Determinants of Caesarean Section Delivery in the Southern Region of India: Insights From the National Family Health Survey 5

Introduction Global caesarean section (CS) rates have increased substantially during the last 20 years. High prevalence of CS delivery has been seen in the southern region of India. The objectives of this study are to determine the prevalence of delivery by CS in the southern region of India and to identify the significant factors associated with delivery by CS. Methods For this study, the data from the fifth round of the National Family Health Survey (NFHS-5) related to the southern region of India are considered. Descriptive statistics, Pearson's chi-square test, and multiple logistic regression analysis were used. Results The percentage of CS delivery in the southern region of India was 46%, which exceeded the guidelines of the World Health Organisation of a 10-15% threshold. Women belonging to the age group of 35-49, living in urban areas, were more likely to deliver by CS as compared to the women of the age group of 15-24 and in rural areas. Muslim, low-wealth quintile, and illiterate women were less likely to deliver by CS. Multiple logistic regression analysis revealed that women aged 25-34 years, those with higher education, and those from wealthier households, birth order of one or two, late age at first birth (≥30 years), overweight or obesity, and more antenatal care (ANC) visits were also significantly associated with delivery by CS. Deliveries in private facilities had three times higher odds of CS (aOR: 3.00; 95% CI: 2.82-3.19). Conclusion This study highlights the high prevalence of CS deliveries in the southern region of India. It underscores the urgent need for government interventions to reduce unnecessary CS and to promote safe, evidence-based, and natural childbirth practices.