Caesarean Section Deliveries in Ghana: Trends, Disparities And Influencing Factors

ABSTRACT

C-section births have been increasing, yet disparities exist in the rates spatially and among socioeconomic sub-groups globally. Wide C-section disparities mirror a situation of overuse or underuse of the procedure with implications for maternal mortality. Factors associated with the Csection rise and disparities have not been well documented. The determinants of C-section rise and disparities have focused extensively on individual, institutional and medical factors to the neglect of influence of beliefs and community factors. The study examines the levels and trends as well as the influence of beliefs of childbearing women (women aged 18-49 who had a child in the last five years) and community factors on C-section rise and disparities in Ghana. The study employed mixed research methods approach. The quantitative method used the GDHS datasets of 2003, 2008 and 2014. The qualitative methods employed key informants in-depth interviews with health workers and childbearing women respectively from Greater Accra and Northern regions of Ghana as a case study. SPSS version 20 software was used to analyse the quantitative data and Nvivo version 11 software was used to analyse the qualitative data. The findings indicate that C-section rate in Ghana has increased from 9.8 percent in 2003 to 18.2 percent as at 2014, and it is above the recommended WHO threshold of 15 percent. Drawing on the Socio-Ecological Model, the study suggests that C-section rise and disparities could be attributed mostly to individual, interpersonal, community and medical factors. The results of the qualitative data revealed that Ghanaian women were similar on the score of susceptibility to labour pains, perceived severity to C-section, cues to action and community beliefs. Women differ on the score of perceived barriers and perceived benefits of C-section delivery. Women in the Northern and Greater Accra regions identified beliefs and financial barriers respectively as obstacles to C-section delivery. The regression analysis suggests that community-level factors did not predict C-section delivery. However, community belief was identified in the qualitative study to have influenced C-section delivery. Women aged 35-49 years, wealthy, educated and those who have had a history of previous C-section were more likely to have C-section delivery. Similarly, women whose partners accompanied them to ANC visits were more likely to deliver by C-section. Further, women who had average-sized babies and multiparous are less likely to have C-section. Individual, interpersonal and medical factors were significant predictors of C-section rise and disparities. These findings could have implications for maternal mortality. Low C-section levels in community with negative C-section beliefs and the high C-section delivery among wealthy educated women could have negative implication for both infant and maternal mortality. It is therefore important to consider in maternal health interventions, the predictors (such beliefs) of C-section delivery to ensure that C-section is provided and accepted for medical reasons.