Are cesarean deliveries equitable in India: assessment using benefit incidence analysis

Abstract

Background In the last two decades, cesarean section (CS) deliveries in India have increased by six-fold and created economic hardship for families and households. Although several schemes and policies under the National Health Mission (NHM) have reduced the inequality in the use of maternal care services in India, the distributive effect of public health subsidies on CS deliveries remains unclear. In this context, this paper examines the usage patterns of CS delivery and estimates the share of public health subsidies on CS deliveries among mothers by different background characteristics in India. Data Data from the fourth round of the National Family Health Survey (NFHS-4) was used for the study. Out-of-pocket (OOP) payment for CS delivery was used as a dependent variable and was analyzed by level of care that is, primary (PHC, UHC, other) and secondary (government/municipal, rural hospital). Descriptive statistics, binary logistic regression, benefit incidence analysis, concentration curve and concentration index were used for the analysis. Results A strong economic gradient was observed in the utilization of CS delivery from public health facilities. Among mothers using any public health facility, 23% from the richest quintile did not pay for CS delivery compared to 13% from the poorest quintile. The use of the public subsidy among mothers using any type of public health facility for CS delivery was pro-rich in nature; 9% in the poorest quintile, 16.1% in the poorer, 24.5% in the middle, 27.5% among richer and 23% in the richest quintile. The pattern of utilization and distribution of public subsidy was similar across the primary and secondary health facilities but the magnitude varied. The findings from the benefit-incidence analysis are supported by those obtained from the inequality analysis. The concentration index of CS was 0.124 for public health centers and 0.291 for private health centers. The extent of inequality in the use of CS delivery in public health centers was highest in the state of Mizoram (0.436), followed by Assam (0.336), and the lowest in Tamil Nadu (0.060), followed by Kerala (0.066). Conclusion The utilization of CS services from public health centers in India is pro-rich. Periodically monitoring and evaluating of the cash incentive schemes for CS delivery and generating awareness among the poor would increase the use of CS delivery services in public health centers and reduce the inequality in CS delivery in India.

Are institutional deliveries equitable in the southern states of India? A benefit incidence analysis

“…Finally, we noted in tandem with benefit incidence accruing quite heavily for middle-income quintiles, larger proportions were not paying for institutional delivery in these groups as compared to poorer quintiles, particularly in public facilities. This suggests that the inequitable incidence of the benefit of public subsidy may in part, be offsetting the costs of institutional delivery, but not among those with the greatest economic disadvantage [ 5 , 9 , 11 , 26 ].…”

“…We have used a number of variables such as institutional delivery, delivery care at the public health sector (subcentre [SC], Primary Health Centre [PHC]/additional PHC, Urban family Welfare Centre [UFWC]/ Urban Health Post [UHP]/Urban Health Centre [UHC], other public sector health facility, government/municipal hospital, government dispensary, community health centre [CHC]/rural hospital/block PHC), the total cost of delivery, place of residence (rural/urban), educational attainment (less than ten years schooling, 10 & above years of schooling), social group (Scheduled Caste, Scheduled Tribe, Other backward class, Others) 1 , wealth quintile (poorest, poorer, middle, richer, and richest), ANC visits (< 4 visits, ≥ 4 visits), and household size (less than 5, 5 and above)were used in the analyses, based on indicator definitions used in previous studies [ 3 , 5 , 17 , 18 , 26 ]. The term “institutional birth” refers to the delivery of a child that takes place within a healthcare facility, whether public or private health facility.…”

Clinical Equivalence of Polyglycolic Acid Suture and Polyglactin 910 Suture for Subcutaneous Tissue Closure After Cesarean Delivery: A Single-Blind Randomized Study

“…10 Mirroring the global rise, India too has witnessed a steady increase in the prevalence of CS, as sixfold rise in CS rate is recorded in the last two decades. 11 Despite its effectiveness in saving maternal and neonatal life, CS can cause remarkable complications in the settings of unsafe surgery. 10 Since CS is commonly performed, it is necessary to propose safe intervention and evidence-based approaches to reduce the CS-associated post-operative complications.…”

Biochemical and immunomodulatory insights of extracellular matrix from decellularized human whole cervix: recellularization and in vivo ECM remodeling interplay

“…The cervix, the lower portion of uterus connecting to the vagina, serves as a vital anatomical structure for sustenance of pregnancy and the process of parturition. Globally, one-third of pregnancies, accounting to an approximate 21.1%, culminate in caesarean section deliveries, surpassing the 10%-15% threshold established by the World Health Organization [1,2]. Nevertheless, a significant majority of women undergo non-caesarean deliveries, where the cervix assumes a pivotal role.…”