Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
International Institute for Population Sciences, Mumbai, India.
Soc Sci Med. 2019 Mar;224:45-57. doi: 10.1016/j.socscimed.2019.01.048. Epub 2019 Jan 31.
Increasing caesarean births is a global trend and of recent origin in India. Besides its utility and disutility, increasing caesarean births exert higher economic burden on households and the nation. Using 148,746 births from the National Family Health Survey, 2015-16, this paper examines the correlates and provides comparable estimates of out of pocket expenditure (OOPE) on caesarean births in public and private health centres in India. The monthly state specific rural-urban consumer price index and the OOPE on births over seven years are used to derive comparable OOPE estimate at 2016 prices. A composite variable combining type of birth and place of delivery is computed and classified as private and caesarean, public and caesarean, private and non-caesarean, public and non-caesarean. Descriptive statistics, logistic and tobit regression model were used to understand the differentials and determinants of OOPE on caesarean births. Caesarean births were significantly higher among mothers belonging to higher socioeconomic status, first order births, mothers with high BMI, pregnancy complications, repeat caesarean and in private health centres confirming that both maternal demand and institutional factors are leading to the increasing in caesarean rates in India. The mean OOPE of caesarean births in public health centres of poorer states was higher than that in the richer states of India (US$107 in low performing states compared to US$88 in high performing states) while such differentials across private health centres are small. The marginal effect of a caesarean birth in private health centres in low performing states was US$296 dollar higher than that of non-caesarean births. Improving the public health centres for conducting caesarean births, developing standard guideline for clinical practices in conducting caesarean births and creating awareness on comprehensive pregnancy care can reduce the caesarean rates and OOPE on caesarean birth in India.
剖宫产分娩的增加是一个全球性趋势，在印度是最近才出现的现象。除了其效用和弊端之外，剖宫产分娩的增加也给家庭和国家带来了更高的经济负担。本文利用 2015-16 年全国家庭健康调查中的 148746 例分娩数据，研究了剖宫产分娩的相关因素，并提供了在印度公立和私立医疗中心进行剖宫产分娩的自费支出（OOP）的可比估计。使用特定于州的每月农村-城市消费价格指数和七年期间的分娩 OOPE，将其换算为 2016 年价格的可比 OOPE 估计值。本文计算了一个结合分娩类型和分娩地点的综合变量，并将其分类为私立和剖宫产、公立和剖宫产、私立和非剖宫产、公立和非剖宫产。本文使用描述性统计、逻辑和 Tobit 回归模型来了解剖宫产自费支出的差异和决定因素。结果显示，社会经济地位较高、初产妇、BMI 较高、妊娠并发症、重复剖宫产以及在私立医疗中心分娩的母亲，剖宫产分娩的比例明显更高，这表明产妇需求和医疗机构因素都导致了印度剖宫产率的上升。较贫穷州的公立医院剖宫产自费支出的平均值高于印度较富裕州（表现较差的州为 107 美元，表现较好的州为 88 美元），而私立医疗中心之间的差异较小。在表现较差的州，私立医疗中心的剖宫产分娩的边际效应比非剖宫产分娩高出 296 美元。改善公立医院进行剖宫产的条件、制定剖宫产临床实践标准并提高全面妊娠护理意识，可以降低印度的剖宫产率和剖宫产自费支出。
