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. 2014 Dec 30;4(12):e005982.
doi: 10.1136/bmjopen-2014-005982.

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

Melissa Neuman  1 , Glyn Alcock  1 , Kishwar Azad  2 , Abdul Kuddus  2 , David Osrin  1 , Neena Shah More  3 , Nirmala Nair  4 , Prasanta Tripathy  4 , Catherine Sikorski  1 , Naomi Saville  1 , Aman Sen  5 , Tim Colbourn  1 , Tanja A J Houweling  6 , Nadine Seward  1 , Dharma S Manandhar  5 , Bhim P Shrestha  5 , Anthony Costello  1 , Audrey Prost  1
Affiliations

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

Melissa Neuman et al. BMJ Open. .

Abstract

Objectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia.

Design: Cross-sectional study.

Setting: 81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban).

Participants: 45,327 births occurring in the study areas between 2005 and 2012.

Outcome measures: Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location.

Results: Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57).

Conclusions: Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring.

Keywords: OBSTETRICS; PUBLIC HEALTH.

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References

    1. World Health Organisation and UNICEF. Countdown 2015: building a future for women and children, the 2012 Report. http://countdown2015mnch.org/documents/2012Report/2012-Complete.pdf (accessed 9 Nov 2013).
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006;368:1284–99. 10.1016/S0140-6736(06)69381-1 - DOI - PubMed
    1. Ronsmans C, De Brouwere V, Dubourg D et al. Measuring the need for life-saving obstetric surgery in developing countries. BJOG 2004;111:1027–30. 10.1111/j.1471-0528.2004.00247.x - DOI - PubMed
    1. World Health Organization. Appropriate technology for birth. Lancet 1985;2:436–7. - PubMed
    1. Betrán AP, Merialdi M, Lauer JA et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007;21:98–113. 10.1111/j.1365-3016.2007.00786.x - DOI - PubMed

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