@article{fdi:010075609,
  title = {{T}rends, regional variations, and socioeconomic disparities in cesarean births in {I}ndia, 2010-2016},
  author = {{G}uilmoto, {C}hristophe and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{IMPORTANCE} {T}he {W}orld {H}ealth {O}rganization recommends that rates of cesarean delivery range from 10% to 15%. {I}ndia has the largest annual number of births in the world and needs updates of existing estimates. {OBJECTIVE} {T}o provide a new set of estimates of the rates of cesarean delivery and to map regional and socioeconomic disparities within these rates in {I}ndia. {DESIGN}, {SETTING}, {AND} {PARTICIPANTS} {C}ross-sectional study primarily based on cross-sectional figures drawn from the fourth round of the {N}ational {F}amily and {H}ealth {S}urvey conducted from {J}anuary 20, 2015, through {D}ecember 4, 2016, by the {I}ndian {I}nstitute for {P}opulation {S}ciences in {M}umbai. {T}he survey interviewed 699 686 girls and women aged 15 to 49 years and collected information on their last 3 pregnancies since {J}anuary 2010 (259 627 births). {T}he study population was statistically representative of {I}ndia's 36 states and {U}nion territories and its 640 districts. {T}he survey also included information on the socioeconomic status of households. {T}he research is based on data tabulations and mapping and on spatial and regression analyses of microdata. {S}ocioeconomic inequalities in access to cesarean deliveries were assessed using the {G}ini coefficient. {D}ata were analyzed from {A}ugust to {O}ctober 2018. {MAIN} {OUTCOMES} {AND} {MEASURES} {R}ate of cesarean deliveries by regional and socioeconomic characteristics. {RESULTS} {T}he cesarean birth rate computed for 699 686 {I}ndian girls and women aged 15 to 49 years (mean [{SD}] age, 26.8 [5.0] years) was 17.2%(95% {CI}, 17.1%-17.3%) in 2010 to 2016, which corresponds to an estimated 4.38 million cesarean deliveries per year during the period (95% {CI}, 4.34-4.41 million) in {I}ndia. {C}esarean birth rates vary widely within the country, with a range of 5.8% (95% {CI}, 5.1%-6.5%) to 40.1%(95% {CI}, 38.4%-41.8%) across states and 4.4%(95% {CI}, 4.3%-4.6%) to 35.9%(35.4%-36.4%) across socioeconomic quintiles. {T}he rate significantly increased from 9.2% (95% {CI}, 9.1%-9.3%) in 2004 to 2008. {A}ccording to the recommended 10% to 15% benchmark of cesarean birth rates by the {WHO}, the estimated deficit of cesarean births in {I}ndia is 0.5 million per year, whereas the estimated excess of cesarean births is 1.8 million. {T}he overall {G}ini coefficient of inequality in access to cesarean deliveries is 46.4. {CONCLUSIONS} {AND} {RELEVANCE} {T}he rate of cesarean births is increasing in {I}ndia and has already crossed the {W}orld {H}ealth {O}rganization threshold of 15%. {M}ore research is needed to understand the factors behind the rapid rise of cesarean deliveries among affluent groups and in more developed regions.},
  keywords = {{INDE}},
  booktitle = {},
  journal = {{JAMA} {N}etwork {O}pen},
  volume = {2},
  numero = {3},
  pages = {e190526 [11 ]},
  ISSN = {2574-3805},
  year = {2019},
  DOI = {10.1001/jamanetworkopen.2019.0526},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075609},
}