Examining inequalities in access to delivery by caesarean section in Nigeria

Abstract

Background Maternal deaths are far too common in Nigeria, and this is in part due to lack of access to lifesaving emergency obstetric care, especially among women in the poorest strata in Nigeria. Data on the extent of inequality in access to such lifesaving intervention could convince policymakers in developing an appropriate intervention. This study examines inequality in access to births by caesarean section in Nigeria. Methods Data for 20,468 women who gave birth in the five years preceding 2013 Nigerian Demographic and Health Survey (DHS) were used for this study. Inequality in caesarean delivery was assessed using the concentration curve and multiple logistic regression models. Results There was a high concentration in the utilisation of caesarean section among the women in the relatively high wealth quintile. Overall, delivery by caesarean section was 2.1%, but the rate was highest among women who had higher education and belonged to the richest wealth quintile (13.6%) and lowest among women without formal education and who belonged to the poorest wealth quintile (0.4%). Belonging to the poorest wealth quintile and having no formal education were associated with lower odds of having delivery by caesarean section. Conclusion In conclusion, women in the richest households are within the WHO’s recommended level of 10–15% for caesarean birth utilisation, but women in the poorest households are so far away from the recommended rate. Equity in healthcare is still a promise, its realisation will entail making care available to those in need not only those who can afford it.

Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

“…Women with private/employer insurance have higher probability to have CS compared to those with no insurance cover (aRRR = 1.6064). Moreover, studies have proved the positive relationship between wealth and CS deliveries [11,22,24], particularly elective CS [27]. In line with these studies, we also find that affluence, represented by the household wealth index, also has a positive influence the probability of CS delivery, both planned and unplanned.…”

“…As for the potential explanatory variables, we selected them based on previous literature [11,[17][18][19][20][21][22][23][24][25][26][27]. We categorized them into several groups, namely spatial variables, maternal variables, demographic variables, access to information, and socio-economic variables.…”

Health-Related Quality-of-Life and Associated Factors Among Post-Partum Women in Arba Minch Town

“…These factors have an improving effect on HRQoL, and this is supported by the study conducted in Sub-Saharan Africa. 35 …”

Magnitude and trends in socio-economic and geographic inequality in access to birth by cesarean section in Tanzania: evidence from five rounds of Tanzania demographic and health surveys (1996–2015)

“…Consistent with previous studies [ 5 , 33 – 35 ], we found a disproportionately higher CS birth service uptake among richest/rich women as compared to poorest/poor women. Poor access to delivery by caesarean section remains mainly an issue among the economically and the socially deprived, which has serious implications for reducing maternal mortality and morbidity and perinatal and neonatal mortality and morbidity in the country [ 36 ]. Because of unaffordability of cost for CS service sometimes women are not able to deliver via CS (37) and hope for positive birth outcome even in case of prolonged labor since cost of CS is beyond their capability (38) as supported by previous studies that paying capability to CS service is one of the determinant for access to birth by CS [ 37 ].…”