Mutually adjusted associations of type of facility of delivery and other selected determinants with caesarean section delivery, by location
| BD (rural) | IN (rural) | IN (urban) | NP (rural)* | |||||
|---|---|---|---|---|---|---|---|---|
| ORs (95% CIs) | ORs (95% CIs) | ORs (95% CIs) | ORs (95% CIs) | |||||
| Crude | Adjusted | Crude | Adjusted | Crude | Adjusted | Crude | Adjusted | |
| Health facility characteristics | ||||||||
| Public health facility (ref) | ||||||||
| Private health facility | 6.82 (5.96 to 7.81) | 5.91 (5.15 to 6.78) | 0.39 (0.25 to 0.61) | 0.46 (0.29 to 0.73) | 1.36 (1.21 to 1.52) | 1.22 (1.09 to 1.38) | 2.42 (1.48 to 3.94) | 2.37 (1.62 to 3.44) |
| Pregnancy and delivery characteristics | ||||||||
| 4+ antenatal care visits (fewer or none=ref)† | 1.46 (1.26 to 1.69) | 1.49 (0.96 to 2.32) | 1.06 (0.93 to 1.21) | 1.92 (1.43 to 2.58) | ||||
| Birth order | ||||||||
| 1 (ref) | ||||||||
| 2 | 0.95 (0.80 to 1.13) | 1.25 (0.80 to 1.95) | 0.65 (0.56 to 0.75) | 1.41 (1.02 to 1.94) | ||||
| 3 | 1.19 (0.94 to 1.52) | 0.36 (0.15 to 0.87) | 0.60 (0.50 to 0.71) | 0.58 (0.37 to 0.92) | ||||
| 4+ | 1.17 (0.90 to 1.53) | 0.36 (0.15 to 0.85) | 0.39 (0.32 to 0.48) | 1.00 (0.54 to 1.84) | ||||
| Serious complications in pregnancy/delivery‡ (no complications=ref) | 0.87 (0.76 to 1.00) | 1.77 (1.17 to 2.67) | 1.71 (1.39 to 2.11) | 4.87 (2.51 to 9.47) | ||||
| Multiple birth (ref=single) | 0.93 (0.65 to 1.32) | 1.57 (0.52 to 4.75) | 3.01 (2.14 to 4.23) | 3.42 (1.77 to 6.61) | ||||
| Maternal characteristics | ||||||||
| Age (years) | ||||||||
| 15–24 (ref) | ||||||||
| 25–34 | 1.12 (0.94 to 1.34) | 1.81 (1.14 to 2.86) | 1.45 (1.27 to 1.66) | 1.52 (0.63 to 1.94) | ||||
| 35+ | 1.10 (0.77 to 1.58) | 2.11 (0.63to 7.07) | 1.79 (1.27 to 2.53) | 1.55 (0.55 to 1.47) | ||||
| Maternal education§ | ||||||||
| No formal education (ref) | ||||||||
| Primary education | 1.07 (0.83 to 1.38) | 0.98 (0.39 to 2.47) | 1.13 (0.85 to 1.49) | 0.90 (0.59 to 1.39) | ||||
| Secondary education | 1.44 (1.13 to 1.84) | 1.11 (0.68 to 1.80) | 1.22 (1.04 to 1.42) | 1.37 (0.97 to 1.94) | ||||
| Bachelor degree or higher | 2.44 (1.52 to 3.92) | 1.20 (0.43 to 3.31) | 1.62 (1.30 to 2.02) | – | ||||
| Household wealth quintile | ||||||||
| 1st (poorest, ref) | ||||||||
| 2nd | 1.31 (1.06 to 1.63) | 1.61 (0.69 to 3.75) | 1.14 (0.77 to 1.68) | 1.11 (0.63 to 1.94) | ||||
| 3rd | 1.41 (1.10 to 1.82) | 1.36 (0.58 to 3.21) | 1.13 (0.95 to 1.33) | 0.90 (0.55 to 1.47) | ||||
| 4th (wealthiest) | 1.36 (1.09 to 1.70) | 2.16 (0.87 to 5.33) | 1.50 (1.27 to 1.78) | 0.99 (0.52 to 1.90) | ||||
| Year of delivery | ||||||||
| 2004–2006 (ref: BD, IN) | – | |||||||
| 2007–2009 (ref: NP rural) | 0.90 (0.74 to 1.10) | 0.90 (0.61 to 1.33) | 1.14 (1.09 to 1.38) | – | ||||
| 2010–2012 | 1.15 (0.94 to 1.41) | – | – | 1.29 (0.91 to 1.82) | ||||
| N | 4592 | 4592 | 1816 | 1816 | 9259 | 9259 | 1586 | 1586 |
All analyses additionally adjusted for survey design using fixed effect of stratum and random effect of cluster.
*Nepal numbers weighted using women’s probability of selection within each cluster, scaled to total number of institutional births.
†At least one visit with skilled provider.
‡Includes: symptoms of eclampsia (fits, seizures, convulsions, or unconsciousness during pregnancy or delivery); reduced or no fetal movement; labour lasting more than 24 h.
§For the Nepal data, two respondents with bachelor degrees (2 respondent total, 1 delivering in institution) were combined with respondents with secondary education.
BD, Bangladesh; IN, India; NP, Nepal.