Too Posh to Push: Determinants of Planned C-Section Delivery Among Indonesian Women

摘要

Caesarean section (CS) delivery in Indonesia is on the rise and has drawn a considerable attention to its social determinants. However, information on planned CS delivery is limited in the Indonesian setting. Hence, this study aims at investigating its correlates. We employed data from the 2017 round of the Indonesian Demographic and Health Survey. The dependent variable is a nominal variable representing method of delivery (1 = natural, 2 = planned CS, 3 = unplanned CS). The explanatory variables comprise three groups, namely spatial, maternal, demographic, socio-economic variables, and access to information. We fitted simple and multivariable multinomial logit models using relative risk ratio as the measure of association. After selecting facility births only and deleting missing cases, we analysed an analytic sample of 12,225 births. Of those births we observed 22.89% were done by CS. There were slight differences related to region of residence and urban residence for both planned and unplanned CS. Higher maternal age corresponds with higher risks of both planned and unplanned CS. Complication during pregnancy was found to increase the risk of planned CS. Moreover, access to internet increases the probability of having planned and unplanned CS delivery. Furthermore, ownership of private insurance and affluence are strongly associated with planned CS delivery. These findings suggest an indication of unnecessary CS deliveries that consume resources that could otherwise be used for other health needs. Educating expectant mothers and families on the benefits of natural birth could reduce the planned c-section rates in Indonesia and save health resources.