Publication:

Predictors of elective and emergency caesarean deliveries in India: evidence from large scale survey

Background Emergency and elective C-sections are essential for strengthening obstetric care, particularly in low- and middle-income countries like India. This study aims to (i) estimate the prevalence of emergency and elective C-section deliveries in India, and (ii) examine sociodemographic and clinical factors associated with these two types of procedures.

Methods Data were drawn from 230,870 individual births that occurred in the five years preceding the survey, using National Family Health Survey (NFHS-V) data. C-section deliveries were categorized into emergency and elective based on reported indications. Descriptive statistics, bivariate analysis, and multivariable logistic regression were used to assess associated factors.

Results The overall C-section rate was 21.6%, of which 14.2% were emergency and 7.4% elective procedures. Multivariable logistic regression indicated that private facility deliveries were strongly associated with higher odds of overall (AOR=4.17), elective (AOR=2.94), and emergency (AOR=3.08) C-sections compared to public facilities. Rural residence reduced C-section likelihood, while wealthier women, especially the richest, had higher odds. Maternal age, education, and media exposure increased odds across all types. Multiple pregnancies substantially raised C-section risk, whereas higher birth order lowered it. Larger birth size increased emergency C-section likelihood. Regional variation was notable, with southern India showing the highest odds. ANC visits increased overall C-section risk but had limited impact on elective or emergency C-sections.

Conclusions Addressing regional inequities, improving obstetric care readiness, and reducing unnecessary elective C-sections are critical for improving maternal and neonatal health outcomes.