Table 4

Effects of ‘free caesarean’ policy on neonatal mortality

Countries with no ‘free caesarean’ policyDiff.Countries with ‘free caesarean’ policyDiff.Effect of ‘free caesarean’ policy
BeforeAfterBeforeAfterAdjusted absolute risk difference (95% CI)†Adjusted ORs (95% CI)‡
All live births26 21827 22029 25417 108
  Death per 100 births2.52.80.32.82.3−0.5−0.8 (−1.2 to −0.4)***0.70 (0.58  to 0.85)***
By level of education of the mother
 Educated14 50215 97859333731
  Early neonatal death rate (%)2.32.70.42.52.3−0.2−0.7 (−1.5 to 0.1)*0.72 (0.51 to 1.03) §
 Non-educated11 71611 24223 32113 377
  Early neonatal death rate (%)2.72.80.12.92.3−0.6−0.7 (−1.3 to −0.1)**0.74 (0.58 to 0.95)*
By zone of residence of the mother**
 Urban8838915986945404
  Early neonatal death rate (%)2.32.50.22.52.2−0.3−0.9 (−1.5 to −0.3)**0.65 (0.46 to 0.92)*
 Rural17 38018 06120 56011 704
  Early neonatal death rate (%)2.62.90.33.02.3−0.7−0.8 (−1.4 to −0.2)**0.73 (0.58 to 0.91)**
By wealth quintiles of household
 Q1 poorest6173615563533491
  Early neonatal death rate (%)2.32.60.32.82.80.0−0.3 (−1.1 to 0.5)0.87 (0.60 to 1.26)
 Q2 poorer5703635060943580
  Early neonatal death rate (%)2.92.90.02.92.4−0.5−0.6 (−1.6 to 0.4)0.80 (0.54 to 1.18)
 Q3 middle4905554562003536
  Early neonatal death rate (%)2.62.90.33.01.9−1.1−1.4 (−2.0 to −0.8)**0.55 (0.36 to 0.84)**
 Q4 richer4806498559653416
  Early neonatal death rate (%)2.42.9−0.52.72.1−0.6−1.1 (−2.1 to −0.1)*0.59 (0.38 to 0.91)*
 Q5 richest4631418546423085
  Early neonatal death rate (%)2.12.50.42.52.1−0.4−0.7 (−1.7 to 0.3)0.71 (0.43 to 1.16)
  • Source: DHS surveys (http://dhsprogramme.com/).

  • *P≤ 0.05; **P≤0.01; ***P≤ 0.001.

  • †The adjusted absolute risk difference represents adjusted differences between group-specific changes over time (adjusted on age, education, wealth quintile of household, parity, multiple pregnancy and took into account sampling weight).

  • ‡The adjusted ORs for the interaction between groups (free caesarean or not) and time (before vs after the implementation of the policy) were estimated using multivariate logistic regression models adjusted on maternal age, zone of residence, education, wealth quintile of household, parity, multiple pregnancy and took into account sampling weight, clustering and strata.

  • §Marginal level of significance (0.05<m<0.10).

  • Countries with ‘free caesarean’ policy: Benin and Mali Countries with no ‘free caesarean’ policy: Cameroon and Nigeria.