Change of C-section rate over time
C-section rate increased dramatically from 4.0% in 1998 to 18.5% in 2017 with a rapid increase in urban areas (Figure 1). In 2017, the C-section rate in urban areas (22.9%) was almost two times that of rural areas (11.8%). The C-section rate increased in all regions, and it was the highest in the western region (21.5% in 2017), followed by the central region (15.6% in 2017) and the eastern region (10.7% in 2017) (Figure S1).
C-section rates increased over time for all sociodemographic groups, with statistically significant changes between each survey period (Table 2). Between 1998 and 2017, we observed the most increase of C-section rate among women who were over 30 years old, were university educated, and had only one child. The C-section rate among women from the richest wealth quintile had the most absolute increase compared to all other sociodemographic groups from 13.0% in 1998-2002 to 33.2% in 2013-2017.
C-section rate increased from 10.5% in 1998-2002 to 22.8% in 2013-2017 for women who used any childbirth care services. C-section rate was higher among women who used public services than women who used private services in the first three waves of the surveys, while the absolute increase of C-sections by private services was more than that of the public services over the study period. In 2013-2017, the C-section rate of births by private services (23.1%) was slightly higher than that by the public services (22.5%) (Table 2).
Between 2008 and 2017, homebirths decreased significantly even among the poorest wealth quintile. The difference in homebirth between the poorest wealth quintile and the richest quintile became smaller over time (p<0.01). Meanwhile, the difference of C-section rate at any service type between the poorest and the richest wealth quintile enlarged over the past decade, with a significant increase in C-section rate among well-off women for both public and private services (Table S1). The C-section rate among women from the poorest wealth quintile who used private services increased over time, while it decreased among those who used public services. In 2017, the C-section rates among the poorest and richest wealth quintile were 12.9% and 36.5%, respectively. For both groups, there were no significant differences in C-section rates by public or private services.