Prevalence and determinants ofcaesarean delivery at child birth order in India: Insights from national representative data

Abstract Background The safe delivery of a baby is a central issue of maternal and child health in low- and middle-income-countries. In India, the C section delivery has drastically increased from 2.9 percent to 17.2 percent nearly in last twenty-three years (NFSH-1, 1992-93 to NFSH-4, 2015-16). The alarming rate of c-section was found in southern states of India. Objective The present study aims to explain the prevalence and determinants of caesarean delivery at child birth order among Indian women aged 15–49 years. Methods Fourth wave of the National Family Health Survey (NFHS-4) data is used for study. Descriptive statistics were carried out to understand the distribution of study participants. Bivariate analysis was conducted to examine the prevalence of caesarean section delivery at the birth order of woman. The multivariable logistic regression was applied to examine the factors associated with c-section delivery at birth order of women. Results The incidence of c-sections was higher in first order birth and it proportionately decreased with increasing the birth order. A mother’s aged above 35 years is more inclined towards c-section (50.1%) at first birth than the last birth (3.5%). The difference of c-section delivery between at first and last birth order acutely found for women belonging to higher education (40.6 vs. 17.3%) and richest HHs quintile (39.3 vs. 13.7%). women aged above 35 years were more likely to experience for caesarean delivery than young mother of 15–24 years at first order birth (OR: 1.7, CI: 1.5–1.9) and second order birth (OR: 1.4, CI: 1.2–1.5). Private health care institutions hold a massive number of c-section deliveries. The women who had higher exposure to mass media were more likely to experience c-section delivery for all birth. Conclusion There is needed to examine elective or emergency CS for rational use of the procedure. There should be maintained strictly the useful guidance and norms of WHO recommendation regarding CS. Finally the holistic programmes in terms of public-private partnerships are needed to reduce unnecessary C-section cases for better improvement of women’s and newborn health.