A Review of Cesarean Section Rates and Associated Factors in Pakistan Using Anderson Health Behavior Model

Abstract

Background: In Pakistan, proportion of births delivered by Cesarean section has rapidly increased from 3.1% in 1992 to 22.3% in 2017-18. This scoping review was conducted to review available evidence on key underlying determinants of caesarean birth rates in Pakistan using Andersen health behavior model, to control this escalating rate of CS in Pakistan. Results:We analyzed utilization of CS services as a function of three different types of factors i.e., i) predisposing ii) enabling, iii) need factors. Predisposing factors included older maternal age, higher education of mother, & living in urban areas with few barriers to getting medical care. Among Enabling factors, cost of CS and type of health facility (public or private) are key drivers of a CS delivery. Need factors included user related and provider related factors. User related factors were found to be influenced by previous pregnancy and childbirth experience, fear of birth trauma or complications of vaginal delivery. Provider related factors suggests that private health sector in Pakistan is over medicalizing childbirth through CS for financial gains and indicates mal practicing at the physician's end. Conclusion:Effective multifaceted targeted response is necessary to reduce unnecessary C-sections in Pakistan. There is need for implementation of universally acceptable standards and audit mechanism without compromising maternal or fetal safety. It is crucial to formulate policies and ensure public health practices to implement proper guidelines, improve training and regulate the conduction of CS in public and private health facilities to reduce burden of CS on healthcare system in Pakistan.