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.

Autor: Dutta R; Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.; Mary Horigan Connors Centre for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA, USA., Tuli S; Department of General Practice, School of Medicine, University of Limerick, Limerick, Ireland., Shukla M; Department of Obstetrics and Gynecology, Public Health Consultant, India., Patil P; Department of Statistics, Bhabha Atomic Research Centre Hospital, Mumbai, India., van Duinen AJ; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.; Department of Surgery, St. Olavs Hospital Universitetssykehuset Trondheim, Trondheim, Norway., Thivalapill N; Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Ghoshal R; Gender Equality Centre, CARE India, New Delhi, India., Jayaram A; Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA., Roy N; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.; The George Institute for Global Health, New Delhi, India., Gadgil A; The George Institute for Global Health, New Delhi, India.; Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India.
Jazyk: angličtina
Zdroj: Global health action [Glob Health Action] 2023 Dec 31; Vol. 16 (1), pp. 2203544.
DOI: 10.1080/16549716.2023.2203544
Abstrakt: 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.
Databáze: MEDLINE
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