“Push out” and “pull in” factors of institutional delivery among rural women in central Myanmar

Myanmar continues to face the burden of maternal mortality, with most maternal deaths occurring during or immediately after childbirth. Many women, particularly those in rural areas, do not deliver in health institutions offering comprehensive obstetric care. Despite the importance of institutional delivery, few studies have examined its determinants among rural women in Myanmar. This community-based cross-sectional study was conducted in selected villages in the Magway region, located in central Myanmar, and exhibited a maternal mortality ratio higher than the national average. A total of 500 married women who had delivered in the two years before the survey were selected using multistage sampling and interviewed with a semi-structured questionnaire. Independent determinants were identified using a generalized linear mixed model under a logistic regression framework. Approximately one-third (35.6%; 95% confidence interval [CI]: 31.5 – 39.9%) of the respondents delivered their last child at a health institution. The “pull in” factors of institutional delivery included being aged 25 – 35 years (adjusted odds ratio [AOR] = 2.96; 95% CI: 1.21 – 7.22), having a secondary or higher education (AOR = 2.83; 95% CI: 1.50 – 5.32), receiving information from health-care providers (AOR = 2.01; 95% CI: 1.11 – 3.83), recognizing high-risk pregnancies (AOR = 5.47; 95% CI: 1.42 – 21.11), and completely taking up antenatal care (AOR = 3.04; 95% CI: 1.42 – 6.49). The “push out” factors that deterred institutional delivery included a lack of women’s autonomy (AOR = 0.26; 95% CI: 0.14 – 0.50) and inadequate birth preparedness (AOR = 0.37; 95% CI: 0.19 – 0.72). The institutional delivery rate among rural women was considerably low. To improve it, it is crucial to provide information about high-risk pregnancies and the importance of institutional delivery during antenatal visits, empower women, and encourage birth preparedness in rural Myanmar.