INSTITUTE OF CHILD HEALTH
Maternal and newborn care practices
among disabled women
Aman Sen, Joanna Morrison, JF Trani, Dhruba Adhikari, Kirti Tumbahangphe ,Tim
Colbourn, Bharat Budhathoki, Machhindra Basnet, DS Manandhar, Anthony
Costello, Nora Groce
Any Disability
Disability
Frequency
Percentage
Not Disabled
9,757
71.29
Disability
3,930
28.71
Identification of Severity of Disability
Answered
1
2
2
if Woman
3
3
4
Times
In every question
1 to 3 times
more than 3 times
1 to 3 times
more than 3 times
1 or more
Categories
Non Disabled
Mild Disabled
Severe Disabled
Very Severe Disabled
We have used "Washington Group on Disability Statistics" as
reference to identify the Severity of Disability
Severity of Disability
Severity
not disabled
Mild
Moderate
Severe
Very Severe
Total
Frequecy
9,757
1,786
1,338
616
190
13,687
Percent
71.29
13.05
9.78
4.50
1.39
100.00
Type of disability of women in rural Nepal
(total represents the 28.7% of all women surveyed who were
found to have some disability)
Physical/mob
ility
Sensory
8%
27%
19%
Learning/Inte
llectual
Behavioural/
psychological
Social
3%
Epilepsy
1%
13%
Multiple
29%
Association of Severity of disability with schooling of Women
schooling
Coef.
Mild
-.0446003
Moderate
-.1167116
Severe
-.1975358
More Severe -.1704682
_cons
.5546787
Disability
Std. Err.
t
P>t
.0218222
.0247181
.0352242
.0621081
.0085838
-2.04
-4.72
-5.61
-2.74
64.62
0.041
0.000
0.000
0.006
0.000
95% Conf. Interval
-.0873747
-.1651624
-.2665801
-.2922086
.5378533
-.0018259
-.0682607
-.1284916
-.0487277
.5715041
All categories of level of severity have significantly less schooling
than non-disabled
Association of Severity of disability and Age of Women
Types
Obs
Mean Age
Not disable
9757
31.28451
Mild
1786
Moderate
1338
33.66667
Severe
616
33.81981
Very Severe
190
33.71053
33.61142
severity
Coef.
Std. Err.
t
P>t
95% Conf.
Interval
age
.0175958
.0011168
15.76
0.000
.0154068
.0197849
_cons
.9540309
.0365779
26.08
0.000
.8823332
1.025729
As should be expected as women get more older likely to be disabled
and Age of women is significantly associated with having more severe
disability: per year of age
Severity of disability association with Parity
Type
Not Disabled
Mild
Moderate
Severe
Very Severe
Obs
9757
1786
1338
616
190
Mean
3.27734
3.82587
3.82437
3.96753
3.47368
Severity
Coef.
Std. Err.
t
P>t
[95% Conf. Interval]
Mild
.5485285
.0576092
9.52
0.000
.4356065
.6614505
Moderate
.5470254
.0652543
8.38
0.000
.419118
.6749327
Severe
.6901931
.0929898
7.42
0.000
.5079204
.8724658
Very Severe
.1963449
.1639618
1.20
0.231
-.1250427
.5177325
_cons
3.277339
.0226607
144.63
0.000
3.232921
3.321757
Women with mild , moderate and severe disability have higher
parity on average
Association between severity of disability and any ANC receive
Any ANC not disabled
No
3,998
40.98
Yes
5,759
59.02
Severity
Mild
Moderate
Severe
Very severe
_cons
Odds Ratio
1.092343
1.316309
1.037111
1.088233
1.44047
Mild Moderate Severe Very Severe
694
462
247
74
38.86
34.53
40.1
38.95
1,092
876
369
116
61.14
65.47
59.9
61.05
Std. Err.
.0575991
.08039
.087894
.1634451
.0296529
z
1.68
4.50
0.43
0.56
17.73
P>z
0.094
0.000
0.667
0.573
0.000
[95% Conf.
.9850882
1.167812
.8783887
.8107321
1.383508
Total
5,475
40
8,212
60
Interval]
1.211275
1.483688
1.224513
1.460719
1.499777
All the levels of severity of disability have higher percentage of
ANC intake but women with moderate disability had
significantly higher ANC intake than non- disabled
Association of Severity of Disability and Institutional Delivery
Institutional
delivery
No
Yes
Severity
not disabled
8,465
86.76
1,292
13.24
Mild Moderate
1,510
1,153
84.6
86.17
276
185
15.5
13.83
Severe
536
87.01
80
12.99
Very Severe
160
84.21
30
15.79
Odds Ratio
Std. Err.
z
P>z
[95% Conf.
Interval]
Mild
1.197558
.0861707
2.51
0.012
1.040035
1.378939
Moderate
1.051252
.0889836
0.59
0.555
.8905465
1.240958
Severe
.9778892
.1207913
-0.18
0.856
.7676215
1.245754
Very
Severe
1.228473
.2471506
1.02
0.306
.8281645
1.822279
_cons
.1526285
.0045588
-62.93
0.000
.1439499
.1618302
Women with mild disability more likely to deliver in a health
facility than non-disabled
Association of Severity of disability and Discarding Colostrum
Discard colostrum
No
Yes
not disabled
6,561
67.24
2,899
29.71
Odds Ratio
Std. Err.
Mild
0.900176
Moderate
Mild Moderate
1,242
871
69.54
65.1
494
435
27.66
32.51
Very Severe
120
63.16
60
31.58
P>z
[95% Conf.
Interval]
0.051921
-1.82 0.068
0.803954
1.007913
1.130298
0.070987
1.95 0.051
0.999388
1.278355
1.23824
0.110056
2.4 0.016
1.040277
1.473874
Very severe
1.131597
0.180692
0.77 0.439
0.827509
1.547429
_cons
0.441853
0.009854
0.422956
0.461595
severity
Severe
z
Severe
382
62.01
209
33.93
-36.62
0
Women with severely disabled slightly more likely to discard
colostrum than non-disabled
Association of Severity of disability and Initiation to breastfeed
Obs
9527
1745
1313
596
183
Initiation to breastfeed
Not disabled
Mild
Moderate
Severe
Very severe
Severity
Mild
Moderate
Severe
Very Severe
_cons
Coef.
-21.94063
25.27909
44.97683
183.7674
322.7681
Std. Err.
27.8228
31.4543
45.1159
79.7411
10.9471
t
-0.79
0.8
1
2.3
29.48
P>t
0.43
0.422
0.319
0.021
0
Mean
322.7681
300.8275
348.0472
367.745
506.5355
[95% Conf.
-76.47726
-36.37585
-43.45672
27.46355
301.3103
Interval]
32.596
86.934
133.41
340.071
344.226
Women with very severely disabled took longer time to initiate
breast-feeding than non-disabled
Association of Severity of disability and Bathtime
Severity
Not disabled
Mild
Moderate
Severe
Very severe
Severity
Obs
9574
1759
1319
600
186
Mean
889.649
916.0284
845.1948
803.0617
939.7312
Coef.
Std. Err.
t
P>t
26.3794
44.4542
86.5874
56.6241
0.47
0.641
64.10813
-0.69
0.488
91.86118
-0.94
0.346
Very Severe 50.0821
_cons
889.649
161.5959
22.30806
0.31
39.88
0.757
0
Mild
Moderate
Severe
[95% Conf. Interval]
137.370
-84.61182
6
81.2067
-170.1152
5
93.4734
-266.6482
5
366.832
-266.6685
7
845.9221 933.376
no significant differences in time to bathing in each of the 4
disabled categories compared to non-disabled
Association of Severity of disability and Used Delivery Kit
Used Delivery kit
No
Yes
Severity
Not disabled
4,574
46.88
1,593
16.33
Mild
934
52.3
301
16.85
Moderate
672
50.22
221
16.52
Severe
298
48.38
79
12.82
Very Seve
91
47.89
35
18.42
Odds Ratio
Std. Err.
z
P>z
[95% Conf.
Interval]
Mild
Moderate
0.925337
0.944286
0.06698
0.07821
-1.07
-0.69
0.284
0.489
0.8029481
0.8027972
1.066381
1.110711
Severe
0.761187
0.09884
-2.1
0.036
0.5901536
0.981787
Very Severe
1.104351
0.22199
0.49
0.621
0.7447375
1.637611
_cons
0.348273
0.01013
-36.26
0
0.3289698
0.368709
significantly less of the severely disabled women used a clean
delivery kit than non-disabled women
Assets Quintile (2nd phase only)
Assets quintile
poorest
second
middle
next-rich
rich
Severity
Mild
Moderate
Severe
Very severe
_cons
Not disabled
1,211
12.41
3,166
32.45
920
9.43
394
4.04
144
1.48
Coef.
0.12405
0.06908
-0.13874
-0.10096
1.159212
Mild
141
7.89
506
28.33
184
10.3
82
4.59
19
1.06
Std. Err.
0.031942
0.035901
0.050378
0.090005
0.011854
Moderate
133
9.94
370
27.65
142
10.61
53
3.96
16
1.2
t
3.88
1.92
-2.75
-1.12
97.79
P>t
0.000
0.054
0.006
0.262
0
Severe
77
12.5
202
32.79
46
7.47
13
2.11
4
0.65
[95% Conf.
0.0614363
-0.0012954
-0.2374982
-0.2773931
1.135975
Very Severe
27
14.21
54
28.42
13
6.84
7
3.68
2
1.05
Interval]
0.186664
0.1394547
-0.03999
0.0754746
1.182449
Women with severe disabled are slightly more likely to be poorer
than the non-disabled
Association of Severity of disability and Neonatal Death
Neonatal Death
No
Yes
Severity
Mild
Moderate
Severe
Very Severe
_cons
Not disabled
9,400
96.34
214
2.19
Odds Ratio
1.04402
0.8109274
1.193215
2.233486
0.022766
Std. Err.
0.180072
0.176207
0.31338
0.778652
0.001574
Mild
1,725
96.58
41
2.3
Moderate
1,300
97.16
24
1.79
z
0.25
-0.96
0.67
2.3
-54.71
P>z
0.803
0.335
0.501
0.021
0
Severe
589
95.62
16
2.6
[95% Conf.
0.74455
0.5296926
0.7131216
1.127801
0.0198811
Very Severe
177
93.16
9
4.74
Interval]
1.463942
1.241481
1.996521
4.423177
0.026069
Women with very severe disabled have a higher neonatal mortality
rate than the non-disabled but numbers of neonatal death are
very small
Association of Severity of disability and Stillbirth
Stillbirth
No
Yes
Severity
Mild
Moderate
Severe
Very Severe
_cons
Not disabled
9,614
98.53
143
1.47
Odds Ratio
0.7613904
0.7108996
1.222378
1.445835
0.0148741
Mild
1,766
98.88
20
1.12
Std. Err.
0.182834
0.200167
0.38589
0.74073
0.001253
Moderate
1,324
98.95
14
1.05
z
-1.14
-1.21
0.64
0.72
-49.95
P>z
0.256
0.226
0.525
0.472
0
Severe
605
98.21
11
1.79
Very Severe
186
97.89
4
2.11
[95% Conf.
0.4755617
0.4093894
0.6584021
0.5297019
0.0126102
Interval]
1.219012
1.234468
2.269445
3.946444
0.017545
Stillbirth rate is higher in very severely disabled and severely
disabled women than the other categories but not statistically
significant
Other findings
• Women with Sensory disability less likely to receive
ANC
• Women with Physical and Behavioral disability more
likely to deliver baby at health facility
• Women with multiple disability more likely to discard
colostrum and more likely to take longer to initiate for
breastfeeding than non disabled women
Thank you