Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey

Intimate partner violence among women in Togo: a generalised structural equation modeling approach

OBJECTIVE

This study aimed to assess the magnitude and identify associated factors with intimate partner violence (IPV) in Togo.

DESIGN

Cross-sectional study.

SETTING

Togo.

PARTICIPANTS

Women of reproductive age (15-49 years).

PRIMARY OUTCOME

Intimate partner violence.

METHODS

This study used data from the 2013 Togolese Demographic and Health Survey. A total of 4910 married or partnered women were included. A Generalised Structural Equation Model (GSEM) was performed to identify significant factors associated with IPV. Results of the GSEM were reported as adjusted ORs (aOR) with their corresponding 95% CIs.

RESULTS

The pooled prevalence of IPV was 35.5% (95% CI: 34.2% to 36.8%). Emotional violence and physical violence were the most reported forms of IPV (29.7% and 20.2%, respectively), while sexual violence was the least common, with a prevalence of 7.5%. Additionally, the results indicated that the following factors related to women, men and households were significantly associated with IPV in Togo: ethnicity, region, religion, wealth index, working status, age at the first union, having attitudes toward wife-beating, participation in household decision-making, education level, alcohol use and controlling behaviour.

CONCLUSION

IPV is a complex and multifactorial phenomenon in Togo. The Togo government as well as women's human rights organisations should consider these factors when designing IPV programmes.

Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh

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.