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Kundu S, Sharif AB, Chowdhury SSA, Afroz S, Dey R, Hossain A. Socioeconomic and geographical inequalities in delivery by cesarean section among women in Bangladesh, 2004-2017. BMC Pregnancy Childbirth 2024; 24:131. [PMID: 38350916 PMCID: PMC10863140 DOI: 10.1186/s12884-024-06327-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. METHODS Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. RESULTS An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69-30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26-35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19-11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66-42.30). CONCLUSION We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.
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Affiliation(s)
- Satyajit Kundu
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
| | - Azaz Bin Sharif
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Syed Sharaf Ahmed Chowdhury
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Sadia Afroz
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Rakhi Dey
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
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Neethi Mohan V, Shirisha P, Vaidyanathan G, Muraleedharan VR. Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh. BMC Pregnancy Childbirth 2023; 23:622. [PMID: 37649006 PMCID: PMC10466745 DOI: 10.1186/s12884-023-05928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG). METHODS Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions. RESULTS The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95-2.29; NFHS-5) those for underweight women. Women aged 35-49 were also twice (OR = 2.10; 95% CI 1.92-2.29; NFHS-5) as likely as those aged 15-24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74-4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor. CONCLUSION The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.
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Affiliation(s)
- Varshini Neethi Mohan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India.
| | - P Shirisha
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - Girija Vaidyanathan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - V R Muraleedharan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
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Manna S, Singh D, Ghosal S, Rehman T, Kanungo S, Pati S. Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5. BMC Public Health 2023; 23:1474. [PMID: 37532981 PMCID: PMC10398927 DOI: 10.1186/s12889-023-16352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Increased coverage for institutional delivery (ID) is one of the essential factors for improved maternal and child health (MCH). Though, ID increased over time, out-of-pocket expenditure (OOPE) for the care-seeking families had been found to be growing, parallelly. Hence, we estimated OOPE in public and private health centres for ID, along with their sources and attributing factors and compared state and union territory-wise, so that financial risk protection can be improved for MCH related services. METHODS We used women's data from the National Family Health Survey, 2019-2021 (NFHS-5). Reproductive aged women (15-49 years) delivering one live child in last 5 years (n = 145,386) in any public or private institutions, were included. Descriptive statistics were presented as frequency and proportions. OOPE, was summarized as median and interquartile range (IQR). To estimate the extent for each covariate's effect, linear regression model was conducted. RESULTS Overall median OOPE for ID was Rs. 4066 (median OOPE: private hospitals: Rs.25600, public hospitals: Rs.2067). Health insurance was not sufficient to slash OOPE down at private facilities. Factors associated significantly to high OOPE were mothers' education, elderly pregnancy, complicated delivery, birth order of the latest child etc. CONCLUSION: A standard norm for ID should be implemented as a component of overseeing and controlling inequality. Aiding the needy is probably just one side of the solution, while the focus is required to be shifted towards reducing disparity among the health facilities, so that the beneficiaries do not need to spend on essential services or during emergencies.
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Affiliation(s)
- Sayantani Manna
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India
| | - Damini Singh
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India
| | - Shishirendu Ghosal
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India
| | - Tanveer Rehman
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India
| | - Srikanta Kanungo
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India.
| | - Sanghamitra Pati
- Division of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar-23, Odisha, India.
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Ahamed F, Rehman T, Kaur A. Why do Mothers from Remote Rural Areas opt for Cesarean Delivery: An Observational Analytical Study from West Bengal, India. Indian J Community Med 2023; 48:573-578. [PMID: 37662136 PMCID: PMC10470558 DOI: 10.4103/ijcm.ijcm_911_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background The percentage of cesarean section (C-section) deliveries has doubled in the last two decades in India. Although C-section delivery is a life-saving intervention, multiple maternal and neonatal morbidities are often associated with this procedure, adversely affecting the quality of life of both the mother and child. Material and Methods This community-based cross-sectional study was conducted to assess the point of view of mothers who delivered from January 2020 to June 2021. Results The mean (standard deviation (SD)) age of the 866 study participants at delivery was 24.5 (4.8) years, and 60.2% were primigravidas. A total of 613 (70.8%; 95% CI: 67.8-73.8) C-sections were conducted, of which 65.9% (n = 404) were planned and 21.9% were done on maternal request. C-sections were significantly associated with private institutes (adjusted prevalence ratio (aPR) 1.90; 95% CI: 1.70-2.11), at-risk pregnancy (aPR 1.37; 95% CI: 1.26-1.49), and primigravida (aPR 1.16; 95% CI: 1.05-1.29). About 55.3%, 29.8%, and 14.9% of women considered vaginal delivery to be risky, painful, and inconvenient, respectively. Conclusion It is imperative to generate awareness regarding modes of delivery during antenatal care (ANC) so that mothers can make better-informed choices.
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Affiliation(s)
- Farhad Ahamed
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
| | - Tanveer Rehman
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Amandeep Kaur
- Department of Community Medicine and Family Medicine, AIIMS Kalyani, NH-34 Connector, Basantapur, Saguna, Nadia, West Bengal, India
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Islam MM, Noor FM. Prevalence and factors of cesarean delivery among Bangladeshi reproductive aged women: evidence from multiple Indicator cluster survey 2019 data. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Roy A, Paul P, Chouhan P, Rahaman M, Kapasia N. Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu. BMC Public Health 2021; 21:1715. [PMID: 34548059 PMCID: PMC8456626 DOI: 10.1186/s12889-021-11750-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively. Methods This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data. Results Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31). Conclusion Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.
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Affiliation(s)
- Avijit Roy
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India. .,Department of Geography, Malda College, Malda, West Bengal, 732101, India.
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University (JNU), New Delhi, 110067, India.,International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, 732103, India
| | - Margubur Rahaman
- International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Nanigopal Kapasia
- Department of Geography, Malda College, Malda, West Bengal, 732101, India
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Sengupta A, Sabastin Sagayam M, Reja T. Increasing trend of C-section deliveries in India: A comparative analysis between southern states and rest of India. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100608. [PMID: 33652351 DOI: 10.1016/j.srhc.2021.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/02/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the socio-demographic variations in overwhelming existence of C-section deliveries in south India, with a comparison to rest of India. METHODS This study analyses data collected from 51,136 mothers under National Family Health Survey (NFHS)-3 (2005-06) and 2,52,183 mothers under NFHS-4 (2015-16), those who have given births during last five years preceding the survey. MAIN OUTCOME MEASURES Descriptive statistics, bivariate analysis with Chi-squared tests and binary logistic regression models with 95% confidence intervals are used. RESULTS In south India at least one out of four women deliver through C-section and there was a notable rise in caesarean deliveries in public facilities as well as among tribal population. In aggregate, number of states exceeding 15% prevalence rate of C-section deliveries doubled to sixteen, while nineteen states registered more than 100% rise. Rural-urban difference is slim in south India, while likelihood for C-section deliveries for richest women as compared to poorest has gone down from 2.76 to 1.88 in south India and 7.75 to 4.58 in other regions during 2005-06 to 2015-16. The odds ratio for C-section is higher in private hospitals (3.26) of southern states with reference to public institutions, while the odds are 3.90 times higher for private facilities in other states. In south India, percentage of C-section deliveries were actually lower among those who reported about pregnancy complications. CONCLUSIONS Despite, several maternal and child health related programs being launched in India, their impact on improving the C-section scenario has remained microscopic, or they have continued to contribute towards a rising prevalence of C-section, especially in south India.
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Affiliation(s)
- Angan Sengupta
- Department of Management, Amrita Vishwa Vidyapeetham, Kasavanahalli, Off Sarjapur Road, Bangalore 560035, Karnataka, India.
| | - Maria Sabastin Sagayam
- Department of Management, Amrita Vishwa Vidyapeetham, Kasavanahalli, Off Sarjapur Road, Bangalore 560035, Karnataka, India.
| | - Tamal Reja
- Centre of Excellence on Public Health Nutrition, Department of Humanities and Social Sciences, National Institute of Technology, Rourkela 769008, Odisha, India
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Abstract
A Caesarean section can be a life-saving intervention in case of pregnancy complications or difficult labour. The prevalence of Caesarean section continues to increase, especially in sub-Saharan Africa, yet the reasons for this remain largely unexplored. This study investigated risk factors contributing to the decision to perform Caesarean sections in Ghana using data from 8645 women aged 15-49 years from the 2017 Ghana Maternal Health Survey. The data were analysed by applying complementary log-log and logit models. The majority of Ghanaian women (about 87%) reported preferring vaginal delivery to Caesarean section. Of those who had undergone a Caesarean section for their most recent birth, about 55% had an elective rather than an emergency section. Women with labour complications (prolonged/obstructed labour) were significantly more likely to have a Caesarean section (OR=4.09, 95% CI=3.10-5.41). Furthermore, women with maternal complications, particularly prolonged/obstructed labour, were less likely to have an elective Caesarean section than those who had no such complications (OR=0.25, 95% CI=0.14-0.46). Compared with poorer women, wealthy women were significantly more likely to have an elective Caesarean section (OR=1.84, 95% CI=1.08-3.14). The findings suggest that beyond maternal complications, women's socioeconomic and demographic characteristics are important risk factors for undergoing a Caesarean section in Ghana.
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