Dataset Information

Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016.

ABSTRACT:

Importance

The World Health Organization recommends that rates of cesarean delivery range from 10% to 15%. India has the largest annual number of births in the world and needs updates of existing estimates.

Objective

To provide a new set of estimates of the rates of cesarean delivery and to map regional and socioeconomic disparities within these rates in India.

Design, setting, and participants

Cross-sectional study primarily based on cross-sectional figures drawn from the fourth round of the National Family and Health Survey conducted from January 20, 2015, through December 4, 2016, by the Indian Institute for Population Sciences in Mumbai. The survey interviewed 699?686 girls and women aged 15 to 49 years and collected information on their last 3 pregnancies since January 2010 (259?627 births). The study population was statistically representative of India's 36 states and Union territories and its 640 districts. The survey also included information on the socioeconomic status of households. The research is based on data tabulations and mapping and on spatial and regression analyses of microdata. Socioeconomic inequalities in access to cesarean deliveries were assessed using the Gini coefficient. Data were analyzed from August to October 2018.

Main outcomes and measures

Rate of cesarean deliveries by regional and socioeconomic characteristics.

Results

The cesarean birth rate computed for 699?686 Indian girls and women aged 15 to 49 years (mean [SD] age, 26.8 [5.0] years) was 17.2% (95% CI, 17.1%-17.3%) in 2010 to 2016, which corresponds to an estimated 4.38 million cesarean deliveries per year during the period (95% CI, 4.34-4.41 million) in India. Cesarean birth rates vary widely within the country, with a range of 5.8% (95% CI, 5.1%-6.5%) to 40.1% (95% CI, 38.4%-41.8%) across states and 4.4% (95% CI, 4.3%-4.6%) to 35.9% (35.4%-36.4%) across socioeconomic quintiles. The rate significantly increased from 9.2% (95% CI, 9.1%-9.3%) in 2004 to 2008. According to the recommended 10% to 15% benchmark of cesarean birth rates by the WHO, the estimated deficit of cesarean births in India is 0.5 million per year, whereas the estimated excess of cesarean births is 1.8 million. The overall Gini coefficient of inequality in access to cesarean deliveries is 46.4.

Conclusions and relevance

The rate of cesarean births is increasing in India and has already crossed the World Health Organization threshold of 15%. More research is needed to understand the factors behind the rapid rise of cesarean deliveries among affluent groups and in more developed regions.

SUBMITTER: Guilmoto CZ

PROVIDER: S-EPMC6583298 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016.

Guilmoto Christophe Z CZ Dumont Alexandre A

JAMA network open 20190301 3

<h4>Importance</h4>The World Health Organization recommends that rates of cesarean delivery range from 10% to 15%. India has the largest annual number of births in the world and needs updates of existing estimates.<h4>Objective</h4>To provide a new set of estimates of the rates of cesarean delivery and to map regional and socioeconomic disparities within these rates in India.<h4>Design, setting, and participants</h4>Cross-sectional study primarily based on cross-sectional figures drawn from the ...[more]

PMID: 30901040

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Project description:BackgroundThe prevalence of cesarean section procedures is on the rise worldwide, necessitating a deeper understanding of the factors driving this trend to mitigate potential adverse consequences associated with unnecessary cesarean section deliveries.ObjectivesThis study aims to investigate the rate of primary cesarean deliveries (PCD), a potential key indicator of obstetric care quality.Study designA national retrospective cohort study was conducted utilizing extensive data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan spanning the years 2012 to 2018. The study examined the temporal trends in PCD rates and the indications for these procedures across different prefectures. Additionally, the study employed the obstetrician disproportionality index, as published by the Ministry of Health, Labour, and Welfare, to assess the influence of obstetrician availability on PCD rates.ResultsThroughout the study period from 2012 to 2018, the rate of PCD in Japan remained relatively stable at approximately 14%. The primary indications for PCD in 2018 included labor arrest (18.3%), malpresentation (16.5%), nonreassuring fetal status (6.5%), and macrosomia (6.0%). Substantial regional disparities in PCD rates were observed, ranging from 8.9% to 20.4% among prefectures in 2018. Notably, prefectures categorized in the bottom 10 of the obstetrician disproportionality index exhibited significantly higher PCD rates compared to the top 10 prefectures (P=.0232), with a similar trend noted for PCD due to labor arrest (P=.0288). Furthermore, a negative correlation was identified between the obstetrician disproportionality index and PCD rates at the prefectural level (r=-0.3119, P=.0328).ConclusionsOur study presents a comprehensive analysis of PCD rates in Japan, shedding light on regional disparities and highlighting the notable influence of obstetrician availability on clinical decision-making. This study contributes to the ongoing discourse on the escalating global trend in cesarean sections and the importance of healthcare resource allocation in maternal care.

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Dataset Information

Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Trends, Regional Variations, and Socioeconomic Disparities in Cesarean Births in India, 2010-2016.

Similar Datasets

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