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. 2019 Aug 29;14(8):e0221778.
doi: 10.1371/journal.pone.0221778. eCollection 2019.

Examining inequalities in access to delivery by caesarean section in Nigeria

Boniface Ayanbekongshie Ushie  1 , Ekerette Emmanuel Udoh  2 , Anthony Idowu Ajayi  1
Affiliations

Examining inequalities in access to delivery by caesarean section in Nigeria

Boniface Ayanbekongshie Ushie et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Concentration curve for cumulative caesarean delivery by wealth quintile in Nigeria.
See this image and copyright information in PMC

References

    1. World Health Organization, UNICEF. Trends in maternal mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division; 2014.
    1. Pathak PK, Singh A, Subramanian S. Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992–2006. PloS one. 2010;5(10):e13593 10.1371/journal.pone.0013593 - DOI - PMC - PubMed
    1. Dahlgren G, Whitehead M. European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen: World Health Organization; 2006.
    1. Tumwine JK. Equitable access to health care. BMJ. 2007. - PMC - PubMed
    1. Meyer SB, Luong TC, Mamerow L, Ward PR. Inequities in access to healthcare: analysis of national survey data across six Asia-Pacific countries. BMC health services research. 2013;13(1):238. - PMC - PubMed