Change of C-section rate over time
C-section rate increased dramatically from 4.0% in 1998 to 18.5% in
2017 with a rapid increase in urban areas (Figure 1). In 2017, the
C-section rate in urban areas (22.9%) was almost two times that of
rural areas (11.8%). The C-section rate increased in all regions, and
it was the highest in the western region (21.5% in 2017), followed by
the central region (15.6% in 2017) and the eastern region (10.7% in
2017) (Figure S1).
C-section rates increased over time for all sociodemographic groups,
with statistically significant changes between each survey period (Table
2). Between 1998 and 2017, we observed the most increase of C-section
rate among women who were over 30 years old, were university educated,
and had only one child. The C-section rate among women from the richest
wealth quintile had the most absolute increase compared to all other
sociodemographic groups from 13.0% in 1998-2002 to 33.2% in 2013-2017.
C-section rate increased from 10.5% in 1998-2002 to 22.8% in 2013-2017
for women who used any childbirth care services. C-section rate was
higher among women who used public services than women who used private
services in the first three waves of the surveys, while the absolute
increase of C-sections by private services was more than that of the
public services over the study period. In 2013-2017, the C-section rate
of births by private services (23.1%) was slightly higher than that by
the public services (22.5%) (Table 2).
Between 2008 and 2017, homebirths decreased significantly even among the
poorest wealth quintile. The difference in homebirth between the poorest
wealth quintile and the richest quintile became smaller over time
(p<0.01). Meanwhile, the difference of C-section rate at any
service type between the poorest and the richest wealth quintile
enlarged over the past decade, with a significant increase in C-section
rate among well-off women for both public and private services (Table
S1). The C-section rate among women from the poorest wealth quintile who
used private services increased over time, while it decreased among
those who used public services. In 2017, the C-section rates among the
poorest and richest wealth quintile were 12.9% and 36.5%,
respectively. For both groups, there were no significant differences in
C-section rates by public or private services.