Abstract
BackgroundThe objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women’s and Children’s Health Research (Global Network).MethodsThis is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites.ResultsCesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p < 0.001. For multiparous women with a history of prior cesarean birth, rates of vaginal birth after cesarean were about 20% in the Latin American and Southeast Asian sites and about 84% at the sub-Saharan African sites. In the African sites, proportions of cesarean birth in the study were highest among women without a prior cesarean and a single, cephalic, term pregnancy. In the non-African sites, groups with the greatest proportion of cesarean births were nulliparous women with a single, cephalic, term pregnancy and all multiparous women with at least one previous uterine scar with a term, cephalic pregnancy.ConclusionCesarean birth rates continue to rise within the Global Network. The proportions of cesarean birth are higher among women with no history of cesarean birth in the African sites and among women with primary elective cesarean, primary cesarean after induction, and repeat cesarean in the non-African sites.
Highlights
The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women’s and Children’s Health Research (Global Network)
Cesarean birth rates continue to rise within the Global Network
This study serves to update the analysis of cesarean birth rates in the Global Network, to observe risk factors associated with cesarean birth, and to consider subgroups contributing to the cesarean birth rates
Summary
The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women’s and Children’s Health Research (Global Network). The Global Network prospectively collects population-based data on home and facility births in six lowand middle-income countries that span Latin America, sub-Saharan Africa, and Southeast Asia in an ongoing registry [5]. Data from this Maternal Newborn Health Registry (MNHR) within the Global Network was previously analyzed to show that over a relatively short period of time (2010–2016), cesarean birth rates doubled at all non-sub-Saharan African sites, almost reaching 30% in one Indian site [4]. This study serves to update the analysis of cesarean birth rates in the Global Network, to observe risk factors associated with cesarean birth (our primary outcome), and to consider subgroups contributing to the cesarean birth rates (our secondary outcome)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
