Maternal and child healthcare utilization and associated factors in private health institutions in Nepal

Abstract Background Private health institutions play a significant role in providing maternal and child health services globally. This study examines the utilization of maternal and child health services in Nepal and assesses socio-economic factors associated with the choice of private institutions, using data from the 2022 Nepal Demographic and Health Survey (NDHS). Methods The study used NDHS 2022 data. Maternal healthcare was assessed by the institution of antenatal care (ANC) and the place of delivery; child healthcare by the institution sought for fever/ARI and diarrhea treatment. Adjusted logistic regression identified socio-demographic determinants of private health-seeking behavior. Results Private institutions were used more for childhood illnesses—fever/ARI (81.3%) and diarrhea (77.2%)—than maternal healthcare, with 40% of women receiving ANC and 22.4% receiving delivery services privately. Children in the Terai had higher odds of private care for diarrhea (AOR 7.5; 95% CI: 1.6–35.4) and fever/ARI (AOR 10.1; 95% CI: 4.4–23.2) than those in the Mountain region. Household wealth was positively associated with private care for childhood illnesses, with the richest households showing markedly higher odds for fever/ARI (AOR 18.4; 95% CI: 4.4–76.3). Private maternal healthcare use was associated with ecological region, maternal education, and caste/ethnicity; the wealthiest women had higher odds of private ANC (AOR 9.2; 95% CI: 5.2–16.1), and greater maternal schooling predicted private delivery care. Conclusions Private institutions play a major role in Nepal's healthcare, particularly for childhood illnesses, with use shaped by agroecological zone, wealth, and education. Policies should promote equitable access across socioeconomic groups while strengthening both public and private services.