Prevalence and determinants of caesarean section delivery in Ethiopia: analysis of the 2019 EMDHS using Poisson regression with robust standard errors

Previous studies in Ethiopia have examined factors associated with caesarean section delivery, but all reported odd ratios from logistic regression. Prevalence ratios estimated using Poisson regression with robust standard errors is more directly interpretable for public health and policy audience than odd ratios. Therefore, this study aimed to determine the prevalence and associated factors of caesarean section delivery in Ethiopia using Poisson regression with robust standard errors. This study analyzed secondary data from 5753 reproductive-age women using 2019 Ethiopian Mini Demographic and Health Survey. Poisson regression with robust standard errors was performed using Stata version 17. Statistical significance was declared at p-value < 0.05, and Adjusted prevalence ratios (APR) with 95% confidence intervals (CIs) were reported. The prevalence of caesarean section delivery in Ethiopia was 6.1% (95% CI: 5.5–6.7). Women aged 35–49 years (APR = 1.79; 95% CI: 1.20–2.60, p = 0.004), those of Christian religion (APR = 1.70; 95% CI: 1.25–2.30, p = 0.001), and women with secondary (APR = 1.92; 95% CI: 1.40–2.70, p < 0.001) or higher education (APR = 2.20; 95% CI: 1.54–3.20, p < 0.001) had a significantly higher likelihood of caesarean delivery. Similarly, women with three ANC visits (APR = 4.70; 95% CI: 2.50–8.70, p < 0.001) or four or more visits (APR = 3.00; 95% CI: 1.67–5.40, p < 0.001), and those residing in Amhara region (APR = 2.03; 95% CI: 1.09–3.86, p = 0.026), Harari (APR = 2.04; 95% CI: 1.12–3.70, p = 0.019), Addis Ababa (APR = 2.25; 95% CI: 1.26–4.01, p = 0.006), and Dire Dawa (APR = 3.00; 95% CI: 1.70–5.50, p < 0.001) also had a significantly higher likelihood of undergoing caesarean delivery. In contrast, women residing in rural areas (APR = 0.68; 95% CI: 0.45–0.99, p = 0.045) and those with a high birth order (APR = 0.76; 95% CI: 0.58–0.98, p = 0.032) had a significantly lower prevalence ratio of caesarean delivery compared with their counterparts. Caesarean section delivery is rare in Ethiopia, with higher rates among older, educated, Christian women and those receiving more antenatal care, especially in urban areas like Addis Ababa and Dire Dawa. To address disparities, targeted efforts are needed to improve access in rural areas, strengthen antenatal care, and raise awareness among less-educated women and non-Christian women.