Unpacking equity trends and gaps in Nepal’s progress on maternal health service utilization: Insights from the most recent Demographic and Health Surveys (2011, 2016 and 2022)

Background: Improving maternal health is a global priority for overall socioeconomic development countries, especially in the low- and middle-income countries including Nepal. Recently, Nepal has made significant progress in enhancing access to maternal health services and in reducing maternal mortality ratio (MMR). Nonetheless, the MMR remains high (151 maternal deaths per 100,000 live births), with a slower rate of decline in recent years, particularly among disadvantaged groups. This study investigates trends and determinants of key maternal health services in Nepal. Methods: We conducted further analysis of secondary data from the most recent three Nepal Demographic and Health Surveys (NDHS) conducted in 2011 (n = 1,057), 2016 (n = 964), and 2022 (n = 981) among women aged 15–49 who had at least one live birth prior to each survey. The outcome variables for the trend analysis included the uptake of at least four antenatal care (4ANC) visits, institutional deliveries, first postnatal care (PNC) within 48 hours of childbirth, and completion of all these three routine visits. Determinants of institutional delivery, delivery in private health facilities (HFs), cesarian section (CS) deliveries, and uptake of maternity incentive were investigated. Independent variables included socioeconomic characteristics of women and their marginalization status, geographic factors (e.g., province), health system factors (health service use). A multivariable logistic regression analysis was conducted using data from the NDHS 2022 to investigate the associated determinants of outcome variables considering p value