High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India

Abstract

BackgroundWorldwide rising cesarean section (CS) births is an issue of concern. In India, with increase in institutional deliveries there has also been an increase in cesarean section births. Aim of the study is to quantify the prevalence of cesarean section births in public and private health facility, and also to determine the factors associated with cesarean section births.MethodsWe analyzed data from district level household survey data 4 (DLHS-4) combined individual level dataset for 19 states/UTs of India comprising 24,398 deliveries resulting in 22,111 live births for year 2011. The percentages and Chi-square has been computed for the select variables viz. Socio demographic, maternal, antenatal care and delivery related based on type of births (CS Vs normal births). The multiple logistic regression model has been used to identify the potential risk factors associated with CS births.ResultsOf 22,111 live birth analyzed 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries. Prevalence of CS births were 13.7% (95% CI; 13.0- 14.3%) and 37.9% (95% CI; 36.7- 39.0%) in the public and private sectors, respectively. Higher odds of CS births were observed with- delivery at private health facility (OR 3.79; 95% C.I 3.06-4.72), urban residence (OR 1.15; 95% C.I 1.00- 1.35), first delivery after 35 years of maternal age (OR 5.5; 95% C.I 1.85- 16.4), hypertension in pregnancy (OR 1.32; 95% C.I 1.06- 1.65) and breach presentation (OR 2.37; 95% C.I. 1.63- 3.43).ConclusionsOur findings shows that CS births are nearly three times more in private as compared to public sector health facilities.The higher rates of CS births, especially in private sector, not only increase the cost of care but may pose unnecessary risks to women (when there is no indications for CS). The government of India need to take measures to strengthen existing public health facilities as well as ensure that cesarean sections are performed based upon medical indications in both public and private sector health facilities.

Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

“…This present study found that 18.5% of women who delivered in health facilities 5 years preceding the survey delivered their babies through CS, a figure that exceeds the threshold of 5-15% recommended by WHO [7]. This corroborates the findings in previous studies in low-and -middle income countries such as Pakistan [1], Egypt, [11], Bangladesh [12], Ethiopia [31], India [32], Jordan [33] and Tanzania [34]. An improved propensity toward available medical interventions and continued discouragement of VD after previous CS may have added to the recent increase in CS rates as noted in other countries [35].…”

How respectfully women are treated during difficult phase like childbirth? A primary survey of differently-managed health facilities in Odisha, India

“…This is true irrespective of woman reporting any complication either during gestation or at the time of delivery. 5,26 The assessment of qualitative information also supplemented these quantitative inferences.…”

Trends of Caesarean Section Deliveries in Pakistan: Secondary Data Analysis from Demographic and Health Surveys, 1990-2018

“…It is obvious that higher socio-economic status provides sufficient finances to bear the higher expenditure of caesarean surgery. Thus, caesarean section is more prevalent in women belonging to higher socio-economic class [32]. On the other hand, women belonging to lower socioeconomic status might not be able to afford the expenses of caesarean delivery or they do not have access to the obstetric care facilities required for caesarean delivery.…”