Influence of internal migration on the use of reproductive and maternal health services in Nepal: An analysis of the Nepal Demographic and Health Survey 2016

BACKGROUND: Internal migration has been an integral part of socioeconomic transformation in a country. Migrants are a vulnerable group for access to the reproductive and maternal health services. Very little is known regarding the role of internal migration on the use of reproductive and maternal health services in Nepal. This study examines the effect of internal migration on the use of reproductive and maternal health services in Nepal. METHODS: The data for this study were extracted from the 2016 Nepal Demographic and Health Survey (2016 NDHS). The study population is women age 15–49. The sample population is different for modern contraceptive use than for Antenatal care (ANC) visits and place of delivery. The sample population for modern contraceptive use is restricted to the 8,811 (weighted) women who are currently married. The total analytic sampled population for ANC visits and place of delivery is 3,220 (weighted) women. The study used descriptive and logistic regression analysis, with three outcome measures: current use of modern contraception; at least four ANC visits; and place of delivery. RESULTS: Sixty-eight percent women were internal migrants. Forty-four percent of eligible women reported current use of modern contraception, 71% of women made at least four ANC visits, about 9% of women made 8 or more ANC visits and 58% of women delivered in a health facility. Our findings show that modern contraceptive use is significantly higher among urban non-migrant women and urban-to-urban migrants. Urban-to-urban migrant women and rural-to-urban migrant women have significantly higher odds of attending at least four ANC visits for the most recent birth compared with rural-to-rural migrant women. Women who moved between urban areas, women who moved from an urban to a rural area, women who moved from a rural area to an urban area and urban non-migrants are significantly more likely to deliver in a health facility compared with women who moved between rural areas. CONCLUSION: The differentials of use of reproductive and maternal health services by migration status may need consideration during program planning to improve women's reproductive and maternal health services in Nepal.