Factors Associated With Maternal Health Care Facilities Utilization in the Slum Communities of Kathmandu Valley,...

Maternal health remains a serious concern in urban low-resource settings where healthcare disparities persist. Women residing in slums in Nepal face multiple obstacles that delay access to health facility-based delivery services, contributing to high maternal mortality. This study aimed to assess socioeconomic and demographic factors influencing the utilization of health facilities for delivery among women residing in slum communities within the Kathmandu Valley, guided by Andersen's Behavioral Model of Health Services Utilization.

A cross-sectional study was conducted from November 27, 2023, to November 27, 2024. Data were collected using a two-stage cluster sampling technique, selecting 580 households across 29 slum sites. The study population included 1042 married women of reproductive age (15-49 years) who had given birth within the last 5 years and were interviewed using a structured questionnaire. Descriptive analysis, χ ² tests, and binary logistic regression were performed; an a priori significance level was set at α = 0.05 for two-sided tests.

Among the 1042 participants, 77.0% (n = 802) delivered in Health facilities. Younger women aged 15-34 years had higher health delivery rates (79.7%-83.1%) than older women aged 35-49 years, among whom 52.1% delivered at home. In terms of education, 86.8% of women with higher education were delivered in health facilities compared with 66.1% of women with no formal education (p = 0.06). Caste/ethnicity showed significant disparities: Brahmin/Chhetri women had the highest delivery rate at health facilities (93.3%), followed by Madhesi women (91.7%), while Dalit women had the lowest rate (49.2%, p < 0.001). In the multivariate logistic regression, Dalit women had significantly lower odds of health facility delivery (odds ratio [OR] = 0.051, 95% confidence interval [CI] 0.012-0.218, p < 0.001), while home ownership (OR = 3.401, 95% CI 1.525-7.584, p = 0.003) and residence in Kathmandu district (OR = 2.700, 95% CI 1.138-6.409, p = 0.024) were associated with higher odds of health facility delivery.

Maternal health disparities in slum communities require culturally sensitive interventions, financial incentives, and improvements to healthcare infrastructure. Addressing caste-based discrimination, improving housing security, and implementing district-specific strategies are essential to reduce maternal and neonatal health risks in Nepal's urban slums. Multisectoral collaborations involving health, housing, and social welfare sectors will be most effective.