From Village to Clinic: Structural Barriers and Intersecting Challenges in Maternal Healthcare Access in Rural Nepal

This study explores the lived experiences of pregnant women in rural Nepal navigating maternal healthcare amidst intersecting structural barriers. Using the Social Determinants of Health framework and intersectionality, we examine how geographic isolation, inadequate infrastructure, and economic hardship compound risks to timely and safe maternal care. Twenty in-depth interviews were conducted at a district hospital in the eastern region of Koshi Province, Nepal. Four major themes were identified through inductive thematic analysis. These are: geographic vulnerability and transport challenges; gaps in rural maternal health provision; accommodation and institutional support deficits; and economic vulnerability and hidden costs of care. Findings reveal that poor road conditions, unreliable transport, and limited diagnostic services force women to undertake long, costly journeys, often requiring temporary relocation without institutional accommodation support. Despite policies such as the Safe Motherhood Programme, implementation gaps persist, leaving women to bear significant financial and emotional burdens. These experiences underscore systemic inequities in resource distribution and highlight the compounded disadvantage faced by women from rural and marginalised communities. To ensure equitable maternal healthcare, this study advocates for the decentralisation of health services and the implementation of inclusive financial protection policies tailored to the needs of women from rural and marginalised communities. To promote equitable maternal healthcare, we recommend strengthening rural health infrastructure, implementing maternity waiting homes, and expanding financial protection schemes tailored to vulnerable populations. This research offers critical insights for policymakers to address maternal health inequalities and advance Nepal's progress toward Universal Health Coverage and Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages).