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Cited by 195Maternal and Perinatal Health InterventionsGlobal Maternal and Child HealthReproductive Health and Contraception

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal

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Neuman, Melissa, Alcock, Glyn, Azad, Kishwar, Kuddus, Abdul, Osrin, David, More, Neena Shah, Nair, Nirmala, Tripathy, Prasanta +10 more·2014·BMJ Open
DOI 10.1136/bmjopen-2014-005982PMC PMC4283435
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Abstract

OBJECTIVES: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. DESIGN: Cross-sectional study. SETTING: 81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban). PARTICIPANTS: 45,327 births occurring in the study areas between 2005 and 2012. OUTCOME MEASURES: Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location. RESULTS: Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57). CONCLUSIONS: Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring.

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Authors
Neuman, M., Alcock, G., Azad, K., Kuddus, A., Osrin, D., More, N. S., Nair, N., Tripathy, P., Sikorski, C., Saville, N., Sen, A., Colbourn, T., Houweling, T. A. J., Seward, N., Manandhar, D. S., Shrestha, B. P., Costello, A., & Prost, A.
Affiliations
  • University College London (GB)
  • Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
  • Society for Nutrition Education and Health Action (IN)
  • Ekjut (IN)
  • Mother and Infant Research Activities (NP)
  • Erasmus MC (NL)
Corresponding author
Prost, Audrey
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2014-12
Volume
4
Issue
12
Pages
e005982
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2014-005982
PMC
PMC4283435
OpenAlex
W2047256592
Cited by
195
References
2
Citations by year
2026: 15 · 2025: 11 · 2024: 18 · 2023: 25 · 2022: 9 · 2021: 24 · 2020: 22 · 2019: 24 · 2018: 24 · 2017: 12 · 2016: 8 · 2015: 3
FWCI
8.16
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion)
  • Greater South Information System
Funders
  • United States Agency for International Development
  • Wellcome Trust (091561/Z/10/Z, 085417MA/Z/08/Z, 85417MA/Z/08/Z, 091561, 100714, 081052, 085417)
  • UBS Optimus Foundation
  • Economic and Social Research Council (ES/I033572/1)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
cesarean section, private health facilities, public health facilities, institutional delivery, maternal education, urban-rural differences, underserved populations, South Asia, Bangladesh, India, Nepal
MeSH terms
Adolescent, Adult, Bangladesh, Cesarean Section, Charities, Cross-Sectional Studies, Educational Status, Female, Health Facilities, Health Services Accessibility, Humans, India, Nepal, Pregnancy, Pregnancy Complications, Residence Characteristics, Rural Population, Urban Population, Prevalence, Private Sector, Public Sector, Delivery, Obstetric, Young Adult

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