Differentials and Determinants of Cesarean Deliveries in India: Insights from High Prevalent States

Purpose: With the increasing prevalence of cesarean deliveries in India, this study aimed to assess the differentials and determinants of these deliveries in highly prevalent states across India. This study used mixed methods (quantitative and qualitative) to fulfil the objectives. Design/methodology/approach: The research team collected quantitative data from recently delivered mothers through normal vaginal delivery and cesarean delivery. Moreover, qualitative data was collected via in-depth interviews (IDIs) from 37 obstetrician-gynaecologists. While analyzing quantitative data, proportion tests and multivariable logistic regression analysis were used. Findings: Proportion tests suggest that the prevalence of cesarean delivery was significantly higher in private health facilities, obese women, and women who had a history of cesarean delivery and who were living in households with business- or salary-based income. After adjusting for other covariates, the regression results suggest that women who delivered in private health facilities and those who were obese were more likely to have a cesarean delivery compared to women who delivered in public health facilities and those who were not obese, respectively. We did not find any association between cesarean deliveries with age and physical stature of women. Women who are obese, delivered in private health facilities, and had a previous history of cesarean delivery are more likely to be delivered through cesarean delivery. The qualitative data support these findings. Originality: To tackle increasing cesarean rates, the government needs to develop strict policies centric on primigravida and obese women. Moreover, rigorous monitoring of private health facilities might help control increased cesarean rates. Key words: Cesarean delivery, qualitative, quantitative, differentials and determinants, India.