Rohini Dutta, MBBS

Pronouns

She/Her/Hers

Job Title

Global Women's Health Fellow

Academic Rank

Department

Connors Center for Women's Health and Gender Biology

Authors

Rohini Dutta, Shagun Tuli, Minal Shukla, Priti Patil, Alex van Duinen, Neil Thivalapill, Anusha Jayaram, Nobhojit Roy, Anita Gadgil

Principal Investigator

Anita Gadgil

Research Category: PCERC/Health Policy/Outcomes

Geographic and Socioeconomic Disparities in Cesarean Delivery Rates at the District Level in Madhya Pradesh, India: A Secondary Analysis of the National Family Health Survey

Scientific Abstract

Background: Cesarean delivery (CD) accounts for 17.2% of births in India with 41% of CDs occurring in private facilities. There is a paucity of information on district level CD rates. We investigated geographic and socioeconomic inequities of CD among Madhya Pradesh’s (MP) 50 districts and compared the contribution of public and private healthcare facilities to the state’s CD rates.

Methods: This cross-sectional study used the National Family Health Survey (NFHS)-5 from January 2019- April 2021 to analyze district level CD rates. Descriptive statistics and univariate regression analysis were performed.

Results: Taking a 10-19% threshold for ‘optimal’ CD rate as per WHO, 6 districts had a CD rate of 10%, 18 had a rate below 10% while 26 districts were above the 10% threshold. CD rates in both private and public health care facilities declined as we moved from districts with relatively rich to poorer populations. However, this decline was steeper for private health care facilities (R2=0.382) revealing a possible dependency of the poor populations on public health care facilities (R2=0.009) in accessing CD.

Conclusion: Though in MP, the CD rates have increased from 8.2% in 2015 to 12.1% in 2019-21, the accessibility to CD is still in question. Our findings reveal a variation across districts due to factors such as wealth status and geographic constraints.

Lay Abstract

Background: Cesarean delivery (CD) accounts for 17.2% of births in India with 41% of CDs occurring in private facilities. There is a paucity of information on district-level CD rates. We aimed to investigate geographic and socioeconomic inequities of CD among Madhya Pradesh’s (MP) 50 districts and compare the contribution of public and private healthcare facilities to the state’s CD rates.

Methods: This cross-sectional study used the National Family Health Survey (NFHS)-5 from January 2019- April 2021 to analyze district-level CD rates. Descriptive statistics and univariate regression analysis were performed.

Results: Taking a 10-19% threshold for ‘optimal’ CD rate as per WHO, 6 districts had a CD rate of 10%, 18 districts had a rate below 10% while 26 districts were above the 10% threshold. CD rates in both private and public health care facilities declined as we moved from districts with relatively rich to poorer populations. However, this decline was steeper for private health care facilities (R2=0.382) revealing a possible dependency of the poor populations on public health care facilities (R2=0.009) in accessing CD.

Clinical Implications

Disaggregation of the CD rates with respect to the wealth quintiles highlights existing inequities within the public and private health systems. CD rates when stratified by socioeconomic development, women’s education, urbanization, fertility, and availability of skilled personnel reveal that richer, more educated women residing in urban areas are more likely to use private facilities to access CD than poorer, less educated, and rural women.

Geographic and Socioeconomic Disparities in Cesarean Delivery Rates at the District Level in Madhya Pradesh, India: A Secondary Analysis of the National Family Health Survey

Scientific Abstract

Lay Abstract

Clinical Implications

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