Does delivery in private hospitals contribute largely to Caesarean Section births? A path analysis using generalised structural equation modelling

Abstract

Background The rate of Caesarean Section (CS) deliveries has shown an alarming rise in recent years. CS is a surgical procedure used when there is apprehension of risk to the life of mother or baby in case of vaginal delivery, but its rates higher than 10-15 per cent are not justifiable. It is well recognised that a CS delivery could have a large number of adverse impacts on women and infants. Several studies, especially in developing countries, have revealed that delivery in private hospitals is one of the most contributing factors in CS deliveries. The present study conceptualises a causal pathway in which the possible risk factors, socioeconomic , maternal and pregnancy-related, as well as institutional, influence the chances of CS delivery. It is hypothesised that certain factors would contribute to CS deliveries largely indirectly through the place of delivery, that is, either a public or private institution. Methods and findings To test the hypotheses, this study analysed 146,280 most recent live births delivered in hospitals during the five years preceding the fourth round of India's National Family Health Survey (NFHS-4), carried out during 2015-2016. The analysis, using generalised structural equation modelling (GSEM), revealed that many exogenous variables considered in the path models influence CS deliveries significantly, directly and/or indirectly through the place of delivery factor. Prominent among these are wealth index and receiving ANC services at only private hospitals; the total effects of these variables are even higher than the direct/total effect of place of delivery. Conclusion From this finding, it could be said that the place of delivery is a proximate determinant of a CS delivery or a mediator of other co-factors. Interventions to curb higher CS deliveries

Too many yet too few caesarean section deliveries in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys data

“…This is the primary reason of booming the CS use in the private health facilities as CS use on women's demand is mostly available there-contradict to the government health facilities practice [19]. Moreover, a large percentage of women admitted in the government health centre, finally changes their mind and shift to the private facilities and choose to undergo CS [37,38]. The reasons are lack of healthcare personnel in the governmental health facilities, poor quality of care, long waiting time for the doctors and unsupportive behaviours of the nurses and other associated medical staff [19,38].…”

“…Moreover, a large percentage of women admitted in the government health centre, finally changes their mind and shift to the private facilities and choose to undergo CS [37,38]. The reasons are lack of healthcare personnel in the governmental health facilities, poor quality of care, long waiting time for the doctors and unsupportive behaviours of the nurses and other associated medical staff [19,38]. Conversely, in the private health facilities, even though they are profit making institutions, they always ensure better care and concern for the patients [19].…”

Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis

“…The rates of caesarean section differ among these countries, with high-income countries, showing increased rates during the past three decades [ 54 ]. The type of health care system (public, private) is also associated with caesarean section rates, with private health systems cited as the most important structural factor in increased caesarean delivery [ 55 , 56 ]. These same factors are associated with access to ART, with documented widespread disparities in access to ART between countries, and between private and public health care systems [ 57 ].…”

Too many yet too few caesarean section deliveries in Bangladesh: an ongoing public health challenge to improve maternal and child health

“…This is the primary reason of booming the CS use in the private health facilities as CS use on women’s demand is mostly available there – contradict to the government health facilities practice [18]. Moreover, a large percentage of women admitted in the government health centre, finally changes their mind and shift to the private facilities and choose to undergone through the CS [33, 34]. The reasons are lack of healthcare personnel in the governmental health facilities, poor quality of care, long waiting time for the doctors and unsupportive behaviours of the nurses and other associated medical staffs [18, 34].…”

“…Moreover, a large percentage of women admitted in the government health centre, finally changes their mind and shift to the private facilities and choose to undergone through the CS [33, 34]. The reasons are lack of healthcare personnel in the governmental health facilities, poor quality of care, long waiting time for the doctors and unsupportive behaviours of the nurses and other associated medical staffs [18, 34]. Conversely, in the private health facilities, even though they are profit making institutions, they always ensure better care and concern for the patients[18].…”