Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-14T05:27:34.222Z Has data issue: false hasContentIssue false
  • English
  • Français

Household- and community-level determinants of low-risk Caesarean deliveries among women in India

Published online by Cambridge University Press:  30 January 2020

Pradeep Kumar Open the ORCID record for Pradeep Kumar [Opens in a new window]  and
Preeti Dhillon Open the ORCID record for Preeti Dhillon [Opens in a new window]
Pradeep Kumar*
Affiliation:
International Institute for Population Sciences, Mumbai, India
Preeti Dhillon
Affiliation:
International Institute for Population Sciences, Mumbai, India
*
*Corresponding author. Email: pradeepiips@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Caesarean section delivery rates in India have doubled from 9% in 2005–06 to 17% in 2015–16, increasing the clinical and economic burden on the health care system. This study applied multilevel models to assess the role of household- and community-level factors in Caesarean section (CS) deliveries among low-risk women in India using data from Round 4 of the National Family Health Survey (NFHS-4) conducted in 2015–16. The sample size was 59,318 low-risk women who had their last birth in an institution during the 5 years preceding the survey. These women were nested in 57,279 households, which were nested in 22,183 communities, which were further nested in 640 districts in India. Around 21% of the low-risk women and 24% of all women who had delivered in an institution had undergone CS. The CS rates among low-risk women were extremely high in private institutions (40%) and in southern India (43%). The explanatory variables age, education of women, household wealth and number of antenatal visits were significantly positively associated, while women’s parity was negatively associated, with CS delivery among low-risk women. The multilevel analysis suggested that the likelihood of a low-risk woman opting for CS was influenced by a similar decision of another woman from the same household (37%) and/or community (18%). Furthermore, women with low-risk pregnancies from higher educated communities were less likely (OR 0.92) to undergo CS. There is therefore a need for a community-level awareness programme on the risks and benefits of low-risk CS and vaginal delivery, particularly in the southern region of India.

Keywords

CaesareanLow-risk womenMultilevel
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 1 , January 2021 , pp. 55 - 70
Copyright
© The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al Rifai, RH (2017) Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014. BMC Pregnancy & Childbirth 17(1), 417.CrossRefGoogle ScholarPubMed
Allen, VM, O’Connell, CM, Farrell, SA and Baskett, TF (2005) Economic implications of method of delivery. American Journal of Obstetrics and Gynecology 193(1), 192–197.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists (2007) Cesarean delivery on maternal request ACOG Committee Opinion No. 394. Obstetrics and Gynecology 110(6), 1501.CrossRefGoogle Scholar
Begum, T, Ellis, C, Sarker, M, Rostoker, JF, Rahman, A, Anwar, I et al. (2018) A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh. BMC Pregnancy Childbirth 18(1), 368.Google ScholarPubMed
Behague, DP, Victora, CG and Barros, FC (2002) Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. British Medical Journal 324(7343), 942–945.CrossRefGoogle ScholarPubMed
Betrán, AP, Torloni, MR, Zhang, JJ and Gülmezoglu, AM (for the Section WHO Working Group on Caesarean Section) (2016) WHO statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology 123(5), 667–670.CrossRefGoogle ScholarPubMed
Danilack, VA, Nunes, AP and Phipps, MG (2015) Unexpected complications of low-risk pregnancies in the United States. American Journal of Obstetrics and Gynecology 212(6), 809.e1–809.e6.CrossRefGoogle ScholarPubMed
Declercq, E, Barger, M, Cabral, HJ, Evans, SR, Kotelchuck, M, Simon, C et al. (2007) Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstetric and Gynecology 109(3), 669–677.Google ScholarPubMed
Divyamol, N, Raphael, L and Koshy, N (2016) Caesarean section rate and its determinants in a rural area of South India. International Journal of Community Medicine and Public Health 3(10), 2836–2840.Google Scholar
Einarsdóttir, K, Kemp, A, Haggar, FA, Moorin, RE, Gunnell, AS, Preen, DB et al. (2012) Increase in caesarean deliveries after the Australian private health insurance incentive policy reforms. PLoS One 7(7), e41436.CrossRefGoogle ScholarPubMed
Epstein, AJ and Nicholson, S (2009) The formation and evolution of physician treatment styles: an application to cesarean sections. Journal of Health Economics 28(6), 1126–1140.CrossRefGoogle ScholarPubMed
Gibbons, L, Belizán, JM, Lauer, JA, Betrán, AP, Merialdi, M and Althabe, F (2010) The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report 30, 1–31.Google Scholar
Gibbs, RS (2008) Preterm Labor. Danforth’s Obstetrics and Gynecology: Preterm Labor and Post-Term Delivery. Lippincott Williams & Wilkins, Philadelphia.Google Scholar
Gonen, R, Tamir, A and Degani, S (2002) Obstetricians’ opinions regarding patient choice in cesarean delivery. Obstetrics and Gynecology 99(4), 577–580.Google ScholarPubMed
Gould, JB, Davey, B and Stafford, RS (1989) Socioeconomic differences in rates of cesarean section. New England Journal of Medicine 321(4), 233–239.CrossRefGoogle ScholarPubMed
Grant, D (2009) Physician financial incentives and cesarean delivery: new conclusions from the healthcare cost and utilization project. Journal of Health Economics 28(1), 244–250.CrossRefGoogle ScholarPubMed
Hall, MH (1994) Variation in caesarean section rate. Maternal mortality higher after caesarean section. British Medical Journal 308(6929), 654.Google ScholarPubMed
Hopkins, K (2000) Are Brazilian women really choosing to deliver by cesarean? Social Science & Medicine 51(5), 725–740.CrossRefGoogle ScholarPubMed
Hsu, KH, Liao, PJ and Hwang, CJ (2008) Factors affecting Taiwanese women’s choice of cesarean section. Social Science & Medicine 66(1), 201–209.CrossRefGoogle ScholarPubMed
IIPS and ICF (2017) National Family Health Survey (NFHS-4), 2015-16. International Institute for Population Sciences, Mumbai, India. URL: http://rchiips.org/NFHS/NFHS-4Reports/India.pdf (accessed 14th April 2019).Google Scholar
Jejeebhoy, SJ and Sathar, ZA (2001) Women’s autonomy in India and Pakistan: the influence of religion and region. Population Development Review 27(4), 687–712.CrossRefGoogle Scholar
Kazmi, T, Sarva Saiseema, V and Khan, S (2012) Analysis of Cesarean Section Rate – according to Robson’s 10-group classification. Oman Medical Journal 27(5), 415–417.CrossRefGoogle ScholarPubMed
Kuklina, E V, Meikle, SF, Jamieson, DJ, Whiteman, MK, Barfield, WD, Hillis, SD et al. (2010) Severe obstetric morbidity in the United States: 1998–2005. Obstetric Anesthesia and Critical Care 30(1), 31.Google Scholar
Lazo-Porras, M, Bayer, AM, Acuña-Villaorduña, A, Zeballos-Palacios, C, Cardenas-Montero, D, Reyes-Diaz, M et al. (2017) Perspectives, decision making, and final mode of delivery in pregnant women with a previous C-Section in a general hospital in Peru: prospective analysis. MDM Policy and Practice 2(2), 2381468317724409.CrossRefGoogle Scholar
Lin, HC and Xirasagar, S (2004) Institutional factors in cesarean delivery rates: policy and research implications. Obstetric and Gynecology 103(1), 128–136.Google ScholarPubMed
Liston, WA (2003) Rising caesarean section rates: can evolution and ecology explain some of the difficulties of modern childbirth? Journal of the Royal Society of Medicine 96(11), 559–561.CrossRefGoogle ScholarPubMed
Litorp, H, Mgaya, A, Mbekenga, CK, Kidanto, HL, Johnsdotter, S and Essén, B (2015) Fear, blame and transparency: obstetric caregivers’ rationales for high caesarean section rates in a low-resource setting. Social Science & Medicine 143, 232–240.CrossRefGoogle Scholar
Liu, S, Liston, RM, Joseph, KS, Heaman, M, Sauve, R and Kramer, MS (2007) Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian Medical Association Journal 176(4), 455–460.CrossRefGoogle Scholar
MacDorman, MF, Declercq, E, Menacker, F and Malloy, MH (2008) Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an ‘intention‐to‐treat’ model. Birth 35(1), 3–8.CrossRefGoogle ScholarPubMed
Menacker, F, Declercq, E and Macdorman, MF (2006) Cesarean delivery: background, trends, and epidemiology. Seminars in Perinatology 30(5), 235–241.Google Scholar
Milcent, C and Rochut, J (2009) Hospital payment system and medical practice. Cesarean births in France. Revue économique 60(2), 489–506.CrossRefGoogle Scholar
Milcent, C and Zbiri, S (2018) Prenatal care and socioeconomic status: effect on cesarean delivery. Health Economics Review 8(1), 7.CrossRefGoogle ScholarPubMed
Mishra, US and Ramanathan, M (2002) Delivery-related complications and determinants of caesarean section rates in India. Health Policy and Planning 17(1), 90–98.CrossRefGoogle ScholarPubMed
Niino, Y (2011) The increasing cesarean rate globally and what we can do about it. Bioscience Trends 5(4), 139–150.CrossRefGoogle Scholar
Nour, NM (2006) Health consequences of child marriage in Africa. Emerging Infectious Diseases 12(11), 1644–1649.CrossRefGoogle ScholarPubMed
O’Donovan, C and O’Donovan, J (2018) Why do women request an elective cesarean delivery for non-medical reasons? A systematic review of the qualitative literature. Birth 45(2), 109–119.CrossRefGoogle Scholar
Padmadas, SS, Kumar, SS, Nair, SB and Kumari, KRA (2000) Caesarean section delivery in Kerala, India: evidence from a National Family Health Survey. Social Science & Medicine 51(4), 511–521.CrossRefGoogle ScholarPubMed
Pang, SMW, Leung, DTN, Leung, TY, Lai, CY, Lau, TK and Chung, TKH (2007) Determinants of preference for elective caesarean section in Hong Kong Chinese pregnant women. Hong Kong Medical Journal 13(2), 100–105.Google ScholarPubMed
Potter, JE, Berquó, E, Perpétuo, IH, Leal, OF, Hopkins, K, Souza, MR et al. (2001) Unwanted caesarean sections among public and private patients in Brazil: prospective study. British Medical Journal 323(7322), 1155–1158.CrossRefGoogle ScholarPubMed
Potter, JE, Hopkins, K, Faundes, A and Perpetuo, I (2008) Women’s autonomy and scheduled cesarean sections in Brazil: a cautionary tale. Birth 35(1), 33–40.CrossRefGoogle ScholarPubMed
Radhakrishnan, T, Vasanthakumari, KP and Babu, PK (2017) Increasing trend of Caesarean rates in India: evidence from NFHS-4. Journal of Medical Science and Clinical Research 5(8), 26167–26176.Google Scholar
Sanchez-Ramos, L, Wells, TL, Adair, CD, Arcelin, G, Kaunitz, AM and Wells, DS (2001) Route of breech delivery and maternal and neonatal outcomes. International Journal of Gynaecology and Obstetric 73(1), 7–14.CrossRefGoogle ScholarPubMed
Silver, RM (2012) Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. Seminars in Perinatology 36(5), 315–323.Google Scholar
Singh, S (2010) Women’s autonomy in rural India: need for culture and context. International Social Work 53(2), 169–186.CrossRefGoogle Scholar
Souza, JP, Gulmezoglu, A, Lumbiganon, P, Laopaiboon, M, Carroli, G, Fawole, B et al. (2010) Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal and Perinatal Health. BMC Medicine 8, 71.CrossRefGoogle ScholarPubMed
Sufang, G, Padmadas, SS, Fengmin, Z, Brown, JJ and Stones, RW (2007) Delivery settings and caesarean section rates in China. Bulletin of the World Health Organization 85(10), 755–762.CrossRefGoogle ScholarPubMed
Tapia, V, Betran, AP and Gonzales, GF (2016) Caesarean section in Peru: analysis of trends using the Robson Classification System. PLoS One 11(2), e0148138.CrossRefGoogle ScholarPubMed
Tatar, M, Gunalp, S, Somunoglu, S and Demirol, A (2000) Women’s perceptions of caesarean section: reflections from a Turkish teaching hospital. Social Science & Medicine 50(9), 1227–1233.CrossRefGoogle ScholarPubMed
Thompson, JF, Roberts, CL, Currie, M and Ellwood, DA (2002) Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth 29(2), 83–94.CrossRefGoogle ScholarPubMed
Tilstra, AM (2018) Estimating educational differences in Low-Risk Cesarean Section delivery: a multilevel modeling approach. Population Research and Policy Review 37(1), 117–135.CrossRefGoogle Scholar
Van Roosmalen, J and Van der Does, CD (1995) Caesarean birth rates worldwide. A search for determinants. Tropical and Geographical Medicine 47(1), 19.Google ScholarPubMed
Weaver, JJ, Statham, H and Richards, M (2007) Are there ‘unnecessary’ cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth 34(1), 32–41.Google ScholarPubMed
World Health Organization (2015) WHO Statement on Caesarean Section Rates. URL: https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/ (accessed 25th April 2019).Google Scholar
Ye, J, Zhang, J, Mikolajczyk, R, Torloni, MR, Gülmezoglu, AM and Betran, AP (2016) Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data. BJOG: An International Journal of Obstetrics & Gynaecology 123(5), 745–753.CrossRefGoogle ScholarPubMed
Zhang, J, Liu, Y, Meikle, S, Zheng, J, Sun, W and Li, Z (2008) Cesarean delivery on maternal request in southeast China. Obstetric and Gynecology 111(5), 1077–1082.CrossRefGoogle ScholarPubMed