Karmakar Gobinda, Tariqujjaman Md, Alam Aklima, Haque Md Ahshanul, Naila Nurun Nahar, Ahmed Tahmeed
Nutrition Research Division, icddr, b, Dhaka, Bangladesh.
PLoS One. 2025 Sep 12;20(9):e0328830. doi: 10.1371/journal.pone.0328830. eCollection 2025.
The extensive use of caesarean delivery has adverse consequences for both maternal and neonatal health. This study aims is to investigate regional variation and identify region-specific determinants of caesarean deliveries among ever-married women in Bangladesh.
A total of 17,704 women aged 15-49 who had given birth to children within three years preceding each of the surveys were included in this study, based on the last four consecutive nationally representative surveys between 2011 and 2022. Various demographics and socio-economic variables were considered as exposure variables. Bivariate and multiple mixed-effects logistic regression models were used to draw inferences from the data.
In Bangladesh, between 2011 and 2022, the percentage of caesarean deliveries increased threefold (15% to 46%). Additionally, more than half of the children born in Dhaka and Khulna were via caesarean deliveries. After adjusting for relevant covariates in each of the region-specific models, women with highly educated husbands had significantly higher odds of undergoing a caesarean delivery compared to those with less educated husbands in Barisal (OR: 4.48), Chattogram (OR: 2.69), and Rangpur (OR: 2.46) divisions. The likelihood of caesarean delivery was considerably higher among overweight or obese women in Dhaka and Sylhet (OR: 2.33 and 2.50), as well as among women living in households with higher wealth status than their counterparts in Sylhet and Khulna (OR: 2.95 and 2.22), respectively.
Policymakers can address the high rate of caesarean deliveries by targeting several key factors at various geographic levels. Raising family awareness about the benefits of normal delivery can encourage expectant parents to make informed choices. They should also ensure the quality of care provided in hospitals, ensuring that medical professionals follow evidence-based guidelines for childbirth. Furthermore, implementing a centralized or local pregnancy registration system may enhance the monitoring and access to maternal health services.
剖宫产的广泛使用对孕产妇和新生儿健康均有不良影响。本研究旨在调查孟加拉国已婚妇女剖宫产的地区差异，并确定特定地区剖宫产的决定因素。
基于2011年至2022年期间连续进行的四次全国代表性调查，本研究纳入了总共17704名年龄在15 - 49岁之间、在每次调查前三年内生育过子女的妇女。各种人口统计学和社会经济变量被视为暴露变量。使用双变量和多变量混合效应逻辑回归模型对数据进行推断。
在孟加拉国，2011年至2022年期间，剖宫产的比例增长了两倍（从15%增至46%）。此外，在达卡和库尔纳出生的孩子中，超过一半是通过剖宫产出生的。在每个特定地区模型中对相关协变量进行调整后，与丈夫受教育程度较低的妇女相比，丈夫受教育程度高的妇女在巴里萨尔（比值比：4.48）、吉大港（比值比：2.69）和朗布尔（比值比：2.46）地区进行剖宫产的几率显著更高。在达卡和锡尔赫特，超重或肥胖妇女进行剖宫产的可能性相当高（比值比：2.33和2.50），在锡尔赫特和库尔纳，生活在财富状况高于同龄人的家庭中的妇女进行剖宫产的可能性也分别相当高（比值比：2.95和2.22）。
政策制定者可以通过针对不同地理层面的几个关键因素来解决剖宫产率高的问题。提高家庭对顺产益处的认识可以鼓励准父母做出明智的选择。他们还应确保医院提供的护理质量，确保医疗专业人员遵循基于证据的分娩指南。此外，实施集中或地方妊娠登记系统可能会加强对孕产妇健康服务的监测和获取。
