Faculty of Public Health - Andalas University - OCS, 13th IEA SEA Meeting and ICPH - SDev

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Caesarean Section Births in South India: An Inference from District Level Analysis
Rakesh Mishra

Last modified: 2018-08-07


Background : Over the last few decades, there has been a dramatic increase in the rate of C-section deliveries across the world, including India where in some states like Telangana, it is recorded to be as high as 57.72 per cent. More than 95% of the district in South India have much higher cesarean deliveries than the ideal rate of 10%-15% (WHO). The increased estimates of C-section are not limited to private health facilities but varies significantly in the public health facilities as well across all districts and socioeconomic groups. Thus, it becomes essential to understand and differentiate the causes of rising C-section deliveries through an in-depth examination.

Materials and methods : The secondary data has been obtained from the recent wave of Indian Demographic Health Survey (NFHS-4), which was released in the public domain in 2018. Southern India has been carved out from India considering the extremely high C-section birth in the region. The analysis is based on the weighted sample of 47,199. Multivariate Oaxaca Decomposition has been employed to understand the difference C-section deliveries attributed to private and public health facilities in south India in the light of several socioeconomic, biodemographic, and complications cofactors.

Results : The quantum of C-section varies from a highest of 74.47% (Telangana) to a lowest of 38.64% (Kerala) in the private health facilities in south India, while it is above ideal level of 15% in all districts. Likely there is a huge disparity in the C-section deliveries in public health facilities as well. The analysis from Oaxaca Decomposition indicates that the wealth of the family contributes to 10.12% of the total variation in the incidence of the C-section deliveries between private and public health facilities. Complication factors contribute to 21.88% explanation of the difference in the C-section taking place in south India. Adding to that biodemographic covariates like under-nutrition, obesity and order of the birth also significantly contributes to the rising C-section in South India.

Conclusions : The remarkably higher C-section births are often used to indicate that all is not well within our health system in Southern India. However, a decidedly significant explained variation can be attributed to the lifestyle factors like obesity and undernutrition of the women. Economic factor like wealth of the household also contributes significantly to higher C-Section in Southern India. It has also been observed that the states with high institutionalised births and low fertility have considerably higher rates of C-section delivery.

Keywords :  C-section deliveries, Oaxaca Decomposition, Bio-demographic factors, Private and Public health facilities.