Prevalence and determinants of Caesarean delivery in Punjab, Pakistan.

Background: Caesarean section (C-section) is a life-saving obstetric procedure that reduces maternal mortality and improves reproductive health. Although, vaginal delivery is still an important safe and low-cost method of delivery, C-section is sometimes performed when it is not even required, which creates health challenges for pregnant women and their newborn infants.

Aims: To estimate the effect of a set of institutional, demographic, socioeconomic and spatial variables on C-section delivery (n = 2424) in Punjab, Pakistan.

Methods: We used data from the Multiple Indicator Cluster Survey Punjab 2014 and multiple logistic regression analysis. Analysis was carried out using STATA version 12.

Results: Higher maternal age at first marriage, higher number of antenatal care visits, and higher wealth quintiles were associated with higher risk of C-section. Women in Punjab were more likely to deliver through C-section in private health facilities and there was no significant difference between urban and rural areas. There was a significant difference in the risk of C-section in different divisions of Punjab, for example, DG Khan and Rawalpindi showed the lowest risk compared with the reference division of Bahawalpur, which is partially explained by the developmental disparities and access to public healthcare facilities.

Conclusions: The government should facilitate access to healthcare facilities in areas that are easily accessible, especially, to rural women.