Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

Abstract

BackgroundInappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it.MethodsData from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities.ResultsOut of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile .ConclusionsThis study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.

Assessing Socio-Demographic Factors of Cesarean Delivery in India: Insights From National Family Health Survey-4

“…This could be explained by the fact that older mothers are highly susceptible to pregnancy and delivery-related complications. 8,16,17 Therefore, older women may incline towards the cesarean section as a safe delivery option to protect their fetus after a long period of conception di culty. 8,18 The higher prevalence of cesarean birth was also found among women who married at a higher age.…”

“…8,16,17 Therefore, older women may incline towards the cesarean section as a safe delivery option to protect their fetus after a long period of conception di culty. 8,18 The higher prevalence of cesarean birth was also found among women who married at a higher age. The possible reason could be adult married women may have higher decision-making autonomy in terms of their health-seeking behavior compared to child married women.…”

“…However, during the last decade, the increase in cesarean section deliveries has become a matter of serious concern for public health experts globally. 8 India is not an exception. The rate of cesarean delivery is dramatically increasing from 10% in 2005-06 to 17% in 2015- 16.…”

“…9,10 Studies have indicated that socio-demographic, economic, cultural and psychological factors determine cesarean delivery in India. 8 It is evidenced that education, wealth status, occupation, place of delivery and nutritional status of the mother are signi cant predictors of cesarean delivery. 6,11 Previous studies revealed that educational attainment and household wealth status are positively associated with a cesarean birth.…”

Assessing the Contextual Effect of Community in the Utilization of Postnatal Care Services in Ghana

“…Finally, women's employment status was grouped into not working and working. The categorizations of the study predictors were adopted from the literature [34,35].…”