Prevalence and factors associated with institutional delivery service utilization among mothers in government health facilities of Tamankhola Rural Municipality: A community-based cross-sectional study

Abstract Introduction Despite constitutional and legal guarantees for safe motherhood and reproductive health in Nepal, significant disparities persist in institutional delivery service utilization, particularly among marginalized groups and rural regions. According to the Nepal Demographic and Health Survey (NDHS) 2022, 19% of births still occur at home. This study assessed the prevalence and determinants of institutional delivery among mothers in government health facilities of Tamankhola Rural Municipality to address this gap. Methods A descriptive cross-sectional study was conducted from January to June 2022 in Tamankhola Rural Municipality, Baglung. Using simple random sampling from immunization records, 126 mothers of children born between 2077/11/01 and 2078/11/01 B.S. were interviewed with a pretested structured questionnaire. Descriptive statistics and logistic regression analyses identified factors associated with institutional delivery. Result The mean age of mothers was 25.27 years; 68.25% were Dalit and 69.05% belonged to lower socio-economic status. The prevalence of institutional delivery was 90.48%. Most mothers (89.68%) had four or more Ante-Natal Care (ANC) visits, and 98.41% received counseling, primarily on institutional delivery while only 5.56% of the mothers received counseling on Post-Natal Care (PNC). While 88.09% had knowledge of birth preparedness, only 46.82% recognized danger signs of pregnancy. A statistically significant association was found between birth order and institutional delivery (p=0.04), with mothers having more than one child being significantly less likely to utilize institutional delivery services (AOR=0.11; 95% CI: 0.01–0.97). Conclusion The prevalence of institutional delivery was high and significantly associated with birth order of the child. Counseling on Post-Natal Care and information on danger signs during pregnancy. Despite the high institutional delivery rate, 9.52% still delivered at home, mainly due to poor road conditions. Strengthening PNC counseling, improving health education on danger signs during pregnancy, and addressing structural barriers are essential to address the problem of home delivery in Tamankhola rural municipality.