ArticleBMJ global health2020
Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017.
Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Profit over woman-centred care? A commentary on drivers of high rates of caesarean birth in Indonesia.BMJ global health · 2026Article
- Observational
- Delineating the risk factors, sources of acquisition and clinical outcomes in neonates colonised with multidrug-resistant bacteria: the NeoCol study.Nature communications · 2026Article
- Article
- Prevalence and Determinants of Caesarean Section Deliveries in Ghana: A Population-Based Cross-sectional Study.Public health in practice (Oxford, England) · 2025Article
- The first 1000 days: the price of inequalities in high and middle-income countries.Pediatric research · 2025Review
- Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature.Maternal and child health journal · 2025Article
- The Portrayal of Cesarean Section on Instagram: Mixed Methods Social Media Analysis.JMIR formative research · 2024Article
- Rising caesarean section rates and factors affecting women's decision-making about mode of birth in Indonesia: a longitudinal qualitative study.BMJ global health · 2024Article
- Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study.BMJ open · 2024Article
- Trends and determinants of caesarean section in South Asian countries: Bangladesh, Nepal, and Pakistan.PloS one · 2024Article
- Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis.BMC public health · 2023Article
- Article
- Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features.BMC health services research · 2022Article
- Caesarean section in Sudan: findings from nationwide household surveys on rates, trends, and geographic and sociodemographic variability.BMC pregnancy and childbirth · 2022Article
- Article
- Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital.Frontiers in medicine · 2021Article
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Abstract
introductionCaesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period.
methodsSeven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference.
resultsThe proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales.
conclusionThis study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.
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