Understanding the Three Delays among Postpartum Women at Health Facilities in Nepal: Further Analysis of the Nepal Health Facility Survey 2021

The model identifies three distinct delays that postpartum women may experience: delay 1, which is the delay in deciding to come to a health facility; delay 2, which is the delay in getting to a health facility; and delay 3, which is the delay in seeing a health care worker after arriving at a health facility. According to the 2021 Nepal Health Facility Survey (NHFS), the most common delay experienced by postpartum women in Nepal is delay 2, which occurred among 47% of women. Delay 1 occurred among 11% of women, while delay 3 occurred among 6% of women. These findings are similar to those reported in the 2017 NHFS, with a slight reduction in delay 3. Sociodemographic characteristics of the women and facility characteristics were included in logistic regression models to identify determinants of each delay. The results show that women with basic education had higher odds of delay 1, while those with higher education had lower odds of experiencing delay 3 compared to women with no education. Women who experienced any danger signs before arriving at the health facility had higher odds of experiencing delays 1 and 2. Being accompanied to the facility by a non-husband, parent, relative, or friend was associated with lower odds of experiencing delay 2 than when being accompanied by a husband. Facility characteristics also played a significant role in determining the delays. Women who delivered at a facility with a higher level of physical resources—drugs, equipment, and commodities—had lower odds of experiencing delay 3. There were also some geographic differences, with women delivering at facilities in Lumbini Province having higher odds of delay 1, and women in Madhesh and Lumbini Province having lower odds of delay 2 compared to women delivering in facilities in Koshi Province. The findings of this study demonstrate that nearly half of postpartum women who delivered at a health facility in Nepal experience one of the three delays. These results can begin to shed light on which programs and policies may contribute to reductions in these delays. Understanding the determinants of the three delays is essential for developing targeted interventions to improve maternal health outcomes in Nepal. The study used data from the 2021 NHFS, which included a postpartum exit interview with women who delivered at health facilities. The data were analyzed using logistic regression models to identify the determinants of each delay. The results were compared to those reported in the 2017 NHFS to assess changes in the levels and determinants of the three delays over time. The study's findings have implications for maternal health policy and programming in Nepal. They highlight the need for targeted interventions to address the three delays, particularly delay 2, which is the most common delay experienced by postpartum women in Nepal. The study's results also suggest that improving education and physical resources at health facilities may be effective strategies for reducing the three delays.