Factors Associated with Skilled Birth Attendance in Slum Areas of Kathmandu Valley, Nepal

Skilled birth attendance (SBA) is propitiatory to reducing maternal and neonatal mortality, promoting safe deliveries, and preventing delivery complications. However, despite the efforts to improve institutional delivery services, a significant number of women in Kathmandu Valley slums continue to give birth at home, barring any professional medical assistance. This study purposes to examine the socio-demographic, economic, and geographical determinants affecting SBA utilization in these marginalized communities. A cross-sectional study design with cluster sampling in two stages was used in which 283 married women of reproductive age from the slums of Kathmandu, Lalitpur, and Bhaktapur districts were surveyed. Data was analyzed using mean and frequency distributions, chi-square tests, and logistic regression models to assess determinants of SBA utilization. The study indicates that age plays a significant role in use of the skilled birth attendant; comparatively high SBA uptakes were found for women in the younger age group (15-24 yrs; 81.2 %) while older women at ages 35-49 utilized SBAs poorly (54.2 %) (p = 0.000). Caste/ethnicity significantly affects SBA utilization such that the respondents from the Dalit caste indicated significantly lower SBA utilization (50.9 %) as go compared to Brahmins/Chhetris (95.6 %) (p = 0.000). Home ownership is another important factor, with property owners (86.5 %) being more likely to use the SBA than those who do not (71.6 %) (p = 0.004). Geographically, women in Kathmandu (82.6%) utilized SBA far better than those in Bhaktapur (66.7%) and Lalitpur (70.4%) (p = 0.017). However, education and religion were not statistically significant predictors of SBA utilization (p>0.05). The study further suggests significant disparities regarding SBA utilization based on age, caste, and economic status. Improving health-care accessibility, adopting strategies for increasing financial support, and resolving cultural barriers are some significant.