Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

Abstract

ObjectivesTo describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia.DesignCross-sectional study.Setting81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban).Participants45 327 births occurring in the study areas between 2005 and 2012.Outcome measuresProportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location.ResultsInstitutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57).ConclusionsOur results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring.

Prevalence and factors associated with caesarean section: a community based cross sectional study in rural parts of Rangareddy district, Telangana, India

“…9 In contrast, Neuman M et al observed that higher maternal age associated with increased odds of caesarean section in urban India. 11 Significant association between maternal education and caesarean delivery was found and the odds of caesarean section were greater in private and charitable health facilities than in public facilities. Limitations of the study small sample size and convenient sampling limits the generalis ability of the findings.…”

Unmet need for surgery in South Asia

“…17 For example, a cross-sectional analysis of data from Bangladesh, India, and Nepal showed higher rates of caesarean section in private healthcare facilities than in public ones, even when adjusted for pregnancy, delivery, maternal characteristics and year of delivery. 18 This uncontrolled growth is largely driven by market forces, and has worsened the uneven distribution and inequity of surgical care in the region. 16 For those who can afford it, advanced surgery, such as cancer surgery, transplantation for organ failure and functional brain surgery, now offers hope for diseases that until recently had a very poor prognosis.…”

Study of indications and post-operative complications of primary caesarean section in tertiary care hospital in Nepal

“…In Nepal the caesarean section rate rose from 1% in 2000 to 5% in 2011; in India it rose from 3% in 1992 to 11% in 2006 and in Bangladesh it rose from 2% in 2000 to 17% in 2011. 1 The caesarean section rate in the tertiary hospitals in Nepal is 12 to 25% (2012). 2 The caesarean section rate in NMCTH was 22.30% in 2013 which has increased from 9.4% in 2002.…”