Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Dec 27;12(12):e0189260.
doi: 10.1371/journal.pone.0189260. eCollection 2017.

Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India

Gayatri Desai  1 , Ankit Anand  2 , Dhiren Modi  2 , Shobha Shah  3 , Kalpana Shah  1 , Ajay Shah  1 , Shrey Desai  2 , Pankaj Shah  1   2
Affiliations
Comparative Study

Rates, indications, and outcomes of caesarean section deliveries: A comparison of tribal and non-tribal women in Gujarat, India

Gayatri Desai et al. PLoS One. .

Abstract

Background: Even though the caesarean section is an essential component of comprehensive obstetric and newborn care for reducing maternal and neonatal mortality, there is a lack of data regarding caesarean section rates, its determinants and health outcomes among tribal communities in India.

Objective: The aim of this study is to estimate and compare rates, determinants, indications and outcomes of caesarean section. The article provides an assessment on how the inequitable utilization can be addressed in a community-based hospital in tribal areas of Gujarat, India.

Method: Prospectively collected data of deliveries (N = 19923) from April 2010 to March 2016 in Kasturba Maternity Hospital was used. The odds ratio of caesarean section was estimated for tribal and non-tribal women. Decomposition analysis was done to decompose the differences in the caesarean section rates between tribal and non-tribal women.

Results: The caesarean section rate was significantly lower among tribal compared to the non-tribal women (9.4% vs 15.6%, p-value < 0.01) respectively. The 60% of the differences in the rates of caesarean section between tribal and non-tribal women were unexplained. Within the explained variation, the previous caesarean accounted for 96% (p-value < 0.01) of the variation. Age of the mother, parity, previous caesarean and distance from the hospital were some of the important determinants of caesarean section rates. The most common indications of caesarean section were foetal distress (31.2%), previous caesarean section (23.9%), breech (16%) and prolonged labour (11.2%). There was no difference in case fatality rate (1.3% vs 1.4%, p-value = 0.90) and incidence of birth asphyxia (0.3% vs 0.6%, p-value = 0.26) comparing the tribal and non-tribal women.

Conclusion: Similar to the prior evidences, we found higher caesarean rates among non-tribal compare to tribal women. However, the adverse outcomes were similar between tribal and non-tribal women for caesarean section deliveries.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Number of deliveries and caesarean sections in KMH (2010–16), Bharuch, Gujarat.
Fig 2
Fig 2. Annual caesarean rates (%) among tribal and non-tribal women in KMH (2010–16), Bharuch, Gujarat.
See this image and copyright information in PMC

References

    1. Anderson I, Robson B, Connolly M, Al-Yaman F, Bjertness E, King A, et al. Indigenous and tribal peoples’ health (The Lancet—Lowitja Institute Global Collaboration): a population study. The Lancet. 2016;388(10040):131–157. - PubMed
    1. Stephens C, Porter J, Nettleton C, Willis R. Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide. The lancet. 2006;367(9527): 2019–2028. - PubMed
    1. Paxton A, Bailey P, Lobis S, Fry D. Global patterns in availability of emergency obstetric care. International Journal of Gynecology & Obstetrics. 2006;93(3):300–307. - PubMed
    1. Ronsmans C, Holtz S, Stanton C. Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. The Lancet 2006;368:1516–1523. - PubMed
    1. Weil O, Fernandez H. Is safe motherhood an orphan initiative? The Lancet 1999;54: 940–943. - PubMed

Publication types