International Institute for Population Sciences, Mumbai, India.
J Biosoc Sci. 2021 Jan;53(1):55-70. doi: 10.1017/S0021932020000024. Epub 2020 Jan 30.
Caesarean section delivery rates in India have doubled from 9% in 2005-06 to 17% in 2015-16, increasing the clinical and economic burden on the health care system. This study applied multilevel models to assess the role of household- and community-level factors in Caesarean section (CS) deliveries among low-risk women in India using data from Round 4 of the National Family Health Survey (NFHS-4) conducted in 2015-16. The sample size was 59,318 low-risk women who had their last birth in an institution during the 5 years preceding the survey. These women were nested in 57,279 households, which were nested in 22,183 communities, which were further nested in 640 districts in India. Around 21% of the low-risk women and 24% of all women who had delivered in an institution had undergone CS. The CS rates among low-risk women were extremely high in private institutions (40%) and in southern India (43%). The explanatory variables age, education of women, household wealth and number of antenatal visits were significantly positively associated, while women's parity was negatively associated, with CS delivery among low-risk women. The multilevel analysis suggested that the likelihood of a low-risk woman opting for CS was influenced by a similar decision of another woman from the same household (37%) and/or community (18%). Furthermore, women with low-risk pregnancies from higher educated communities were less likely (OR 0.92) to undergo CS. There is therefore a need for a community-level awareness programme on the risks and benefits of low-risk CS and vaginal delivery, particularly in the southern region of India.
印度的剖宫产率从 2005-06 年的 9%增加到 2015-16 年的 17%，这增加了医疗保健系统的临床和经济负担。本研究应用多水平模型，利用 2015-16 年进行的第四次全国家庭健康调查（NFHS-4）的数据，评估了家庭和社区层面因素在印度低风险妇女剖宫产中的作用。样本量为 59318 名低风险妇女，她们在调查前 5 年内曾在机构中分娩。这些妇女被嵌套在 57279 个家庭中，这些家庭嵌套在 22183 个社区中，这些社区进一步嵌套在印度的 640 个地区中。约 21%的低风险妇女和 24%的所有在机构分娩的妇女接受了剖宫产。低风险妇女在私立机构（40%）和印度南部（43%）的剖宫产率极高。解释变量妇女的年龄、教育、家庭财富和产前检查次数与剖宫产呈显著正相关，而妇女的产次与低风险妇女的剖宫产呈负相关。多水平分析表明，低风险妇女选择剖宫产的可能性受到同一家庭（37%）和/或社区（18%）中另一名妇女类似决定的影响。此外，来自受教育程度较高社区的低风险妊娠妇女接受剖宫产的可能性较低（OR 0.92）。因此，需要在社区层面开展关于低风险剖宫产和阴道分娩风险和益处的宣传计划，特别是在印度南部地区。
