Abstract
BackgroundWorldwide rising cesarean section (CS) births is an issue of concern. In India, with increase in institutional deliveries there has also been an increase in cesarean section births. Aim of the study is to quantify the prevalence of cesarean section births in public and private health facility, and also to determine the factors associated with cesarean section births.MethodsWe analyzed data from district level household survey data 4 (DLHS-4) combined individual level dataset for 19 states/UTs of India comprising 24,398 deliveries resulting in 22,111 live births for year 2011. The percentages and Chi-square has been computed for the select variables viz. Socio demographic, maternal, antenatal care and delivery related based on type of births (CS Vs normal births). The multiple logistic regression model has been used to identify the potential risk factors associated with CS births.ResultsOf 22,111 live birth analyzed 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries. Prevalence of CS births were 13.7% (95% CI; 13.0- 14.3%) and 37.9% (95% CI; 36.7- 39.0%) in the public and private sectors, respectively. Higher odds of CS births were observed with- delivery at private health facility (OR 3.79; 95% C.I 3.06-4.72), urban residence (OR 1.15; 95% C.I 1.00- 1.35), first delivery after 35 years of maternal age (OR 5.5; 95% C.I 1.85- 16.4), hypertension in pregnancy (OR 1.32; 95% C.I 1.06- 1.65) and breach presentation (OR 2.37; 95% C.I. 1.63- 3.43).ConclusionsOur findings shows that CS births are nearly three times more in private as compared to public sector health facilities.The higher rates of CS births, especially in private sector, not only increase the cost of care but may pose unnecessary risks to women (when there is no indications for CS). The government of India need to take measures to strengthen existing public health facilities as well as ensure that cesarean sections are performed based upon medical indications in both public and private sector health facilities.
Highlights
Worldwide rising cesarean section (CS) births is an issue of concern
Urban Frame Survey (UFS) blocks in each district have been stratified into million-class cities and non-million class cities and allocation of sample was proportional to relative sizes
Prevalence of CS births were in public sector health facilities was13.7% as compared to
Summary
In India, with increase in institutional deliveries there has been an increase in cesarean section births. As per recently published WHO report, “At population level, Cesarean section rates higher than 10% are not associated with reductions in maternal and new-born mortality rates” [1]. In India as per District level household survey 3 (DLHS) CS rate is 28.1% in private sector and 12% in public sector health facilities [7]. This survey shows share of Cesarean deliveries in institutional births have increased in India, especially in private sector health facilities. DLHS 4 shows similar trend in various states though country wide reports are not currently available [8]
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