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Household- and community-level determinants of low-risk Caesarean deliveries among women in India

Published online by Cambridge University Press:  30 January 2020

Pradeep Kumar Open the ORCID record for Pradeep Kumar [Opens in a new window]  and
Preeti Dhillon Open the ORCID record for Preeti Dhillon [Opens in a new window]
Pradeep Kumar*
Affiliation:
International Institute for Population Sciences, Mumbai, India
Preeti Dhillon
Affiliation:
International Institute for Population Sciences, Mumbai, India
*
*Corresponding author. Email: [email protected]
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Abstract

Caesarean section delivery rates in India have doubled from 9% in 2005–06 to 17% in 2015–16, increasing the clinical and economic burden on the health care system. This study applied multilevel models to assess the role of household- and community-level factors in Caesarean section (CS) deliveries among low-risk women in India using data from Round 4 of the National Family Health Survey (NFHS-4) conducted in 2015–16. The sample size was 59,318 low-risk women who had their last birth in an institution during the 5 years preceding the survey. These women were nested in 57,279 households, which were nested in 22,183 communities, which were further nested in 640 districts in India. Around 21% of the low-risk women and 24% of all women who had delivered in an institution had undergone CS. The CS rates among low-risk women were extremely high in private institutions (40%) and in southern India (43%). The explanatory variables age, education of women, household wealth and number of antenatal visits were significantly positively associated, while women’s parity was negatively associated, with CS delivery among low-risk women. The multilevel analysis suggested that the likelihood of a low-risk woman opting for CS was influenced by a similar decision of another woman from the same household (37%) and/or community (18%). Furthermore, women with low-risk pregnancies from higher educated communities were less likely (OR 0.92) to undergo CS. There is therefore a need for a community-level awareness programme on the risks and benefits of low-risk CS and vaginal delivery, particularly in the southern region of India.

Keywords

CaesareanLow-risk womenMultilevel
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 1 , January 2021 , pp. 55 - 70
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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