Effects of ‘free caesarean’ policy on facility-based delivery
| Countries with no ‘free caesarean’ policy | Diff. | Countries with ‘free caesarean’ policy | Diff. | Effect of ‘free caesarean’ policy | ||||
| Before | After | Before | After | Adjusted absolute risk difference (95% CI)† | Adjusted ORs (95% CI)‡ | |||
| All pregnant women | 26 129 | 11 593 | 29 097 | 17 088 | ||||
| FBD rate (%) | 42.4 | 42.7 | 0.3 | 57.1 | 66.8 | 9.7 | 8.7 (7.7 to 9.7)*** | 1.68 (1.48 to 1.89)*** |
| FBD | 11 078 | 11 593 | 16 607 | 11 412 | ||||
| Hospital delivery rate (%) | 60.5 | 62.5 | 2.0 | 20.4 | 31.3 | 10.9 | 9.7 (8.1 to 11.3)*** | 1.71 (1.49 to 1.95)*** |
| Women by level of education | ||||||||
| Educated | 14 456 | 15 946 | 5895 | 3725 | ||||
| FBD rate (%) | 64.0 | 63.0 | −1.0 | 82.8 | 89.2 | 6.4 | 5.0 (3.0 to 7.0)*** | 1.62 (1.35 to 1.96)*** |
| Non-educated | 11 673 | 11 216 | 23 202 | 13 363 | ||||
| FBD rate (%) | 15.6 | 13.8 | −1.8 | 50.5 | 60.5 | 10.0 | 9.2 (7.8 to 10.6)*** | 1.59 (1.36 to 1.87)*** |
| Women by zone of residence | ||||||||
| Urban | 8800 | 9142 | 8643 | 5395 | ||||
| FBD rate (%) | 67.8 | 70.0 | 2.2 | 79.8 | 89.3 | 9.5 | 6.4 (4.6 to 6.2)*** | 2.14 (1.70 to 2.70)*** |
| Rural | 17 329 | 18 020 | 20 454 | 11 693 | ||||
| FBD rate (%) | 29.5 | 29.0 | −0.5 | 47.5 | 56.4 | 8.9 | 9.7 (8.3 to 11.1)*** | 1.62 (1.40 to 1.87)*** |
| Women by wealth quintiles of households | ||||||||
| Q1 poorest | 6155 | 6141 | 6322 | 3487 | ||||
| FBD rate (%) | 15.1 | 9.2 | −5.9 | 37.2 | 50.2 | 13.0 | 16.8 (14.6 to 19.0) *** | 2.94 (2.34 to 3.71)*** |
| Q2 poorer | 5681 | 6338 | 6061 | 3577 | ||||
| FBD rate (%) | 24.3 | 26.8 | 2.5 | 46.2 | 56.1 | 9.9 | 9.3 (6.9 to 11.7)*** | 1.47 (1.21 to 1.78)*** |
| Q3 middle | 4896 | 5530 | 6173 | 3532 | ||||
| FBD rate (%) | 41.6 | 46.9 | 5.3 | 53.1 | 60.7 | 7.6 | 6.0 (3.3 to 8.7)*** | 1.31 (1.09 to 1.59)* |
| Q4 richer | 4781 | 4973 | 5928 | 3412 | ||||
| FBD rate (%) | 62.0 | 64.5 | 2.5 | 67.9 | 76.3 | 8.4 | 8.2 (5.7 to 10.7)*** | 1.66 (1.33 to 2.08)*** |
| Q5 richest | 4616 | 4180 | 4613 | 3080 | ||||
| FBD rate (%) | 81.7 | 84.5 | 2.8 | 90.1 | 94.4 | 4.3 | 3.3 (1.3 to 5.3)** | 2.03 (1.44 to 2.85)*** |
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.
FBD, facility-based delivery.