Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016

Guilmoto, Christophe Z.; Dumont, Alexandre

doi:10.1001/jamanetworkopen.2019.0526

Cited by 44 publications

(41 citation statements)

References 27 publications

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“…For example, CS rate increased to 24.5% in 2011 from 14.3% in 2007 in Bangladesh [10,14]. India also showed a similar trend like that of Nepal with an [31]. Several factors such as maternal education, wealth index, and accessibility to emergency obstetric care, women's preferences and healthrelated policy factors of the country may be responsible for an upward trend in CS rates in these countries [32].…”

Section: Discussionmentioning

confidence: 86%

Trends and correlates of cesarean section rates over two decades in Nepal

Bhandari¹,

Dhungel²,

Rahman³

2020

BMC Pregnancy Childbirth

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Background Cesarean section (CS) is a major component of emergency obstetric care. There has been a substantial rise in the rate of CS in private institutions in Nepal which might reflect the successful implementation of delivery schemes introduced by the government extended to the private organizations alternatively, it may also reflect the need for more public health care facilities to provide maternal and child health care services. Hence, the objective of this study was to examine the trends in institutional-based CS rates in Nepal along with its correlates over time. Methods We used the National Demographic and Health Survey (NDHS) data collected every 5 years, from 1996 to 2016. The trend in CS rates based on five waves of NDHS data along with its correlates were examined using multivariable logistic regression models after adjusting for socio-demographics and pregnancy-related variables. Results We included 20,824 reproductive-aged women who had a history of delivery within the past 5 years. The population-based CS rate increased from 0.9% in 1996 [95% CI: (0.6–1.2) %] to 10.2% in 2016 [95% CI: (8.9–11.6) %, p < 0.01] whereas the institutional-based CS rate increased from 10.4% in 1996 [95% CI: (8.3–12.9) %] to 16.4% in 2016 [95% CI: (14.5–18.5) %, p < 0.01]. Private institutions had a nearly 3-fold increase in CS rate (8.9% in 1996 [95% CI: (4.8–16.0) %] vs. 26.3% in 2016[95% CI: (21.9–31.3) %]. This was also evident in the trend analysis where the odds of having CS was 3.58 times higher [95% CI: (1.83–7.00), p < 0.01] in 2016 than in 1996 in the private sectors, while there was no evidence of an increase in public hospitals (10.9% in 1996 to 12.9% in 2016; p for trend > 0.05). Education of women, residence, wealth index, parity and place of delivery were significantly associated with the CS rate. Conclusion Nepal has observed a substantial increase in cesarean delivery over the 20 years, which might indicate a successful implementation of the safe motherhood program in addressing the Millennium Development Goals and Universal Health Care agenda on maternal and child health. However, the Nepal government should examine existing disparities in accessibility of emergency obstetric care services, such as differences in CS between public and private sectors, and promote equity in maternal and child health care services accessibility and utilization.

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Section: Discussionmentioning

confidence: 86%

Trends and correlates of cesarean section rates over two decades in Nepal

Bhandari¹,

Dhungel²,

Rahman³

2020

BMC Pregnancy Childbirth

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“…However, high rates of caesarean births in health facilities in Mali and Benin have been documented recently, particularly among women with low obstetric risk, suggesting that overuse of technology in childbirth is emerging in these countries (Schantz et al, 2018). These observations indicate the coexistence of the under-and overuse of caesarean section in these countries, as has been documented in other contexts (Guilmoto and Dumont, 2019), and this fact constitutes an a-priori paradoxical situation that must be explored in more detail through a qualitative in-depth approach. This article aims to describe the practice of caesarean section inside labour rooms in these two low-income countries in Western Africa, and to understand why and how caesarean sections are performed.…”

Section: Abstract: Caesarean Section Biomedical Technology Maternalmentioning

confidence: 66%

Caesarean section in Benin and Mali: increased recourse to technology due to suffering and under-resourced facilities

Schantz¹,

Aboubakar²,

Traoré³

et al. 2020

Reproductive Biomedicine & Society Online

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In line with policies to combat maternal mortality, the medicalization of childbirth is increasing in low-income countries, while access to healthcare services remains difficult for many women. High caesarean section rates have been documented recently in hospitals in Mali and Benin, illustrating an a-priori paradoxical situation, compared with low caesarean section rates in the population. Through a qualitative approach, this article aims to describe the practice of caesarean section in maternity wards in Bamako and Cotonou. Workshops with obstetricians and midwives; participant observation inside labour rooms; and in-depth interviews with caregivers, patients and policy makers have indicated increased recourse to caesarean section due to women's and caregivers' suffering and under-resourced facilities. Within these procedures, two types of caesarean section were documented: 'maternal distress caesarean section' and 'preventive caesarean section'. The main reasons for these caesarean sections are maternal fear and pain, and a lack of resources. Inadequately resourced facilities lead to staff suffering and ethical breakdowns, and encourage the inappropriate use of technology. The policy of access to free caesarean section procedures exacerbates the issue of non-medically-justified caesarean sections in these countries. The overuse of caesarean section is particularly alarming in countries with high fertility as it constitutes a danger to both mothers and babies in the short and long term. Currently, conditions are in place in Benin and Mali for an increase in non-medically-justified caesarean sections. In the short term, such an increase could constitute a new burden for these two sub-Saharan countries, where maternal mortality is high.

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“…The national CS rate is reported by place of service focused HMIS as 17.5% of live births for 2017–2018 while the household focused NFHS reports a similar figure. 14 This average, which is higher than the WHO benchmark for necessary surgical delivery of 10%–15%, 21 masks substantial state-wide variation ranging from 2.5% in Bihar to over 45% in Tamil Nadu. 15 The NFHS reported 31% of Indian women that had a sterilisation which is close to the highest rate internationally—33% in the Dominican Republic.…”

Section: Resultsmentioning

confidence: 96%

Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery

2020

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IntroductionThere continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India.MethodsThe study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken.ResultsSurgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity.ConclusionIn low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated.

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Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016

Cited by 44 publications

References 27 publications

Trends and correlates of cesarean section rates over two decades in Nepal

Trends and correlates of cesarean section rates over two decades in Nepal

Caesarean section in Benin and Mali: increased recourse to technology due to suffering and under-resourced facilities

Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery

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