A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century

Abstract

Introduction Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates. Material and methods This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels. Results The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off. Conclusions This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.

Implementation of Robson classification for caesarean section using health insurance claims: the experience of Indonesia

“…These high CS rates have raised a question whether this CS procedure was deemed necessary and appropriate according to medical indications. This number is much higher than the average CS rate at global level (19.9%)[13] and among other South-east Asian countries (1.51%-31.78%)[14]. Nevertheless, the result should be interpreted cautiously since it did not reflect CS rate at population level, and merely included deliveries at secondary care level and women who were members of NHI.…”

Trends, District-Level Variations, and Socioeconomic Disparities in Cesarean Section Delivery and its Association with Neonatal Mortality in Bangladesh

“…While previous observations linked rising CS rates to lower neonatal mortality [39–41], Bangladesh’s current trend presents a puzzling contradiction. Despite a recent surge in CS deliveries, there is no clear association with reduced child mortality.…”

KMC and Brain Development: A Plea for Starting KMC as Early as Possible and as Long as Possible

“…Let's not forget elective cesarean sections from 34 weeks, especially in Latin America where the cesarean section rate can reach 90% in certain socio-economic environments. 5,6 Prematurity is not solely responsible for major motor sequelae in early childhood 7 ; it also contributes to minor long-term sequelae up to adulthood. 8 These include problems with coordination, behavior, cognition, learning, hyperactivity, school performance, and even tendencies toward aggressiveness.…”

“…Let’s not forget elective cesarean sections from 34 weeks, especially in Latin America where the cesarean section rate can reach 90% in certain socio-economic environments. 5, 6…”