Abstract
Purpose Caesarean section (CS) is being used as a life-saving surgical tool when complications arise in the process of childbirth. CS rates have dramatically increased across the world, especially in recent decades. In this background, the purpose of this paper is to explore the CS rates and its determinants in Karnataka, India. Design/methodology/approach The study uses multiple rounds of the District Level Household Survey (DLHS) data to show the trends, differentials and determinants in CS deliveries. Both bivariate and multivariate analyses have been carried out, and the χ2 test and logistic regression models were applied. Findings Result shows a sharp increase in CS rates across Karnataka; further, this is high and reaches an alarming level in southern parts of the state. Along with a huge rural–urban difference, significant biological and socio-economic differences were observed. Further, a very dramatic increase in the CS rate was observed in private health facilities, whereas it was stagnant or even decreased in public health facilities during recent years. Mothers age at birth, birth weight, birth order, multiple births, birth institution and place of residence were significantly associated with CS delivery. Unlike these biological factors, the social-economic factors like maternal education, caste, religion and below poverty line household were not found to be significant in determining CS deliveries. Originality/value A strong policy to address the dramatic increase in CS deliveries is the need of the hour. Further, there should be a proper mechanism at national, state and sub-state level to provide appropriate checks and monitoring for CS deliveries which are unnecessary.
Highlights
Approximately 287,000 maternal and 2.9m neonatal deaths are reported annually
53.4 percent of mothers belonged to other backward classes (OBCs) followed by scheduled castes (SCs) (21 percent), scheduled tribes (STs) (11 percent) and the rest belong to others (15 percent)
The results show that unlike the overall percentage of caesarean section (CS) deliveries shown in Figure 1, the increase was only observed in private health facilities, whereas this proportion was stagnant or even decreased in public health facilities during the third and fourth round of District Level Household Survey (DLHS) survey
Summary
Approximately 287,000 maternal and 2.9m neonatal deaths are reported annually. Access to extensive emergency obstetric care, including caesarean section (CS), is a vital key to reducing these deaths[1, 2]. In spite of being a life-saving surgical tool when complications arise in the process of childbirth, the CS is a major surgical procedure and is associated with immediate maternal and perinatal risks and may have long-term effects and implications for future pregnancies[3,4,5,6]. Though the proportion of CS births is considered to be an important indicator of emergency obstetric care[7, 8], there is an ongoing debate on how to quantify the need for life-saving obstetric surgery. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode
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