ArticleBMC health services research2023
Out of pocket expenditure and distress financing on cesarean delivery in India: evidence from NFHS-5.
Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Understanding out-of-pocket expenditure in India: a systematic review.Frontiers in public health · 2025Pooled it
- Beyond the scar: a qualitative study on the physical, psychosocial and economic impacts of caesarean section in Keonjhar District of Odisha.BMC pregnancy and childbirth · 2026Article
- Article
- Article
- Insights into Public-Private Sector Variations in Maternal Health Care Utilization in an Urban Slum in Mumbai.Cureus · 2026Article
- Article
- Caesarean deliveries and their impact on financial burden and quality of life among post-partum mothers in Tamil Nadu, India.PloS one · 2026Article
- The price of equality: determinants of the convergence in delivery costs in Bangladesh.Frontiers in public health · 2026Article
- Health system drivers of caesarean deliveries in south Asia: a scoping review.The Lancet regional health. Southeast Asia · 2025Review
- Private sector delivery of care for maternal and newborn health: trends over a decade in the Indian state of Bihar.BMC medicine · 2025Article
- State-wise variation and inequalities in caesarean delivery rates in India: analysis of the National Family Health Survey-5 (2019-2021) data.The Lancet regional health. Southeast Asia · 2025Article
- Preventing the preventable: Assessing the burden of incessant caesarean deliveries in select Indian states using NFHS-5.PloS one · 2025Article
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3 authors.
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Abstract
backgroundThough over three-fourths of all births receive medical attention in India, the rate of cesarean delivery (22%) is twice higher than the WHO recommended level. Cesarean deliveries entail high costs and may lead to financial catastrophe for households. This paper examines the out-of-pocket expenditure (OOPE) and distress financing of cesarean deliveries in India.
methodsWe used data from the latest round of the National Family Health Survey conducted during 2019-21. The survey covered 636,699 households, and 724,115 women in the age group 15-49 years. We have used 159,643 births those delivered three years preceding the survey for whom the question on cost was canvassed. Descriptive analysis, bivariate analysis, concentration index (CI), and concentration curve (CC) were used in the analysis.
resultCesarean deliveries in India was estimated at 14.08%, in private health centres and 9.96% in public health centres. The prevalence of cesarean delivery increases with age, educational attainment, wealth quintile, BMI and high for those who had pregnancy complications, and previous birth as cesarean. The OOPE on cesarean births was US$133. It was US$498 in private health centres and US$99 in public health centres. The extent of distress financing of any cesarean delivery was 15.37%; 27% for those who delivered in private health centres compared to 16.61% for those who delivered in public health centres. The odds of financial distress arising due to OOPE on cesarean delivery increased with the increase of OOPE [AOR:10.00, 95% CI, 9.35-10.70]. Distress financing increased with birth order and was higher among those with low education and those who belonged to lower socioeconomic strata.
conclusionHigh OOPE on a cesarean delivery leads to distress financing in India. Timely monitoring of pregnancy and providing comprehensive pregnancy care, improving the quality of primary health centres to conduct cesarean deliveries, and regulating private health centres may reduce the high OOPE and financial distress due to cesarean deliveries in India.
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