Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour’s travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband’s support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.

Food security is a global challenge. This paper examines the regional variation in household food security in Nepal. Specifically, I examine the variation in household level food security with particular reference to newly formed provinces constructed as per the new constitution (2015) of the country, three ecological regions and rural-urban locations of households. I use the nationally representative data from 2011 Nepal Demographic Health Survey to investigate the issue. Using both descriptive as well as multivariate analysis, evidences show that there is regional variation in overall food security in Nepal. Findings show that food security is a problem of rural households. Moreover, food security status of households also significantly varied by province. Households living in Karnali and Far-west provinces (province 6 and 7) located in the western part of Nepal are more food insecure as compared to those living in other provinces. Food security status of households also varied by domains of food security. While anxiety about food supply was an issue for households in the mountains and the hills, food security in terms of quality was equally important in all three ecological regions. However, interestingly, quantity of intake was not a major issue in all the three ecological regions. All three domains were important for households that live in rural areas as well as those living in provinces other than those in Karnali and Far-west provinces. These findings provide a macro level snap shot of food security situation of Nepal and are deemed important for the newly formed federal and provincial governments for food policy framing. Further investigation at the micro-level is necessary for more concrete policies.

This methodological paper describes the design and refinement of a calendar method of collecting data on remittance receipt and remittance use and its piloting in a rural remittance dependent setting of Nepal. Much of the previous national surveys collected remittance receipt and remittance use cross-sectional data that used a time frame ranging from 12 – 24 months. These surveys collected remittance receipt data by asking, ‘How much money has he/she sent in the past 12 months or 2 years?’ We believe that the long time frame of one to two years adds burden to respondents for unnecessary calculations and is prone to re-call bias. Moreover, these surveys used vague words such as ‘capital formation’ or ‘daily consumption’ to measure the uses of remittances. Thus, the instrument per se is unreliable posing threats to collecting valid responses. Considering these flaws, in 2013, we designed a calendar with shorter timing cues and simple words for collecting longitudinal data on remittance receipt and remittance use. First, we describe the calendar design process. Next, we provide descriptive results of household responses on the amount of remittance received and the remittance used on various socio-economic and cultural dimensions of household activities. The implications of the insights gained from this study are discussed.