BackgroundThe increasing rate of caesarean deliveries has become a serious concern for public health experts globally. Various medical and non-medical factors, such as maternal socio-demographics, are found to be responsible for this upsurge. Like in other countries, the rate of caesarean sections has increased in Pakistan as well. Therefore, there is a need to investigate the factors behind this increase. This study aims to assess the determinants associated with caesarean deliveries among child-bearing women aged 15–49 years in Pakistan.MethodsSecondary data analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2012–2013. The analysis was limited to mothers aged 15–49 years, who had given birth to at least one child during the 5 years immediately preceding the survey (n = 7461). Maternal socio-demographic characteristics and pregnancy-related variables, including antenatal care utilisation, place of delivery and pregnancy complications were considered as independent variables. The association between caesarean section deliveries (outcome variable) and its determinants was assessed by calculating unadjusted and adjusted odds ratios with 95% confidence intervals using a multivariable binary logistic regression.ResultsOf the women who had given birth to at least one child during the previous 5 years, the percentage of mothers who delivered their babies through caesarean section was found to be 13.6%. The likelihood of caesarean deliveries was associated with mothers aged more than 24 years, women residing in Punjab province, women belonging to the richest class, women with higher education, women employed at professional/managerial/technical level, and women residing in an urban setting. Additionally, the women who had pregnancy complications, a high utilisation of antenatal care and delivered their babies in private hospitals were found to have higher chances of caesarean deliveries.ConclusionsThe study revealed that there are a high percentage of women delivering babies through caesarean section in Pakistan. Therefore, strict measures need to be taken to deal with this concern. For example, detailed medical justifications by doctors for performing caesarean sections and awareness among women regarding the reduction of pregnancy complications can help to reduce the chances of malpractice related to caesarean deliveries.

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Background Pakistan 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. Methods Secondary 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). Results The 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. Conclusions The 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.

Fertility rate is on gradual decline in Pakistan like other developing countries with increased acceptance of family planning methods. Pakistan Demographic and Health Surveys revealed a slow decline from 4.1 in 2007 to 3.8 children per woman in 2013. Despite availability of nationally representative primary data, empirical researches on demographic and health determinants of fertility and fertility preferences in Pakistan are rare. The aim of this study is to assess the major differences in factors determining fertility and fertility preferences in Pakistan Demographic and Health Survey 2006- 2007 and 2012-2013. Using two data sets Pakistan Demographic and Health Survey 2006-2007 and 2012-2013, researchers conducted a comparison of findings generated in secondary analyses. Researchers studied the association of social demographics, reproductive history and infant mortality with fertility and fertility preferences among ever-married women of reproductive age (15-49). Results are indicated using binary logistic regression and multivariate analysis. Findings support the association of social demographics of women, living sons, child mortality and reproductive history with ideal number of children; desire to reproduce more and number of living children. Injection induced labour pains, C-section deliveries, fistula problem, abortions and spotting during gestation are associated significantly with lower ideal number of children. Living sons are positively associated with ideal number of children and negatively associated with desire to reproduce more. The desire to reproduce more in association with women’s age 15-29, rural place of residence and C-section deliveries has reduced over time from 2007 to 2013 in country. Complications during pregnancies and delivery are important determinants of fertility and fertility preferences among women. Further research is needed to assess the association of pregnancy and delivery problems with fertility and fertility preferences in Pakistan.