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Cited by 64Maternal and Perinatal Health InterventionsGlobal Maternal and Child HealthReproductive Health and Contraception

Alarming Trends of Cesarean Section—Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India

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Pandey, Anuj Kumar, Raushan, Mukesh Ravi, Gautam, Diksha, Neogi, Sutapa Bandyopadhyay·2023·Journal of Medical Internet Research
DOI 10.2196/41892PMC PMC9972201
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Abstract

Background: Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. Objective: This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. Methods: Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. Results: The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. Conclusions: The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively.

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Authors
Pandey, A. K., Raushan, M. R., Gautam, D., & Neogi, S. B.
Affiliations
International Institute of Health Management Research, Delhi (IN)
Corresponding author
Neogi, Sutapa Bandyopadhyay
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2023-02-13
Volume
25
Pages
e41892
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/41892
PMC
PMC9972201
OpenAlex
W4312824815
Cited by
64
References
38
Citations by year
2026: 20 · 2025: 23 · 2024: 18 · 2023: 3
FWCI
11.04
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Journal of Medical Internet Research (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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, elective cesarean section, determinants of cesarean delivery, antenatal care visits, maternal education, intimate partner violence, urban-rural disparities, India, National Family Health Survey, maternal health policy, health system burden
MeSH terms
Cesarean Section, Cross-Sectional Studies, Educational Status, Female, Humans, India, Pregnancy, Prenatal Care

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