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. 2023 Aug 30;23(1):622.
doi: 10.1186/s12884-023-05928-4.

Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh

Varshini Neethi Mohan  1 , P Shirisha  2 , Girija Vaidyanathan  2 , V R Muraleedharan  2
Affiliations

Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh

Varshini Neethi Mohan et al. BMC Pregnancy Childbirth. .

Erratum in

Abstract

Background: The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG).

Methods: Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions.

Results: The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95-2.29; NFHS-5) those for underweight women. Women aged 35-49 were also twice (OR = 2.10; 95% CI 1.92-2.29; NFHS-5) as likely as those aged 15-24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74-4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor.

Conclusion: The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.

Keywords: C-section delivery; Caesarean section; India; Inequality; NFHS-5; Private Sector.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of C-Section deliveries across the states of India (NFHS-4 and NFHS-5)
Fig. 2
Fig. 2
Proportions of C-sections in the Public and Private Sectors for NFHS-3, 4 and 5
Fig. 3
Fig. 3
Trends in C-section prevalence for the poor and the non-poor in public facilities in India, TN and CG across NFHS-4 and − 5
Fig. 4
Fig. 4
Trends in C-section prevalence for the poor and the non-poor in private facilities in India, TN and CG across NFHS-4 and 5
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References

    1. Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29. - PubMed
    1. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS et al. Short-term and long-term effects of caesarean section on the health of women and children. The Lancet. 2018;392(10155):1349–57. Available from: http://www.thelancet.com/article/S0140673618319305/fulltext. - PubMed
    1. Regan J, Thompson A, Defranco E. The influence of mode of delivery on breastfeeding initiation in women with a prior cesarean delivery: a population-based study. Breastfeed Med. 2013;8(2). - PMC - PubMed
    1. Surana M, Dongre A. Too much care: private healthcare sector and caesarean sections in India. Econ Polit Wkly. 2020;55(35).
    1. Matevosyan NR. The overuse of Cesarean Section: Medical, Legal, Research, and economical pitfalls. J Knowl Econ. 2015;6(4):1090–103. doi: 10.1007/s13132-013-0178-z. - DOI