Factors influencing inequitable access to maternal health services in Morang district, Nepal

Abstract

This study aimed to compare accessibility to maternal health services between rural and urban areas, and identify socio-economic factors related to four facets of accessibility in Morang District, Nepal. A comparative cross-sectional study was conducted in Rangeli (urban) and Kanepokhari (rural) areas of Morang among 600 women aged 15 to 49 years with at least one child aged under 2 years using a semi-structured questionnaire. Four facets of accessibility to maternal health services, i.e., geographical, financial, cultural and functional accessibility were measured using WHO’s primary health care framework. Frequency and percentage were used to describe domains of accessibility and multiple logistic regression analysis was used to identify related factors. A p-value less than 0.05 was considered statistically significant. Among the four facets of accessibility, financial accessibility was 50% less among rural women than that of urban women (p<0.001). Poor women revealed less accessibility to all facets up to 6 times compared with others. Similarly, low autonomous women who were homemakers had less accessibility to all facets up to 5 times compared with others. Essential maternal health services should be available at all times with a particular focus on regions with poor socio-economic conditions. Further, essential health information and key messages should be evenly disseminated to improve equitable access to maternal health services.