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      Socioeconomic and geographical inequalities in delivery by cesarean section among women in Bangladesh, 2004–2017

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          Abstract

          Background

          There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017.

          Methods

          Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported.

          Results

          An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69–30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26–35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19–11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66–42.30).

          Conclusion

          We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.

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          Global epidemiology of use of and disparities in caesarean sections

          Ties Boerma, Carine Ronsmans, Dessalegn Y Melesse … (2018)
          In this Series paper, we describe the frequency of, trends in, determinants of, and inequalities in caesarean section (CS) use, globally, regionally, and in selected countries. On the basis of data from 169 countries that include 98·4% of the world's births, we estimate that 29·7 million (21·1%, 95% uncertainty interval 19·9-22·4) births occurred through CS in 2015, which was almost double the number of births by this method in 2000 (16·0 million [12·1%, 10·9-13·3] births). CS use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44·3% (41·3-47·4) of births, than in the west and central Africa region, where it was used in 4·1% (3·6-4·6) of births. The global and regional increases in CS use were driven both by an increasing proportion of births occurring in health facilities (accounting for 66·5% of the global increase) and increases in CS use within health facilities (33·5%), with considerable variation between regions. Based on the most recent data available for each country, 15% of births in 106 (63%) of 169 countries were by CS, whereas 47 (28%) countries showed CS use in less than 10% of births. National CS use varied from 0·6% in South Sudan to 58·1% in the Dominican Republic. Within-country disparities in CS use were also very large: CS use was almost five times more frequent in births in the richest versus the poorest quintiles in low-income and middle-income countries; markedly high CS use was observed among low obstetric risk births, especially among more educated women in, for example, Brazil and China; and CS use was 1·6 times more frequent in private facilities than in public facilities.
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            Trends and projections of caesarean section rates: global and regional estimates

            Ana Betran, Jiangfeng Ye, Ann-Beth Moller … (2021)
            Background The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. Methods We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. Results Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia. Conclusion The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.
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              Short-term and long-term effects of caesarean section on the health of women and children

              Jane Sandall, Rachel Tribe, Lisa Avery … (2018)
              The Lancet, 392(10155), 1349-1357
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                Author and article information

                Contributors
                Satyajit Kundu:
                ORCID: http://orcid.org/0000-0001-9610-1479
                satyajitnfs@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Pregnancy Childbirth
                Journal ID (iso-abbrev): BMC Pregnancy Childbirth
                Title: BMC Pregnancy and Childbirth
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2393
                Publication date (Electronic): 13 February 2024
                Publication date PMC-release: 13 February 2024
                Publication date Collection: 2024
                Volume: 24
                Electronic Location Identifier: 131
                Affiliations
                [1 ]Global Health Institute, North South University, ( https://ror.org/05wdbfp45) Dhaka, 1229 Bangladesh
                [2 ]Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, ( https://ror.org/03m50n726) Patuakhali, 8602 Bangladesh
                [3 ]Department of Public Health, North South University, ( https://ror.org/05wdbfp45) Dhaka, 1229 Bangladesh
                [4 ]Statistics Discipline, Khulna University, ( https://ror.org/05pny7s12) Khulna, 9208 Bangladesh
                [5 ]College of Health Sciences, University of Sharjah, ( https://ror.org/00engpz63) Sharjah, 27272 United Arab Emirates
                Author information
                http://orcid.org/0000-0001-9610-1479
                Article
                Publisher ID: 6327
                DOI: 10.1186/s12884-024-06327-z
                PMC ID: 10863140
                PubMed ID: 38350916
                SO-VID: d1ff9a24-ff5e-4c2b-89ba-b5c3c151f6b1
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 3 September 2023
                Date accepted : 7 February 2024
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: cesarean section,delivery,inequality,trends,bangladesh
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: cesarean section, delivery, inequality, trends, bangladesh

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