Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017

Dados Bibliográficos

ID21878602
AutoresRana Islamiah Zahroh (0000-0001-7831-2336, The University of Melbourne, autor correspondente), George Disney (0000-0002-6321-3084, The University of Melbourne), Ana Pilar Betran (0000-0002-5631-5883, World Health Organization), Meghan A Bohren (0000-0002-4179-4682, The University of Melbourne)
Ano2020
Volume5
Fascículo12
Páginase003844
Data de publicação2020-12-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoBMJ Global Health (JOURNAL)
Identificadores do periódicoISSN: 2059-7908 • E-ISSN: 2059-7908
EditoraBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-003844
PMID33380412
OpenAlexW3117499820
IdiomaEN
Citações recebidas3
Referências citadas45

INTRODUCTION: Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period. METHODS: Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference. RESULTS: The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales. CONCLUSION: This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS

Caesarean section · Economics · Geography · Inequality · Pregnancy · Public health · Residence · Socioeconomics · Sociology · Breastfeeding Practices and Influences · Demography · Maternal and Perinatal Health Interventions · Mathematics · Medicine · Surgical site infection prevention