Socioeconomic, geographic and health system factors associated with rising C-section rate in Indonesia: a cross-sectional study using the Indonesian demographic and health surveys from 1998 to 2017

• Published in: BMJ open 2021-05, Vol.11 (5), p.e045592-e045592
• Main Authors: Wyatt, Sage, Silitonga, Permata Imani Ima, Febriani, Esty, Long, Qian
• Format: Article
• Language: English
• Subjects: Bias; Births; Cesarean section; Childbirth & labor; Cross-sectional studies; Datasets; Demographics; Developing countries; Educational attainment; Epidemiology; Health insurance; Health services; health services administration & management; Health surveys; Hospitals; Households; LDCs; Midwifery; obstetrics; Politics; Public Health; Sociodemographics; Variables; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-045592

IntroductionCaesarean section (C-section) has been a public health concern globally. This study investigated the change in C-section rate in 1998–2017 in Indonesia and explored the socioeconomic, geographic and health system factors associated with the use of C-section.MethodsWe analysed data from demographic health surveys in 2002–2003, 2007, 2012 and 2017 in Indonesia. We included women who reported giving birth within 5 years of each round of the survey (n=56 462) into the analysis. Cross-tabulation was used to examine change of C-section rate by year. We conducted bivariate and multivariate logistic regressions to study the determinants of C-section use.ResultsIn Indonesia, the C-section rate increased from 4.0% in 1998 to 18.5% in 2017. In 2017, the C-section rate in urban areas (22.9%) was almost two times that in rural areas (11.8%). It was almost three times among the richest wealth quintile (36.5%), compared with the poorest wealth quintile (12.9%). Between 2008 and 2017, the difference in the C-section rate by public services enlarged between the poorest and the richest groups. The absolute increase of the C-sections by private services was more than public services over time. In 2013–2017, the C-section rates by public and private services were 22.5% and 23.1%, respectively. After adjusting for all variables, higher education, higher household wealth, primiparity and use of public childbirth services were positively associated with C-section.ConclusionsThe C-section rate increased steadily in the past two decades in Indonesia. Women’s socioeconomic status and health system factors were associated with the increased use of C-section.