Prevalence and determinants of voluntary caesarean deliveries and socioeconomic inequalities in India: Evidence from National Family Health Survey (2015-16)

Introduction: With a substantial increase in Institutional births in India, the prevalence of C-section section deliveries witnessed a sharp rise, with a highly skewed prevalence among births in private health facilities. The study aims to investigate the dynamics of voluntary C-section across different socio-cultural strata in India, along its major drivers. Methods: The study used data on 249,949 live births in the five years preceding 2015-16 NFHS-4 covering 699,686 women from 601,000 households across 640 districts in the country. Bivariate and binary logistic regression analysis have been used to analyses the data. The economic inequalities in voluntary C-section have been analyzed using the poor-rich ratio and the concentration index (CI) Results: Seventeen percent of live births in five years preceding NFHS-4 were delivered by C-section, a sharp rise from 9% in 2005-06. C-section deliveries are common among first births (24%), in private sector health facilities (41% of deliveries), higher educated mothers and those residing in urban areas (28%). The likelihood of C-section deliveries is significantly higher among mother from high-income families. Values of the poor-rich ratio (0.092) and concentration index (0.031) has significantly revealed that voluntary C-section is more concentrated among the affluent class of households in India. Conclusions: The study concludes that older women, higher educated mothers, residing in urban areas and, belonging to high socio-economic status are the ones who opt for voluntary C-section deliveries and seek private instructional delivery. The government of India should strengthen the regulatory protocol for private health facilities.