Abstract
BackgroundPakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018.MethodsSecondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990–91, 2006–07, 2012–13 and 2017–18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR).ResultsThe percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births.ConclusionsThe findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.
Highlights
Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades
Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated
Maternal socio-demographic characteristics Of the mothers who had a delivery in the 5 years preceding the survey, 40.5% were less than 18 years old in 1990–91
Summary
Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Convenient and immediate provision of health care facilities for pregnant women in all countries across the globe is highly important [1]. The instant availability of obstetric care for pregnant women includes the provision of medical facilities for caesarean section deliveries [2]. Caesarean sections are considered to be a safe surgical procedure [3], the progressive increase in caesarean births during the past few years has attracted the attention of public health experts globally [4]. A rising trend of caesarean section deliveries has been documented in South Asian countries including Pakistan, where it increased from 3.2% (1990) to 20% (2018) [5, 6]
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