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. 2021 Aug 12;16(8):e0256096.
doi: 10.1371/journal.pone.0256096. eCollection 2021.

Trends in cesarean section rates in private and public facilities in rural eastern Maharashtra, India from 2010-2017

Elizabeth Simmons  1 , Kevin Lane  2 , Sowmya R Rao  1 , Kunal Kurhe  3 , Archana Patel  3   4 , Patricia L Hibberd  1
Affiliations

Trends in cesarean section rates in private and public facilities in rural eastern Maharashtra, India from 2010-2017

Elizabeth Simmons et al. PLoS One. .

Abstract

Introduction: Rates of cesarean sections (CS) have increased dramatically over the past two decades in India. This increase has been disproportionately high in private facilities, but little is known about the drivers of the CS rate increase and how they vary over time and geographically.

Methods: Women enrolled in the Nagpur, India site of the Global Network for Women's and Children's Health Research Maternal and Neonatal Health Registry, who delivered in a health facility with CS capability were included in this study. The trend in CS rates from 2010 to 2017 in public and private facilities were assessed and displayed by subdistrict. Multivariable generalized estimating equations models were used to assess the association of delivering in private versus public facilities with having a CS, adjusting for known risk factors.

Results: CS rates increased substantially between 2010 and 2017 at both public and private facilities. The odds of having a CS at a private facility were 40% higher than at a public facility after adjusting for other known risk factors. CS rates had unequal spatial distributions at the subdistrict level.

Discussion: Our study findings contribute to the knowledge of increasing CS rates in both public and private facilities in India. Maps of the spatial distribution of subdistrict-based CS rates are helpful in understanding patterns of CS deliveries, but more investigation as to why clusters of high CS rates have formed in warranted.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Map of 20 primary health centers in Nagpur area.
Fig 2
Fig 2. Flow diagram.
Fig 3
Fig 3. Linear trend in population-based Cesarean section (CS) rate and histogram of number of private and public facilities from 2010 to 2017 by facility type.
Fig 4
Fig 4. Change in subdistrict population-based cesarean section rate from 2010 to 2017.
See this image and copyright information in PMC

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