Caesarean deliveries, subsequent reproductive behaviour, and children ever born in low-fertility states of India-Gynecology conference Bangalore 2017
STUDY DESIGN, SIZE, DURATION: The study used data from District Level Household and Facility Survey (DLHS-4). DLHS-4 used multi-level cluster random sampling design. Sample size (n=86054) is large and allows us to perform robust statistical analyses disaggregated by socioeconomic and demographic characteristics of women. The sample covers 99% of the population in the country.
MATERIALS AND METHODS: DLHS-4 collects detailed information from ever married women in areas such as family planning, fertility, and maternal and child health. Bivariate tabulation is used to examine the variation in female sterilisation and number of CEB by C-section deliveries. Correlation plots were estimated to examine the state-level association between C-section deliveries and female sterilisation, as well as between C-section deliveries and mean CEB. Multivariate regressions were used to estimate predicted probability of sterilisation in women with C-section deliveries as compared to normal deliveries; also to estimate the effect of C-section deliveries and female sterilisation on CEB after controlling for other relevant covariates.
MAIN RESULT AND THE ROLE OF CHANCE: Bivariate tabulation shows that female sterilisation is higher in the case of C-section delivery (64.7%) as compared to non-C-section delivery (41.9%). The predicted probabilities from multivariate regression model indicate a higher chance of female sterilisation in women with C-section delivery (0.63, p < 0.01) as compared to non-C-section delivery (0.39, p < 0.01). Overall, results show strong positive relationships between C-section deliveries and female sterilisation and negative relationship between C-section delivery and mean CEB.
LIMITATIONS, REASONS FOR CAUTION: As a part of the cross-sectional study, we are unable to report the causation between C-section delivery and female sterilisation, and further to the number of CEB.
WIDER IMPLICATIONS OF THE FINDINGS: Although a number of studies have reported that the trajectory of fertility transition in India is non-standard, very few have attempted to explain the reasons and pathways for such a pattern of fertility decline. This study will contribute in this direction and advance the reasons for the higher number of female sterilisations and consequent smaller family size in demographically advanced states of India. However, this kind of fertility decline cannot be recommended because it can only contribute to reduce population growth, but not to an improvement in maternal and child health and nutrition which is considered to be a complementary process with fertility decline. Fertility decline in a country should happen through informed choices in family planning and adhere to reproductive rights of women. The increased use of C-section deliveries and consequent female sterilisations is a regressive socio-demographic process and often violates women’s rights. Therefore, India must address abnormal levels of C-section deliveries and consequent female sterilisations.