanmar. This community-based cross-sectional study was conducted in selected villages in the Magway region, located in central Myanmar, and exhibited a maternal mortality ratio higher than the national average. A total of 500 married women who had delivered in the two years before the survey were selected using multistage sampling and interviewed with a semi-structured questionnaire. Independent determinants were identified using a generalized linear mixed model under a logistic regression framework. Approximately one-third (35.6%; 95% confidence interval [CI]: 31.5 - 39.9%) of the respondents delivered their last child at a health institution. The “pull in” factors of institutional delivery included being aged 25 - 35 years (adjusted odds ratio [AOR] = 2.96; 95% CI: 1.21 - 7.22), having a secondary or higher education (AOR = 2.83; 95% CI: 1.50 - 5.32), receiving information from health-care providers (AOR = 2.01; 95% CI: 1.11 - 3.83), recognizing high-risk pregnancies (AOR = 5.47; 95% CI: 1.42 - 21.11), and completely taking up antenatal care (AOR = 3.04; 95% CI: 1.42 - 6.49). The “push out” factors that deterred institutional delivery included a lack of women’s autonomy (AOR = 0.26; 95% CI: 0.14 - 0.50) and inadequate birth preparedness (AOR = 0.37; 95% CI: 0.19 - 0.72). The institutional delivery rate among rural women was considerably low. To improve it, it is crucial to provide information about high-risk pregnancies and the importance of institutional delivery during antenatal visits, empower women, and encourage birth preparedness in rural Myanmar.

Keywords

Institutional delivery / Health facility delivery / Rural women / Myanmar

Acknowledgments

The health authorities and staff from Magway Regional Health Division and the University of Community Health, Magway, are acknowledged for their kind assistance in field data collection.

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: Aye Sandar Mon

Methodology: All authors

Formal analysis: Aye Sandar Mon

Writing - original draft: Aye Sandar Mon

Writing - review & editing: All authors

Ethics approval and consent to participate

This study protocol and the final version of written informed consent were approved by the Khon Kaen University Ethics Committee for Human Research with reference number [HE592256] and the Ethical Committee of the University of Public Health, Yangon, Myanmar (Ethical[6/2016]). Permission to conduct this study was attained from local responsible persons and health authorities. Participation in this study was entirely voluntary and informed consent was taken from all participants before the interview. For participants younger than 18 years, consent was obtained from their respective guardians. All the authors made essential contributions and agreed with the present submission.

Consent for publication

Written informed consent was obtained from each study participant. The following statement was included in the information sheet of the informed consent form and communicated to every study participant: “We will publish the results so that other interested people may learn from the research after deidentification, ensuring your privacy and confidentiality.”

Availability of data

The data underlying the results presented in the study are available from the corresponding author upon reasonable request.

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