Preference of place of delivery and its determinants: a cross-sectional study in Chukha district, Bhutan
Introduction: The estimated global maternal deaths in 2013 was 289000. In Bhutan, Maternal Mortality Ratio has
remarkably declined from 770 deaths per 100,000 live births in 1984 to 86 in 2012. However, the maternal mortality
ratio still remains high and a high proportion of delivery still take place at homes (26%) despite of adopting 100%
institutional delivery policy ever since 2005. This study was carried out to determine the important factors that prevent
women from coming to the health facilities for safe delivery.
Methods: A cross-sectional study among the women who delivered in Chukha District in 2013 was carried out after seeking ethical approval from Research Ethics Board
of Health and World Health Organization. Chukha is a district with the second highest number of population in Bhutan
where 55.7% of the people live in rural villages.
Results: Out of 899 eligible listed women, 78.1% participated in the
study and among the participants 11.5% had delivered at home. The number of home deliveries was higher in rural
areas, 17.3%, as compared to urban places, 6.4%. Women who were delivering for third or more times are 2.42 times
more likely to give birth at home compared to women who were delivering for the first time. Women residing at places
more than three hours away from the health facility were 2.58 times more likely to give birth at home compared to
women residing less than three hours away. During their last pregnancy, 99.4% of the participants have sought at least
Conclusions: This study suggests that the two most important factors associated with home delivery are the
distance to health facility from their residences and the parity.
Keywords: Bhutan; Facility delivery; Home delivery; Place of delivery.