A Higher Maternal Education Level Could Be a Critical Factor in the Exceeded Cesarean Section Delivery in Indonesia
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Abstract
Background: Cesarean section (CS) could be life-saving with medically indicated, but without it, both women and children could be at risk. The maximum rate for CS is 15%, but it tends to exceed globally.
Objective: We aimed to analyze the education level's role in the delivery of CS in Indonesia.
Methods: We used the 2017 Indonesia Demographic and Health Survey data. The study sampled 15,357 women who delivered in five last years. Besides delivery mode and education level, the study also used nine control variables: residence, age, marital, employment, parity, wealth, insurance, antenatal care, and birth type. The study employed a binary logistics regression.
Results: The results show women with secondary education (16.5% CS) are 2.174 times (AOR 2.174; 95% CI 1.095-4.316), and higher education (33% CS) are 3.241 (AOR 3.241; 95% CI 1.624-6.469) times more likely to deliver by CS than no-school education (4.4% CS). There was no significant difference between primary (9.1%) and no-education women. Apart from education, primiparous women, age 34-34 yr, attending antenatal care ≥4 times, non-poorest, having insurance, living in the city, and being unemployed also related to higher risk of CS.
Conclusion: Exceeded CS in Indonesia occurs mostly in higher education women. Higher education women were more likely to access more information and technology, therefore health promotion on healthy normal birth on social media or m-Health (mobile device-based health promotion) and involving health authorities at every level were suitable to reduce the overuse of the CS.
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2. Elnakib S, Abdel-Tawab N, Orbay D, Hassanein N. Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study. BMC Pregnancy Childbirth. 2019;19(1):1–11.
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8. World Health Organization. Appropriate technology for birth. Lancet (London, England). 1985 Aug;2(8452):436–7.
9. Gupta M, Saini V. Cesarean section: Mortality and morbidity. J Clin Diagnostic Res. 2018;12(9):QE01–6.
10. Chu S, Chen Q, Chen Y, Bao Y, Wu M, Zhang J. Cesarean section without medical indication and risk of childhood asthma, and attenuation by breastfeeding. PLoS One. 2017;12(9):e0184920.
11. Polidano C, Zhu A, Bornstein JC. The relation between cesarean birth and child cognitive development. Sci Rep [Internet]. 2017;7(1):1–10. Available from: http://dx.doi.org/10.1038/s41598-017-10831-y
12. Zhang T, Sidorchuk A, Sevilla-Cermeño L, Vilaplana-Pérez A, Chang Z, Larsson H, et al. Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis. JAMA Netw open. 2019 Aug;2(8):e1910236.
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15. Sihombing N, Saptarini I, Sisca Kumala Putri D. Determinan Persalinan Sectio Caesarea di Indonesia. J Kesehat Reproduksi. 2017;8(1):63–75.
16. Willemann MCA, Nicolotti CA, Baratieri T, Kupek E. Factors associated with cesarean delivery in adult nulliparous women. Acta Sci - Heal Sci. 2021;43:1–7.
17. Le K, Nguyen M. How Education Empowers Women in Developing Countries. BE J Econ Anal Policy. 2021;21(2):511–36.
18. Sun Y, Huang K, Hu Y, Yan S, Xu Y, Zhu P, et al. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One. 2019;14(5):1–13.
19. Kolip P, Büchter R. Involvement of first-time mothers with different levels of education in the decision-making for their delivery by a planned Caesarean section. Women’s satisfaction with information given by gynaecologists and midwives. J Public Health (Bangkok). 2009;17(4):273–80.
20. Ezeome I V, Ezugworie JO, Udealor PC. Beliefs, perceptions, and views of pregnant women about cesarean section and reproductive decision-making in a specialist health facility in Enugu, Southeast Nigeria. Niger J Clin Pract. 2018 Apr;21(4):423–8.
21. World Health Organization. Cæsarean Section Rates [Internet]. 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf
22. Islam MA, Sathi NJ, Hossain MT, Jabbar A, Renzaho AMN, Islam SMS. Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa: a meta-analysis. Sci Rep [Internet]. 2022;12(1):1–14. Available from: https://doi.org/10.1038/s41598-022-09567-1
23. Gogoi N. Effectiveness of Education for Ensuring better Health Status and rising other Economic Indicators in the Developing Countries. 2021;10(2):1679–89.
24. Yadav AK, Sahni B, Jena PK. Education, employment, economic status and empowerment: Implications for maternal health care services utilization in India. J Public Aff [Internet]. 2021 Aug 1;21(3):e2259. Available from: https://doi.org/10.1002/pa.2259
25. Suwanrath C, Chunuan S, Matemanosak P, Pinjaroen S. Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand. BMC Pregnancy Childbirth. 2021;21(1):1–6.
26. Ochieng Arunda M, Agardh A, Asamoah BO. Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data. Glob Health Action [Internet]. 2020;13(1). Available from: https://doi.org/10.1080/16549716.2020.1748403
27. Janoudi G, Kelly S, Yasseen A, Hamam H, Moretti F, Walker M. Factors Associated With Increased Rates of Caesarean Section in Women of Advanced Maternal Age. J Obstet Gynaecol Canada [Internet]. 2015;37(6):517–26. Available from: http://dx.doi.org/10.1016/S1701-2163(15)30228-0
28. Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health. 2018;18(1):1–10.
29. Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. Health Econ Rev. 2018;8(1).
30. Mlambo V. An overview of rural-urban migration in South Africa: its causes and implications. Arch Bus Res. 2018;6(4):63–70.
31. de Loenzien M, Schantz C, Luu BN, Dumont A. Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam. PLoS One. 2019;14(7):1–14.
32. Wulandari RD, Laksono AD, Nantabah ZK, Rohmah N, Zuardin Z. Hospital utilization in Indonesia in 2018: do urban–rural disparities exist? BMC Health Serv Res [Internet]. 2022;22(1):1–11. Available from: https://doi.org/10.1186/s12913-022-07896-5
33. Seidu AA, Hagan JE, Agbemavi W, Ahinkorah BO, Nartey EB, Budu E, et al. Not just numbers: Beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):1–10.
34. Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study. PLoS One. 2019;14(1):1–16.
35. Zolta´ Z, Kozinszky Z, Orvos H, Zoboki T, Ma´ M, Katona M, et al. Acta Obstetricia et Gynecologica Scandinavica Risk factors for cesarean section of primiparous women aged over 35 years. Acta Obs Gynecol Scand. 2002;81:313–6.
36. Khatony A, Soroush A, Andayeshgar B, Saedpanah N, Abdi A. Attitude of primiparous women towards their preference for delivery method: A qualitative content analysis. Arch Public Heal. 2019;77(1):1–9.
37. Ali SA, Dero AA, Ali SA, Ali GB. Factors Affecting the Utilization of Antenatal Care among Pregnant Women in Moba Lga of Ekiti State, Nigeria. Int J Tradit Complement Med. 2016;2(2):41–5.
38. Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review. BMJ Open [Internet]. 2019 Oct 1;9(10):e031890. Available from: http://bmjopen.bmj.com/content/9/10/e031890.abstract
39. Zloto K, Hochberg A, Tenenbaum-Gavish K, Berezowsky A, Barbash-Hazan S, Bardin R, et al. Fetal congenital heart disease - mode of delivery and obstetrical complications. BMC Pregnancy Childbirth. 2022;22(1):578.
40. Asoglu MR, Bears B, Turan S, Harman C, Turan OM. The factors associated with mode of delivery in fetuses with congenital heart defects. J Matern Neonatal Med. 2020;33(5):816–24.
2. Elnakib S, Abdel-Tawab N, Orbay D, Hassanein N. Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study. BMC Pregnancy Childbirth. 2019;19(1):1–11.
3. Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2020 Nov;33(22):3867–72.
4. Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Heal. 2021 Jun;6(6).
5. Verma V, Vishwakarma RK, Nath DC, Khan HTA, Prakash R, Abid O. Prevalence and determinants of caesarean section in South and South-East Asian women. PLoS One [Internet]. 2020;15(3):1–15. Available from: http://dx.doi.org/10.1371/journal.pone.0229906
6. Badan Penelitian dan Pengembangan Kesehatan KK. Laporan Nasional Riskedas 2018. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2019.
7. Badan Penelitian dan Pengembangan Kesehatan KK. Riset Kesehatan Dasar. Jakarta; 2013.
8. World Health Organization. Appropriate technology for birth. Lancet (London, England). 1985 Aug;2(8452):436–7.
9. Gupta M, Saini V. Cesarean section: Mortality and morbidity. J Clin Diagnostic Res. 2018;12(9):QE01–6.
10. Chu S, Chen Q, Chen Y, Bao Y, Wu M, Zhang J. Cesarean section without medical indication and risk of childhood asthma, and attenuation by breastfeeding. PLoS One. 2017;12(9):e0184920.
11. Polidano C, Zhu A, Bornstein JC. The relation between cesarean birth and child cognitive development. Sci Rep [Internet]. 2017;7(1):1–10. Available from: http://dx.doi.org/10.1038/s41598-017-10831-y
12. Zhang T, Sidorchuk A, Sevilla-Cermeño L, Vilaplana-Pérez A, Chang Z, Larsson H, et al. Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis. JAMA Netw open. 2019 Aug;2(8):e1910236.
13. Masukume G, O’Neill SM, Baker PN, Kenny LC, Morton SMB, Khashan AS. The Impact of Caesarean Section on the Risk of Childhood Overweight and Obesity: New Evidence from a Contemporary Cohort Study. Sci Rep. 2018;8(1):1–9.
14. Peters LL, Thornton C, de Jonge A, Khashan A, Tracy M, Downe S, et al. The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study. Birth. 2018;45(4):347–57.
15. Sihombing N, Saptarini I, Sisca Kumala Putri D. Determinan Persalinan Sectio Caesarea di Indonesia. J Kesehat Reproduksi. 2017;8(1):63–75.
16. Willemann MCA, Nicolotti CA, Baratieri T, Kupek E. Factors associated with cesarean delivery in adult nulliparous women. Acta Sci - Heal Sci. 2021;43:1–7.
17. Le K, Nguyen M. How Education Empowers Women in Developing Countries. BE J Econ Anal Policy. 2021;21(2):511–36.
18. Sun Y, Huang K, Hu Y, Yan S, Xu Y, Zhu P, et al. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One. 2019;14(5):1–13.
19. Kolip P, Büchter R. Involvement of first-time mothers with different levels of education in the decision-making for their delivery by a planned Caesarean section. Women’s satisfaction with information given by gynaecologists and midwives. J Public Health (Bangkok). 2009;17(4):273–80.
20. Ezeome I V, Ezugworie JO, Udealor PC. Beliefs, perceptions, and views of pregnant women about cesarean section and reproductive decision-making in a specialist health facility in Enugu, Southeast Nigeria. Niger J Clin Pract. 2018 Apr;21(4):423–8.
21. World Health Organization. Cæsarean Section Rates [Internet]. 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf
22. Islam MA, Sathi NJ, Hossain MT, Jabbar A, Renzaho AMN, Islam SMS. Caesarean delivery and its association with educational attainment, wealth index, and place of residence in Sub-Saharan Africa: a meta-analysis. Sci Rep [Internet]. 2022;12(1):1–14. Available from: https://doi.org/10.1038/s41598-022-09567-1
23. Gogoi N. Effectiveness of Education for Ensuring better Health Status and rising other Economic Indicators in the Developing Countries. 2021;10(2):1679–89.
24. Yadav AK, Sahni B, Jena PK. Education, employment, economic status and empowerment: Implications for maternal health care services utilization in India. J Public Aff [Internet]. 2021 Aug 1;21(3):e2259. Available from: https://doi.org/10.1002/pa.2259
25. Suwanrath C, Chunuan S, Matemanosak P, Pinjaroen S. Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand. BMC Pregnancy Childbirth. 2021;21(1):1–6.
26. Ochieng Arunda M, Agardh A, Asamoah BO. Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data. Glob Health Action [Internet]. 2020;13(1). Available from: https://doi.org/10.1080/16549716.2020.1748403
27. Janoudi G, Kelly S, Yasseen A, Hamam H, Moretti F, Walker M. Factors Associated With Increased Rates of Caesarean Section in Women of Advanced Maternal Age. J Obstet Gynaecol Canada [Internet]. 2015;37(6):517–26. Available from: http://dx.doi.org/10.1016/S1701-2163(15)30228-0
28. Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health. 2018;18(1):1–10.
29. Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. Health Econ Rev. 2018;8(1).
30. Mlambo V. An overview of rural-urban migration in South Africa: its causes and implications. Arch Bus Res. 2018;6(4):63–70.
31. de Loenzien M, Schantz C, Luu BN, Dumont A. Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam. PLoS One. 2019;14(7):1–14.
32. Wulandari RD, Laksono AD, Nantabah ZK, Rohmah N, Zuardin Z. Hospital utilization in Indonesia in 2018: do urban–rural disparities exist? BMC Health Serv Res [Internet]. 2022;22(1):1–11. Available from: https://doi.org/10.1186/s12913-022-07896-5
33. Seidu AA, Hagan JE, Agbemavi W, Ahinkorah BO, Nartey EB, Budu E, et al. Not just numbers: Beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):1–10.
34. Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study. PLoS One. 2019;14(1):1–16.
35. Zolta´ Z, Kozinszky Z, Orvos H, Zoboki T, Ma´ M, Katona M, et al. Acta Obstetricia et Gynecologica Scandinavica Risk factors for cesarean section of primiparous women aged over 35 years. Acta Obs Gynecol Scand. 2002;81:313–6.
36. Khatony A, Soroush A, Andayeshgar B, Saedpanah N, Abdi A. Attitude of primiparous women towards their preference for delivery method: A qualitative content analysis. Arch Public Heal. 2019;77(1):1–9.
37. Ali SA, Dero AA, Ali SA, Ali GB. Factors Affecting the Utilization of Antenatal Care among Pregnant Women in Moba Lga of Ekiti State, Nigeria. Int J Tradit Complement Med. 2016;2(2):41–5.
38. Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review. BMJ Open [Internet]. 2019 Oct 1;9(10):e031890. Available from: http://bmjopen.bmj.com/content/9/10/e031890.abstract
39. Zloto K, Hochberg A, Tenenbaum-Gavish K, Berezowsky A, Barbash-Hazan S, Bardin R, et al. Fetal congenital heart disease - mode of delivery and obstetrical complications. BMC Pregnancy Childbirth. 2022;22(1):578.
40. Asoglu MR, Bears B, Turan S, Harman C, Turan OM. The factors associated with mode of delivery in fetuses with congenital heart defects. J Matern Neonatal Med. 2020;33(5):816–24.
| Files | ||
| Issue | Vol 53 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v53i1.14698 | |
| Keywords | ||
| Cesarean section Education level Childbirth Maternal health Public health | ||
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How to Cite
1.
Yunitawati D, Latifah L, Suryaputri I, Laksono A. A Higher Maternal Education Level Could Be a Critical Factor in the Exceeded Cesarean Section Delivery in Indonesia. Iran J Public Health. 2024;53(1):219-227.
