Trend and Sociodemographic Correlates of Cesarean Section Utilization in Nepal: Evidence from Demographic and Health Surveys 2006-2016
Table 3
Maternal age and parity-adjusted cesarean section (CS) rates (%) from the Nepal Demographic and Health Surveys (NDHS) in 2006, 2011, and 2016.
Characteristics
NDHS 2006
NDHS 2011
NDHS 2016
Overall adjusted CS rates (%)
3.2 (2.1-4.3)
6.6 (5.1-8.1)
10.5 (8.9-11.9)
Education
No education
1.3 (0.5-2.1)
4.2 (2.7-5.7)
6.3 (3.5-9.0)
Primary
3.7 (1.1-6.3)
5.7 (2.7-8.7)
6.0 (3.5-8.6)
Some secondary
4.8 (2.4-7.2)
6.2 (3.9-8.5)
10.5 (7.7-13.3)
Secondary and higher
11.0 (7.8-14.2)
17.4 (11.3-23.5)
21.2 (14.7-27.8)
Rate difference
9.7
13.2
15.2
Rate ratio
8.5
4.1
3.5
Current working status
Working
1.6 (0.8-2.3)
4.8 (3.4-6.2)
9.5 (7.6-11.4)
Not working
6.6 (4.2-9.0)
8.7 (6.6-10.7)
11.6 (9.4-13.9)
Rate difference
5.0
3.9
2.1
Rate ratio
4.1
1.8
1.2
Wealth index
Lowest
1.4 (0.1-2.6)
2.7 (0.8-4.6)
2.4 (1.2-3.7)
Second
0.5 (0.03-0.9)
1.3 (0.1-2.6)
5.2 (3.0-7.4)
Middle
1.2 (0.09-2.4)
6.2 (4.0-8.4)
8.0 (4.9-11.1)
Fourth
1.4 (0.6-2.3)
8.7 (5.7-11.6)
9.3 (6.7-12.0)
Highest
10.8 (7.7-13.9)
13.4 (9.7-17.2)
25.1 (20.2-30.1)
Rate difference
10.3
12.1
22.7
Rate ratio
21.6
10.3
10.5
Residence
Urban
8.0 (5.7-10.4)
14.8 (10.8-18.8)
12.4 (10.4-14.4)
Rural
2.0 (1.0-3.0)
5.3 (3.8-6.8)
7.0 (5.1-8.9)
Rate difference
6.0
9.5
5.4
Rate ratio
4.0
2.8
1.8
Ecological region
Mountain
0.8 (0.02-1.6)
1.5 (0.6-2.4)
3.0 (1.1-4.9)
Hill
3.6 (2.0-5.2)
6.7 (4.9-8.5)
12.2 (9.9-14.5)
Terai
2.6 (1.6-3.6)
6.6 (5.1-8.1)
10.0 (7.9-12.1)
Rate difference
2.8
5.2
9.2
Rate ratio
4.5
4.5
4.1
Province
Province 1
1.9 (0.6-3.1)
6.7 (4.0-9.4)
12.2 (8.8-15.6)
Province 2
2.1 (0.6-3.5)
6.6 (4.5-8.8)
6.8 (3.6-9.9)
Bagmati Province
6.0 (3.2-8.8)
12.1 (8.0-16.2)
16.4 (12.6-20.2)
Gandaki Province
2.2 (-0.05-4.5)
4.9 (2.3-7.6)
17.5 (12.5-22.4)
Lumbini Province
3.3 (1.6-5.1)
3.9 (2.1-5.7)
7.8 (5.0-10.5)
Karnali Province
3.0 (-0.1-6.1)
2.9 (2.0-3.7)
2.4 (1.3-3.5)
Sudhurpaschim Province
1.2 (-0.1-2.6)
2.8 (1.4-4.3)
5.7 (2.7-8.7)
Rate difference
4.8
9.3
15.1
Rate ratio
5.0
4.3
7.3
Caste/ethnicity
Brahmin/Chhetri
5.2 (3.0-7.4)
8.3 (6.3-10.4)
11.8 (9.3-14.4)
Terai/Madhesi other
2.8 (0.8-4.9)
8.5 (4.0-13.0)
10.3 (6.1-14.6)
Dalits
0.9 (0.2-1.7)
2.7 (0.7-4.6)
7.8 (4.0-11.6)
Newar/Janajati
2.9 (1.0-4.9)
5.2 (3.3-7.1)
10.2 (7.8-12.6)
Muslim/other
0.8 (-0.2-1.8)
4.5 (0.5-8.6)
11.1 (4.1-18.2)
Rate difference
4.4
5.8
4.0
Rate ratio
6.5
3.1
1.5
Place of delivery
Public facility
12.3 (9.1-15.6)
11.1 (8.4-13.9)
12.6 (10.4-14.8)
Private facility/NGOs
15.8 (9.9-21.6)
26.4 (20.8-31.9)
37.1 (30.5-43.7)
Outside Nepal
NA
NA
0.7 (-0.6-2.0)
Rate difference
3.5
15.3
24.5
Rate ratio
1.3
2.4
2.9
Home deliveries were excluded from the analysis. 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. The study sample of NDHS 2016 () was used as the standard population in the direct standardization. For each survey, categories with the highest and lowest CS rate were used to calculate the rate difference and rate ratios. NA: not available.
