Trends of Caesarean Section Deliveries in Pakistan: Secondary Data Analysis from Demographic and Health Surveys, 1990-2018

Abstract Background Pakistan is amongst those countries where the number of caesarean section births has unusually increased in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy related variables associated with the change in caesarean deliveries from 1990 to 2018.Methods Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to the child-bearing mothers. Sample sizes were 4,029, 5,721, 7,461 and 8,287 for the time period of 1990–91, 2006–07, 2012–13, and 2017–18, respectively. For the present study, socio-demographic information of the mothers and pregnancy related variables were taken as independent variables. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted odds ratios (AOR).Results Out of the mothers who had at least one delivery during the five years prior to each survey, the percentages of the mothers who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers above 24 years of age, located in Punjab, from the richest socio-economic class, and living in urban areas were more likely to have delivered by caesarean section. Mothers with first child in birth order and who had five and above children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability for caesarean section births.Conclusions The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering through caesarean section during the past two decades in Pakistan. In this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons of caesarean delivery are a few important steps that can help in reducing not medically indicated caesarean deliveries in Pakistan.