Trends and changes in cesarean delivery rates in Iraq: findings from the multiple indicator cluster surveys, 2011-2018

Abstract

Background: The increasing trend of cesarean section (CS) delivery can significantly increase the morbidity and mortality among infants and mothers, especially when it is medically unjustified. This study aimed to assess the trends and changes in the CS rates in Iraq between 2011 and 2018 and determine the factors associated with increased rates.

Materials and methods: This study included secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018. The CS rates were calculated for both 2011 and 2018 surveys by governorate and by other exposure variables. The relative change in the CS rates between 2011 and 2018 surveys was computed for each variable.

Results: The CS rates in the 2018 survey remarkably increased compared to the rates of the 2011 survey. The relative change (RC) for Iraq was 49.5%, 58.5% for the Kurdistan Region, and 45.1% for the rest of Iraq. The increase was highest in Kirkuk (RC = 119.5%), Ninewa (RC = 81.1%), and Erbil (RC = 75.4%). The increase was highest among women aged less than 20 years (RC = 80.7%), women with no education (RC = 85.1%), women in the poorest and the middle wealth quintiles (RC = 55.9 and 55.8%), and women from rural areas (RC = 86.3%).

Conclusion: The CS rate in Iraq is significantly higher than the recommended rate. The rates are higher in the Kurdistan Region, while the whole country has witnessed a remarkable increasing trend from 2011 to 2018. The CS rates are higher among women with higher socioeconomic status, while the increasing trend is higher among women with lower socioeconomic status.

Keywords: Cesarean section; associated factors; increasing trend; rate.