Trend and Sociodemographic Correlates of Cesarean Section Utilization in Nepal: Evidence from Demographic and Health Surveys 2006-2016

Table 2

Crude cesarean section (CS) rates (%) by sociodemographic characteristics from the Nepal Demographic and Health Surveys (NDHS) in 2006, 2011, and 2016.

Characteristics	NDHS 2006			NDHS 2011			NDHS 2016
	Total births	CS	%	Total births	CS	%	Total births	CS	%
Total ()	5545	148	2.7	5391	248	4.6	5060	457	9
Maternal age (years)
15-19	368	16	4.2	381	14	3.5	391	25	6.3
20-24	1,931	47	2.4	1,802	64	3.6	1,665	142	8.5
25-29	1,742	56	3.2	1,736	93	5.4	1,780	163	9.2
30-34	785	17	2.2	845	52	6.1	806	88	11
35-39	465	3	0.6	402	18	4.4	297	35	11.8
40-44	196	9	4.4	169	7	4.4	97	4	3.6
45-49	58	0	0	57	<1	0.6	24	0	0
Parity
2 or less	3,132	129	4.1	3,293	203	6.2	3,472	407	11.7
3-4	1,459	7	0.5	1,405	43	3.0	1,161	42	3.6
More than 4	954	11	1.1	693	2	0.3	427	8	1.8
Education
No education	3,343	37	1.1	2,550	45	1.8	1,733	78	4.5
Primary	1,009	28	2.8	1,079	44	4.1	1,019	57	5.6
Some secondary	848	35	4.1	1,039	66	6.3	1,226	110	9
Secondary and higher	345	48	13.9	723	93	12.9	1,082	211	19.5
Current working status
Working	3,824	52	1.4	2,961	82	2.8	2,498	193	8
Not working	1,721	96	5.6	2,431	166	6.8	2,562	264	10
Wealth index
Lowest	1,412	11	0.8	1,390	14	1.0	1,082	26	2.4
Second	1,180	6	0.5	1,182	10	0.8	1,072	46	4.2
Middle	1,132	11	1.0	1,133	52	4.6	1,121	77	6.8
Fourth	983	19	2.0	938	67	7.1	1,036	97	9.4
Highest	838	100	11.9	748	106	14.1	748	211	28.2
Residence
Urban	677	57	8.4	503	77	15.3	2,730	320	11.7
Rural	4,868	90	1.9	4,888	171	3.5	2,330	137	5.9
Ecological region
Mountain	483	4	0.7	428	6	1.4	361	9	2.6
Hill	2,261	70	3.1	2,130	78	3.7	1,911	214	11.2
Terai	2,802	74	2.6	2,833	164	5.8	2,789	234	8.4
Province
Province 1	920	19	2.1	1,135	74	6.5	819	104	12.7
Province 2	1,171	25	2.1	1,146	47	4.1	1,367	69	5.0
Bagmati Province	920	55	6.0	705	59	8.3	813	141	17.4
Gandaki Province	571	10	1.7	589	24	4	388	65	16.7
Lumbini Province	822	27	3.3	810	30	3.7	899	57	6.4
Karnali Province	341	5	1.4	401	4	1	338	7	2.2
Sudhurpaschim Province	800	7	0.8	605	11	1.8	437	13	3.1
Caste/ethnicity
Brahmin/Chhetri	1,639	72	4.4	1,618	118	7.3	1,396	158	11.3
Terai/Madhesi other	685	15	2.2	558	33	6	1,021	73	7.1
Dalits	884	11	1.2	959	20	2.1	695	38	5.4
Newar/Janajati	1,934	45	2.3	1,892	64	3.4	1,573	160	10.2
Muslim/other	402	4	1.0	364	12	3.2	375	28	7.4
Place of delivery
Public facility	724	101	13.9	1,399	120	8.6	2,183	265	12.1
Private facility/NGOs	256	47	18.4	506	129	25.4	548	191	34.8
Outside Nepal	NA	NA	NA	NA	NA	NA	171	1	0.8
Home	4,492	0	0	3,402	0	0	2,096	0	0
Others	73	0	0	85	0	0	61	0	0

Cesarean section was determined for the most recent birth of women aged 15-49 years who had a live birth five years preceding the surveys. All percentages are weighted, so the absolute number of participants does not perfectly correspond to percentages. The question on C-section was asked only of women who delivered in a health facility while analysis was based on the number of total births. NA: not available.