+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries



Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries



BMJ 360: K55



To provide an update on economic related inequalities in caesarean section rates within countries. Secondary analysis of demographic and health surveys and multiple indicator cluster surveys. 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time. Women aged 15-49 years with a live birth during the two or three years preceding the survey. Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change. National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries. Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health.

(PDF emailed within 0-6 h: $19.90)

Accession: 059553305

Download citation: RISBibTeXText

PMID: 29367432

DOI: 10.1136/bmj.k55


Related references

Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2019, 2019

Caesarean section is highly risky for mothers and babies in low and middle income countries. BMJ 364: L1499, 2019

Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013. Health Economics, Policy, and Law 2018: 1-25, 2018

Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network. Reproductive Health 12 Suppl 2: S7, 2016

Investigating equalisation of health inequalities during adolescence in four low-income and middle-income countries: an analysis of the Young Lives cohort study. BMJ Open 8(9): E022114, 2018

Seatbelt wearing rates in middle income countries: a cross-country analysis. Accident; Analysis and Prevention 71: 115-119, 2015

Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low- and Middle-Income Countries: A Hospital-Level Analysis of Two WHO Surveys. Paediatric and Perinatal Epidemiology 31(4): 251-262, 2017

Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature. BMJ Open 6(3): E010391, 2016

Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of Demographic and Health Survey data. International Journal of Epidemiology 42(3): 781-791, 2014

Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries. Maternal and Child Health Journal 20(2): 434-446, 2015

Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries. Injury Prevention 14(5): 284-289, 2008

Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries. Tobacco Control 27(1): 26-34, 2016

Socioeconomic inequalities in risk factors for noncommunicable diseases in low-income and middle-income countries. 2012

Reporting of inequalities in blindness in low income and middle income countries: a review of cross sectional surveys. Clinical and Experimental Ophthalmology 46(1): 99-100, 2017

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet 378(9799): 1339-1353, 2011