Factors associated with the choice of delivery place in Nepal based on dual pathway analysis using demographic and health survey 2022

The choice of delivery place is a critical determinant that significantly impacts maternal and neonatal health. This study applies the Andersen Behavioral Model to identify factors associated with the choice of delivery place. This study utilized secondary data from the Nepal Demographic and Health Survey 2022. A complex sample analysis was employed considering the survey’s stratified, sampling weights, and cluster design. A multivariable binary logistic regression analysis was performed for dual pathway analysis. Among the 1,977 live births from women aged 15–49, 1,569 (79.4%) chose institutional delivery, while 370 (18.4%) chose home delivery. Women with no education (AOR:0.234), agriculture occupation (AOR:0.521), no internet access (AOR:0.581), Madhesh province (AOR:0.342), poorest (AOR:0.045), who did not visit health facility last 12 months (AOR:0.700), who never attended antenatal care visits (AOR:0.254), and multiparous women (AOR: 0.178) exhibited a lower AOR for institutional deliveries compared to the reference category. Conversely, women with no education (AOR:5.050), agriculture occupation (AOR:1.902), no internet access (AOR:1.601), Madhesh province (AOR:2.960), poorest (AOR:33.521), who did not visit health facility last 12 months (AOR:1.464), who never attended antenatal care visits (AOR:4.197), and multiparous women (AOR:5.479) exhibited a higher AOR for home deliveries compared to the reference category. Improving women’s education, healthcare access in agricultural areas, internet connectivity, health facility access, addressing provincial and economic disparities, expanding insurance coverage, promoting antenatal visits, and institutional delivery for multiparous women are essential to increase institutional deliveries and minimize home-based deliveries to improve maternal health outcomes in Nepal.