PMID- 37139686
OWN - NLM
STAT- MEDLINE
DCOM- 20230505
LR  - 20230513
IS  - 1654-9880 (Electronic)
IS  - 1654-9716 (Print)
IS  - 1654-9880 (Linking)
VI  - 16
IP  - 1
DP  - 2023 Dec 31
TI  - Geographic and socioeconomic inequities in cesarean delivery rates at the 
      district level in Madhya Pradesh, India: A secondary analysis of the national 
      family health survey-5.
PG  - 2203544
LID - 10.1080/16549716.2023.2203544 [doi]
LID - 2203544
AB  - BACKGROUND: In India, caesarean delivery (CD) accounts for 17% of the births, of 
      which 41% occur in private facilities. However, areas to CD in rural areas are 
      limited, particularly for the poor populations. Little information is available 
      on state-wise district-level CD rates by geography and the population wealth 
      quintiles, especially in Madhya Pradesh (MP), the fifth most populous and third 
      poorest state. OBJECTIVE: Investigate geographic and socioeconomic inequities of 
      CD across the 51 districts in MP and compare the contribution of public and 
      private healthcare facilities to the overall state CD rate. METHODS: This 
      cross-sectional study utilised the summary fact sheets of the National Family 
      Health Survey (NFHS)-5 performed from January 2019 to April 2021. Women aged 15 
      to 49 years, with live births two years preceding the survey were included. 
      District-level CD rates in MP were used to determine the inequalities in 
      accessing CD in the poorer and poorest wealth quintiles. CD rates were stratified 
      as <10%, 10-20% and >20% to measure equity of access. A linear regression model 
      was used to examine the correlation between the fractions of the population in 
      the two bottom wealth quintiles and CD rates. RESULTS: Eighteen districts had a 
      CD rate below 10%, 32 districts were within the 10%-20% threshold and four had a 
      rate of 20% or higher. Districts with a higher proportion of poorer population 
      and were at a distance from the capital city Bhopal were associated with lower CD 
      rates. However, this decline was steeper for private healthcare facilities 
      (R2 = 0.382) revealing a possible dependency of the poor populations on public 
      healthcare facilities (R2 = 0.009) for accessing CD. CONCLUSION: Although CD 
      rates have increased across MP, inequities within districts and wealth quintiles 
      exist, warranting closer attention to the outreach of government policies and the 
      need to incentivise CDs where underuse is significant.
FAU - Dutta, Rohini
AU  - Dutta R
AUID- ORCID: 0000-0002-9674-0067
AD  - Program in Global Surgery and Social Change, Department of Global Health and 
      Social Medicine, Harvard Medical School, Boston, MA, USA.
AD  - Mary Horigan Connors Centre for Women's Health and Gender Biology, Brigham and 
      Women's Hospital, Boston, MA, USA.
FAU - Tuli, Shagun
AU  - Tuli S
AUID- ORCID: 0000-0001-6820-4892
AD  - Department of General Practice, School of Medicine, University of Limerick, 
      Limerick, Ireland.
FAU - Shukla, Minal
AU  - Shukla M
AD  - Department of Obstetrics and Gynecology, Public Health Consultant, India.
FAU - Patil, Priti
AU  - Patil P
AD  - Department of Statistics, Bhabha Atomic Research Centre Hospital, Mumbai, India.
FAU - van Duinen, Alex J
AU  - van Duinen AJ
AUID- ORCID: 0000-0002-6943-0100
AD  - Department of Public Health and Nursing, Norwegian University of Science and 
      Technology, Trondheim, Norway.
AD  - Department of Surgery, St. Olavs Hospital Universitetssykehuset Trondheim, 
      Trondheim, Norway.
FAU - Thivalapill, Neil
AU  - Thivalapill N
AUID- ORCID: 0000-0003-3398-6710
AD  - Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
FAU - Ghoshal, Rakhi
AU  - Ghoshal R
AD  - Gender Equality Centre, CARE India, New Delhi, India.
FAU - Jayaram, Anusha
AU  - Jayaram A
AUID- ORCID: 0000-0003-3776-7419
AD  - Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA.
FAU - Roy, Nobhojit
AU  - Roy N
AUID- ORCID: 0000-0003-2022-7416
AD  - Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
AD  - The George Institute for Global Health, New Delhi, India.
FAU - Gadgil, Anita
AU  - Gadgil A
AD  - The George Institute for Global Health, New Delhi, India.
AD  - Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Glob Health Action
JT  - Global health action
JID - 101496665
SB  - IM
MH  - Pregnancy
MH  - Female
MH  - Humans
MH  - Cross-Sectional Studies
MH  - *Health Services Accessibility
MH  - *Cesarean Section
MH  - Poverty
MH  - India/epidemiology
MH  - Health Surveys
MH  - Socioeconomic Factors
PMC - PMC10161939
OTO - NOTNLM
OT  - Cesarean delivery rates
OT  - Global women's health
OT  - global surgery
OT  - health disparity
OT  - wealth quintiles
COIS- No potential conflict of interest was reported by the author(s).
EDAT- 2023/05/04 06:41
MHDA- 2023/05/05 06:42
PMCR- 2023/05/04
CRDT- 2023/05/04 04:04
PHST- 2023/05/05 06:42 [medline]
PHST- 2023/05/04 06:41 [pubmed]
PHST- 2023/05/04 04:04 [entrez]
PHST- 2023/05/04 00:00 [pmc-release]
AID - 2203544 [pii]
AID - 10.1080/16549716.2023.2203544 [doi]
PST - ppublish
SO  - Glob Health Action. 2023 Dec 31;16(1):2203544. doi: 
      10.1080/16549716.2023.2203544.