Research Institute for Sustainable Development (IRD)-Centre Population and Development (CEPED), INSERM ERL 1244, Université de Paris, 45 rue des saints pères, 75006, Paris, France.
Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung, P. 12, Q. 10, Ho Chi Minh City, Vietnam.
BMC Pregnancy Childbirth. 2021 Jan 4;21(1):3. doi: 10.1186/s12884-020-03482-x.
Women's empowerment, and maternal and neonatal health are important targets of the Sustainable Development Goals. Our objective is to examine the relationship between women's empowerment and elective cesarean section (ECS), focusing on Vietnam, a country where the use of CS has increased rapidly in recent decades, which raises public health concerns.
We hypothesized that in the context of the developing biomedicalization of childbirth, women's empowerment increases the use of ECS due to a woman's enhanced ability to decide her mode of delivery. By using microdata from the 2013-2014 Multiple Indicator Clusters Survey, we conducted a multivariate analysis of the correlates of ECS. We studied a representative sample of 1343 institutional single birth deliveries. Due to higher ECS rates among multiparous (18.4%) than primiparous women (10.1%) and the potential interaction between parity and other correlates, we used separate models for primiparous and multiparous women.
Among the indicators of women's external resources, which include a higher level of education, having worked during the previous 12 months, and having one's own mobile phone, only education differed between primiparous and multiparous women, with a higher level among primiparous women. Among primiparous women, no resource indicator was significantly linked to ECS. However, considering women's empowerment facilitated the identification of the negative impact of having had fewer than 3 antenatal care visits on the use of ECS. Among multiparous women, disapproval of intimate partner violence (IPV) was associated with a doubled likelihood of undergoing ECS (odds ratio = 2.415), and living in an urban area also doubled the likelihood of ECS. The positive association with living in the richest household quintile was no longer significant when attitude towards IPV was included in the model. In both groups, being aged 35 or older increased the likelihood of undergoing ECS, and this impact was stronger in primiparous women.
These results underline the multidimensionality of empowerment, its links to other correlates and its contribution to clarifying the influence of these correlates, particularly for distinguishing between medical and sociocultural determinants. The results advocate for the integration of women's empowerment into policies aimed at reducing ECS rates.
妇女赋权以及母婴健康是可持续发展目标的重要目标。我们的目的是研究妇女赋权与选择性剖宫产（CS）之间的关系，重点关注越南，这个国家在过去几十年中 CS 的使用迅速增加，这引起了公众健康的关注。
我们假设，在生育的生物医学化的背景下，由于妇女决定分娩方式的能力增强，妇女赋权会增加 CS 的使用。我们使用 2013-2014 年多指标类集调查的微观数据，对 CS 的相关因素进行了多变量分析。我们研究了一个代表性的 1343 例机构单胎分娩样本。由于经产妇（18.4%）的 CS 率高于初产妇（10.1%），并且产次与其他相关因素之间可能存在交互作用，因此我们为初产妇和经产妇分别建立了模型。
在包括教育程度较高、过去 12 个月内工作和拥有自己的移动电话等外部资源指标中，只有教育程度在初产妇和经产妇之间存在差异，初产妇的教育程度较高。在初产妇中，没有资源指标与 CS 显著相关。然而，考虑到妇女赋权有助于确定产前检查次数少于 3 次对 CS 使用的负面影响。在经产妇中，不赞成亲密伴侣暴力（IPV）与 CS 的可能性增加一倍（比值比=2.415），居住在城市地区也使 CS 的可能性增加一倍。当将对 IPV 的态度纳入模型时，与生活在最富裕家庭五分位数的正相关不再显著。在这两个群体中，年龄在 35 岁或以上会增加 CS 的可能性，而且这种影响在初产妇中更为明显。
这些结果强调了赋权的多维性，及其与其他相关因素的联系，以及其对澄清这些相关因素的影响的贡献，特别是用于区分医疗和社会文化决定因素。研究结果主张将妇女赋权纳入旨在降低 CS 率的政策中。
