Cesarean birth in the Global Network for Women's and Children's Health Research: trends in utilization, risk factors, and subgroups with high cesarean birth rates

• Published in: Reproductive health 2020-12, Vol.17 (Suppl 3), p.165-10, Article 165
• Main Authors: Harrison, Margo S, Garces, Ana L, Goudar, Shivaprasad S, Saleem, Sarah, Moore, Janet L, Esamai, Fabian, Patel, Archana B, Chomba, Elwyn, Bose, Carl L, Liechty, Edward A, Krebs, Nancy F, Derman, Richard J, Hibberd, Patricia L, Carlo, Waldemar A, Tshefu, Antoinette, Koso-Thomas, Marion, McClure, Elizabeth M, Goldenberg, Robert L
• Format: Article
• Language: English
• Subjects: Adult; Birth Rate; Cesarean birth; Cesarean section; Cesarean Section - adverse effects; Cesarean Section - statistics & numerical data; Cesarean Section - trends; Child; Child Health; Childbirth & labor; Childrens health; Distribution; Female; Forecasts and trends; Generalized linear models; Gestational age; Humans; Infant, Newborn; Low income groups; Low- and middle-income countries; Medical research; Obstetrics; Parity; Population; Population Surveillance; Pregnancy; Prospective Studies; Reproductive health; Risk Factors; Robson classification; Trends; Vagina; Vaginal birth after cesarean; Vaginal Birth after Cesarean - statistics & numerical data; Variables; Womens health; Young Adult
• ISSN: 1742-4755; 1742-4755
• DOI: 10.1186/s12978-020-01021-7

The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women's and Children's Health Research (Global Network). This is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites. Cesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p