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
. 2024 Aug 14;24(1):538.
doi: 10.1186/s12884-024-06722-6.

Caesarean section and associated factors in Nigeria: assessing inequalities between rural and urban areas-insights from the Nigeria Demographic and Health Survey 2018

Emmanuel O Adewuyi  1 , Wole Akosile  2   3 , Victory Olutuase  4 , Aaron Akpu Philip  5 , Rhoda Olaleru  6 , Mary I Adewuyi  7 , Asa Auta  8 , Vishnu Khanal  9   10
Affiliations

Caesarean section and associated factors in Nigeria: assessing inequalities between rural and urban areas-insights from the Nigeria Demographic and Health Survey 2018

Emmanuel O Adewuyi et al. BMC Pregnancy Childbirth. .

Abstract

Introduction: When medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria.

Methods: We disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria's overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis.

Results: CS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of 0.7%, 1.5% and 0.4% for the overall, urban and rural areas, respectively. Mothers with higher education demonstrated a greater CS prevalence of 14.0% overall, 15.3% in urban and 9.7% in rural residences. Frequent internet use increased CS prevalence nationally (14.3%) and in urban (15.1%) and rural (10.1%) residences. The southern regions showed higher CS prevalence, with the South-West leading overall (7.0%) and in rural areas (3.3%), and the South-South highest in urban areas (8.5%). Across all residences, rich wealth index, maternal age ≥ 35, lower birth order, and ≥ eight antenatal (ANC) contacts increased the odds of a CS. In rural Nigeria, husbands' education, spouses' joint healthcare decisions, birth size, and unplanned pregnancy increased CS odds. In urban Nigeria, multiple births, Christianity, frequent internet use, and ease of getting permission to visit healthcare facilities were associated with higher likelihood of CS.

Conclusion: CS utilisation remains low in Nigeria and varies across rural-urban, regional, and socioeconomic divides. Targeted interventions are imperative for uneducated and socioeconomically disadvantaged mothers across all regions, as well as for mothers in urban areas who adhere to Islam, traditional, or 'other' religions. Comprehensive intervention measures should prioritise educational opportunities and resources, especially for rural areas, awareness campaigns on the benefits of medically indicated CS, and engagement with community and religious leaders to promote acceptance using culturally and religiously sensitive approaches. Other practical strategies include promoting optimal ANC contacts, expanding internet access and digital literacy, especially for rural women (e.g., through community Wi-Fi programs), improving healthcare infrastructure and accessibility in regions with low CS prevalence, particularly in the North-West, and implementing socioeconomic empowerment programs, especially for women in rural areas.

Keywords: Caesarean section; Childbirth; Emergency obstetric care; Inequalities; Maternal-child health; Nigeria; Rural-urban differences.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CS prevalence across rural and urban residences in Nigeria
Fig. 2
Fig. 2
CS prevalence by rural and urban residences across regions in Nigeria
Fig. 3
Fig. 3
CS prevalence by rural and urban residences across maternal education level
Fig. 4
Fig. 4
CS prevalence by rural and urban residences across wealth index
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Betrán AP, et al. WHO statement on caesarean section rates. BJOG. 2016;123:667. 10.1111/1471-0528.13526 - DOI - PMC - PubMed
    1. Mylonas I, Friese K. Indications for and risks of elective cesarean section. Deutsches Ärzteblatt International. 2015;112:489. - PMC - PubMed
    1. Sung S, Mahdy H. Cesarean Section. [Updated 2023 Jul 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546707/ - PubMed
    1. Miller S, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388:2176–92. 10.1016/S0140-6736(16)31472-6 - DOI - PubMed
    1. Gibbons L, et al. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep. 2010;30:1–31.

LinkOut - more resources