Social determinants of delivery mode in Jiangsu, China

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Abstract

Background

Less evidence exists regarding the association of social determinants and delivery mode in Jiangsu, and if the trend is influenced by the type of residence. This study aims to identify the significant social determinants of delivery mode, and also to compare the main differences in delivery mode between urban and rural areas.

Methods

We used data from the cross-sectional National Health Service Surveys conducted in Jiangsu Province in 2013. For the purposes of this study, information from women (15–64 years old) who had experienced childbirth the last 5 years were examined, and a total of 1365 participants were selected as research subjects.

Results

Participants using vaginal delivery mode and cesarean delivery mode were found in 616 (45.1%) and 751(54.9%) participants, respectively. The proportion of women using cesarean delivery was 53.5% in rural area and 58.2% in urban area. Meanwhile, our results showed that women in middle Jiangsu were more likely to use cesarean delivery, and cesarean delivery is more prevalent among richer women. We also find that the more use of prenatal care visit, the more use of cesarean delivery.

Conclusions

This study validated the relationship between social determinants and the mode of delivery in Jiangsu province. Social determinants are contextual factors, which may vary by region and additional work is needed to fully understand these relationships globally. Further studies are needed to elucidate mechanisms and pathways across various populations, and these social determinants should be incorporated into future multi-level interventions designed to decrease the cesarean delivery rate.

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Most cited references 10

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Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Francesca L Cavallaro, Jenny A Cresswell, Giovanny VA Franca … (2013)

Objective To examine temporal trends in caesarean delivery rates in southern Asia and sub-Saharan Africa, by country and wealth quintile. Methods Cross-sectional data were extracted from the results of 80 Demographic and Health Surveys conducted in 26 countries in southern Asia or sub-Saharan Africa. Caesarean delivery rates were evaluated – as percentages of the deliveries that ended in live births – for each wealth quintile in each survey. The annual rates recorded for each country were then compared to see if they had increased over time. Findings Caesarean delivery rates had risen over time in all but 6 study countries but were consistently found to be lower than 5% in 18 of the countries and 10% or less in the other eight countries. Among the poorest 20% of the population, caesarean sections accounted for less than 1% and less than 2% of deliveries in 12 and 21 of the study countries, respectively. In each of 11 countries, the caesarean delivery rate in the poorest 40% of the population remained under 1%. In Chad, Ethiopia, Guinea, Madagascar, Mali, Mozambique, Niger and Nigeria, the rate remained under 1% in the poorest 80%. Compared with the 22 African study countries, the four study countries in southern Asia experienced a much greater rise in their caesarean delivery rates over time. However, the rates recorded among the poorest quintile in each of these countries consistently fell below 2%. Conclusion Caesarean delivery rates among large sections of the population in sub-Saharan Africa are very low, probably because of poor access to such surgery.

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Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014

Md. Nuruzzaman Khan, M Islam, Asma Ahmad Shariff … (2017)

Background Globally the rates of caesarean section (CS) have steadily increased in recent decades. This rise is not fully accounted for by increases in clinical factors which indicate the need for CS. We investigated the socio-demographic predictors of CS and the average annual rates of CS in Bangladesh between 2004 and 2014. Methods Data were derived from four waves of nationally representative Bangladesh Demographic and Health Survey (BDHS) conducted between 2004 and 2014. Rate of change analysis was used to calculate the average annual rate of increase in CS from 2004 to 2014, by socio-demographic categories. Multi-level logistic regression was used to identify the socio-demographic predictors of CS in a cross-sectional analysis of the 2014 BDHS data. Result CS rates increased from 3.5% in 2004 to 23% in 2014. The average annual rate of increase in CS was higher among women of advanced maternal age (≥35 years), urban areas, and relatively high socio-economic status; with higher education, and who regularly accessed antenatal services. The multi-level logistic regression model indicated that lower (≤19) and advanced maternal age (≥35), urban location, relatively high socio-economic status, higher education, birth of few children (≤2), antenatal healthcare visits, overweight or obese were the key factors associated with increased utilization of CS. Underweight was a protective factor for CS. Conclusion The use of CS has increased considerably in Bangladesh over the survey years. This rising trend and the risk of having CS vary significantly across regions and socio-economic status. Very high use of CS among women of relatively high socio-economic status and substantial urban-rural difference call for public awareness and practice guideline enforcement aimed at optimizing the use of CS.

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Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes

Mario Festin, Malinee Laopaiboon, Porjai Pattanittum … (2009)

Background Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries. This audit aimed to report rates and reasons for caesarean and associated clinical care practices amongst nine hospitals in the four South East Asian countries participating in the South East Asia-Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project. Methods Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005. Results Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries. Conclusion Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.

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Author and article information

Contributors

Hong Fan: fanhong@njmu.edu.cn

Hai Gu:

ORCID: http://orcid.org/0000-0002-3572-3052

503192818@qq.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 5 December 2019

Publication date PMC-release: 5 December 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 473

Affiliations

[1 ]ISNI 0000 0001 2314 964X, GRID grid.41156.37, Center for Health Policy and Management Research, , Nanjing University, ; 22 Hankou Road, Nanjing, People’s Republic of China

[2 ]ISNI 0000 0000 9255 8984, GRID grid.89957.3a, Department of Social Medicine and Health Education, , School of Public Health, Nanjing Medical University, ; 101 Longmian Road, Nanjing, People’s Republic of China

Author information

Hai Gu http://orcid.org/0000-0002-3572-3052

Article

Publisher ID: 2639

DOI: 10.1186/s12884-019-2639-2

PMC ID: 6894495

PubMed ID: 31805886

SO-VID: 4c4e6166-ae73-4a46-bc9d-a6cea6de4027

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 March 2018

Date accepted : 26 November 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 71503139

Funded by: FundRef http://dx.doi.org/10.13039/501100002858, China Postdoctoral Science Foundation;

Award ID: 2016M600400

Funded by: FundRef http://dx.doi.org/10.13039/501100010023, Natural Science Research of Jiangsu Higher Education Institutions of China;

Award ID: 16KJB330002

Funded by: Philosophy and Social Science Research of Jiangsu Higher Education Institutions of China

Award ID: 2017SJB0267

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: social determinants,delivery mode,jiangsu,china

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: social determinants, delivery mode, jiangsu, china

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Social determinants of delivery mode in Jiangsu, China

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Jiangsu Journal of Preventive Medicine

Most cited references 10

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014

Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes

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