Prevalence of and factors associated with home births in western Nepal: Findings from the baseline of a community-based prospective cohort study

Problem considered: Home birth in a resource-poor setting such as Nepal is a maternal and newborn survival risk factor. Although the proportion of home births in Nepal has decreased substantially over the last two decades, the progress has yet to be equal in all regions. This study aimed to explore the prevalence of and investigate the factors associated with home birth in the western region of Nepal. Methods: A community-based prospective cohort study was conducted in the Rupandehi district of western Nepal. A total of 735 mother-infant pairs were included (rural = 378, urban = 357). Factors affecting home births were first assessed using chi-square tests, followed by multiple logistic regression. Results: Only 11.8% of mothers had their childbirth at home. Women who had ≤3 antenatal care (ANC) visits (Adjusted Odds Ratio (AOR): 3.15; 95% Confidence Interval (CI): 1.88, 5.29), reported receiving sub-optimal ANC services (AOR: 1.98; 95% CI: 1.18, 3.33), and were multiparous (AOR: 2.18; 95% CI: 1.13, 4.23), were more likely to have home births. Conversely, women from rich families (AOR: 0.19; 95% CI: 0.06, 0.57) were less likely to have home births. Conclusion: Future public health interventions need to focus on ensuring the equitable distribution of maternal health services. There is a need to adapt the maternal incentive schemes to remove the demand side barriers to increase access to childbirth services for women from poor wealth backgrounds. Furthermore, within the supply side, improving the access to and quality of ANC is likely to reduce home births.