Measures
The outcome measure was C-section rate, assessed by the number of births by C-section divided by the total number of births. Women were asked, ”was (name of baby) delivered by cesarean, that is, did they cut your belly open to take the baby out?” This question was labeled ”delivery by cesarean” in the IDHS dataset and coded into a binary response of yes or no based on the most recent birth.
The explanatory variables included the year of childbirth (1998 – 2017), maternal age (≤19, 20 – 29, ≥30), educational attainment (primary school and below, junior and senior high school, university and above), residence (urban, rural), household wealth quintiles (poorest, poorer, middle, richer, and richest), parity (1, 2 – 3, ≥4), childbirth care services (public services, private services, homebirth, other) and region (western, central and eastern). Wealth quintiles were computed each wave by the DHS team, including analysis of physical assets and home construction material. Parity referred to the total number of times a mother had given birth at the survey date. Childbirth care was grouped given the location of childbirth and characteristics of the providers (including public or private providers), extracted from the DHS variable “place of delivery.” Participants who reported they gave birth at home were coded as “homebirth.” The small number of participants reported unclear childbirth services, which was grouped into “other.” Region was categorized according to time zones in Indonesia as of 2020.