Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam

Abstract

Caesarean section (CS) can prevent maternal and neonatal mortality and morbidity. However, it involves risks and high costs that can be a burden, especially in low and middle income countries. The aim of this study is to assess its magnitude and correlates among women of reproductive age in the urban and rural areas of Vietnam. We analyzed microdata from the national Multiple Indicator Cluster Survey (MICS) conducted in 2014 by using a representative sample of households at the national level in both urban and rural areas. A total of 1,350 women who delivered in institutional settings in the two years preceding the survey were included. Frequency and percentage distributions of the variables were performed. Bivariate and multivariate logistic regression analyses were undertaken to identify the factors associated with CS. Odds ratios with a 95% confidence interval were used to ascertain the direction and strength of the associations. The overall CS rate among the women who delivered in healthcare facilities in Vietnam has rapidly increased and reached a high level (29.2%). After controlling for significant characteristics, living in urban areas doubles the likelihood of undergoing a CS (OR = 1.98; 95% CI 1.48 to 2.67). Maternal age at delivery over 35 years is a major positive correlate of CS. Beyond this common phenomenon, different distinct lines of socioeconomic and demographic cleavage operate in urban compared with rural areas. The differences regarding the correlates of CS according to the place of residence suggest that specific measures should be taken in each setting to allow women to access childbirth services that are appropriate to their needs.

Predictors of institutional delivery service utilization among women of reproductive age in Gambia: a cross-sectional analysis

“…As such, the availability of C-section services can vary substantially with lower accessibility in the rural and remote areas. Women living in rural settings and in marginalized conditions are less likely to afford C-section services, even when vaginal delivery is not recommendable in complicated cases [18,26]. Therefore, special measures are necessary to ensure that the service is accessible to women based on need, regardless of geographic remoteness and women's capacity to pay.…”

Socio-demographic factors of cesarean births in Nha Trang city, Vietnam: a community-based survey

“…These facts might slightly influence the representativeness of participants. Second, we did not have information on parity and other clinical factors, such as pregnancy, delivery complications, and the number of antenatal checkups identified in a previous study [ 16 ], as this study was a part of a Streptococcus pneumoniae carriage survey. Third, our data were based on the ability of mothers to recall the requested information, but we were unable to confirm the information that they provided from medical charts.…”

“…A few studies have been conducted that have examined the determinants of CS in Vietnam. For example, Loezenien et al [ 16 ] conducted a secondary analysis using country-wide data of 1350 participants in a 2014 MICS survey. The authors claimed that there was a large gap in CS rates between urban (42.4%) and rural areas (22.9%) and that factors associated with CS rates included maternal age at delivery over 35 years and higher economic background [ 16 ].…”

“…Another two population studies [ 20 , 21 ] conducted in urban and suburban areas of Hanoi also reported a difference in the CS rate between male and female children. Hence, these authors concluded that high income and differences in the CS rates between the sexes might be related to requests made for CS without medical needs [ 16 , 17 ].…”

Midwives Experiences and Views of Their Working Conditions in Vietnamese Maternity Care – A Qualitative Study

“…The overall prevalence of caesarean sections is reported to be approximately 28%, although the rate differs signi cantly between urban (43%) and rural areas (21%), and also between different socio-economic groups [23]. Among urban living women, 55% in the richest quintile are delivered by caesarean sections, compared to 21% in the poorest quintile [37].…”