Women's health insurance and institutional delivery in Nepal: Results of the 2022 Nepal demographic Health Survey.

Background: The Government of Nepal introduced a Health Insurance (HI) program in 2017 to prevent citizens from falling into poverty due to health care costs. This study aimed to assess the association between HI coverage and institutional coverage and institutional delivery among women in Nepal. Methods: This cross-sectional study used secondary data from the Nepal Demographic and Health Survey (NDHS) 2022, conducted every five years since 1996. A total of 1,056 women who had given birth in the past year were included in the analysis. Statistical significance was assessed at the p < 0.05 level. Data analysis was performed using IBM SPSS Statistics version 25. Results: Women covered by HI were more likely to deliver at Health Facilities (HF) within the past year (cOR = 5.775; 95% confidence interval (CI): 2.347 to 14.212; P < 0.001). Women with secondary or higher education were more likely to give birth at an HF (aOR = 3.130; 95% CI: 1.744 to 5.618; P < 0.001). Women residing in Koshi and Madesh provinces were less likely to give birth at HF (aOR = 0.399; 95% CI: 0.177 to 0.901; P < 0.05) and (aOR = 0.198; 95% CI: 0.083 to 0.476; P < 0.001), respectively, compared to those in Bagmati province. Women in the poorer and middle wealth index categories were more likely to give birth at HF (aOR = 1.701; 95% CI: 1.021 to 2.833; P < 0.05) and (aOR = 2.597; 95% CI: 1.461 to 4.615; P < 0.01), respectively. Conclusions: HI coverage, educational level, province, and wealth index were significantly associated with the delivery practice for their most recent child at HF. To increase the use of HF during delivery, targeted interventions addressing educational and economic disparities, particularly in provinces with lower utilization, are needed.