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Prevalence and determinants of voluntary caesarean deliveries and socioeconomic inequalities in India: Evidence from National Family Health Survey (2015-16)
Authors: Shri Kant Singh, Deepanjali Vishwakarma, and Santosh Kumar Sharma
Source: Clinical Epidemiology and Global Health, Published online; DOI: 10.1016/j.cegh.2019.08.018
Topic(s): Cesarean section
Inequality
Institutional births
Maternal mortality
Country: Asia
  India
Published: AUG 2019
Abstract: Introduction With a substantial increase in Institutional births in India, the prevalence of C-section section deliveries witnessed a sharp rise, with a highly skewed prevalence among births in private health facilities. The study aims to investigate the dynamics of voluntary C-section across different socio-cultural strata in India, along its major drivers. Methods The study used data on 249,949 live births in the five years preceding 2015-16 NFHS-4 covering 699,686 women from 601,000 households across 640 districts in the country. Bivariate and binary logistic regression analysis have been used to analyses the data. The economic inequalities in voluntary C-section have been analyzed using the poor-rich ratio and the concentration index (CI) Results Seventeen percent of live births in five years preceding NFHS-4 were delivered by C-section, a sharp rise from 9% in 2005-06. C-section deliveries are common among first births (24%), in private sector health facilities (41% of deliveries), higher educated mothers and those residing in urban areas (28%). The likelihood of C-section deliveries is significantly higher among mother from high-income families. Values of the poor-rich ratio (0.092) and concentration index (0.031) has significantly revealed that voluntary C-section is more concentrated among the affluent class of households in India. Conclusions The study concludes that older women, higher educated mothers, residing in urban areas and, belonging to high socio-economic status are the ones who opt for voluntary C-section deliveries and seek private instructional delivery. The government of India should strengthen the regulatory protocol for private health facilities. Keywords Voluntary C-Section; Socioeconomic inequality; Maternal health; India