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Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017
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 countri...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780721/ https://www.ncbi.nlm.nih.gov/pubmed/33380412 http://dx.doi.org/10.1136/bmjgh-2020-003844 |
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author | Zahroh, Rana Islamiah Disney, George Betrán, Ana Pilar Bohren, Meghan A. |
author_facet | Zahroh, Rana Islamiah Disney, George Betrán, Ana Pilar Bohren, Meghan A. |
author_sort | Zahroh, Rana Islamiah |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7780721 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-77807212021-01-11 Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 Zahroh, Rana Islamiah Disney, George Betrán, Ana Pilar Bohren, Meghan A. BMJ Glob Health Original Research 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. BMJ Publishing Group 2020-12-30 /pmc/articles/PMC7780721/ /pubmed/33380412 http://dx.doi.org/10.1136/bmjgh-2020-003844 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Original Research Zahroh, Rana Islamiah Disney, George Betrán, Ana Pilar Bohren, Meghan A. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title | Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title_full | Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title_fullStr | Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title_full_unstemmed | Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title_short | Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017 |
title_sort | trends and sociodemographic inequalities in the use of caesarean section in indonesia, 1987-2017 |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780721/ https://www.ncbi.nlm.nih.gov/pubmed/33380412 http://dx.doi.org/10.1136/bmjgh-2020-003844 |
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