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Table 1 Risk factors associated with cesarean birth, 2010–2018

From: Cesarean birth in the Global Network for Women’s and Children’s Health Research: trends in utilization, risk factors, and subgroups with high cesarean birth rates

  Overall African sites Non-African sites
Cesarean/total deliveries (%) RR (95% CI)a p valuea Cesarean/total deliveries (%) RR (95% CI)a p valuea Cesarean/total deliveries (%) RR (95% CI)a p valuea
Maternal age (years) 0.001  < 0.001  < 0.001
 < 20 10.0% 1.0 (1.0, 1.0) 0.7 1.5% 1.0 (0.9, 1.1) 0.4 20.1% 1.0 (1.0, 1.0) 0.7
 20–35 14.3% Ref   1.5% Ref   18.9% Ref  
 > 35 10.6% 0.9 (0.9, 1.0)  < 0.001 2.0% 1.4 (1.2, 1.7)  < 0.001 17.2% 0.9 (0.8, 0.9)  < 0.001
Maternal education  < 0.001  < 0.001  < 0.001
 No formal schooling 7.6% Ref   0.9% Ref   8.8% Ref  
 Primary/secondary 13.8% 2.1 (1.9, 2.3)  < 0.001 1.5% 1.5 (1.3, 1.7)  < 0.001 21.4% 2.0 (1.9, 2.2)  < 0.001
 University+ 32.2% 3.9 (3.5, 4.4)  < 0.001 4.8% 4.7 (3.4, 6.3)  < 0.001 37.1% 3.5 (3.2, 3.9)  < 0.001
Parity  < 0.001  < 0.001  < 0.001
 0 19.6% 2.4 (2.2, 2.5)  < 0.001 2.1% 1.7 (1.5, 1.9)  < 0.001 25.7% 2.7 (2.5, 2.8)  < 0.001
 1–2 13.8% 1.7 (1.6, 1.8)  < 0.001 1.4% 1.1 (1.0, 1.2) 0.2 18.4% 2.0 (1.9, 2.1)  < 0.001
 3+ 5.5% Ref  < 0.001 1.2% Ref   8.7% Ref  < 0.001
Antenatal visits  < 0.001  < 0.001  < 0.001
 < 4 7.7% Ref  < 0.001 1.1% Ref   12.0% Ref  < 0.001
 4+ 20.1% 1.9 (1.7, 2.1)  < 0.001 2.2% 1.9 (1.7, 2.1)  < 0.001 26.5% 1.9 (1.7, 2.1)  < 0.001
Multiple pregnancy  < 0.001  < 0.001  < 0.001
 Yes 24.5% 2.0 (1.9, 2.2)  < 0.001 7.6% 5.2 (4.4, 6.2)  < 0.001 35.5% 1.9 (1.8, 2.1)  < 0.001
 No 13.5% Ref   1.5% Ref   18.8% Ref  
Abnormal lie  < 0.001  < 0.001  < 0.001
 Yes 64.0% 5.0 (4.4, 5.5)  < 0.001 29.2% 24.5 (19.7, 30.5)  < 0.001 70.5% 4.1 (3.8, 4.5)  < 0.001
 No 12.5% Ref   1.2% Ref   17.6% Ref  
OL/PL/FLPb  < 0.001  < 0.001  < 0.001
 Yes 56.1% 5.9 (5.0, 6.9)  < 0.001 21.3% 47.5 (35.2, 64.3)  < 0.001 63.9% 5.0 (4.3, 5.8)  < 0.001
 No 9.8% Ref   0.5% Ref   14.1% Ref  
Antepartum hemorrhage  < 0.001  < 0.001  < 0.001
 Yes 21.3% 1.9 (1.7, 2.0)  < 0.001 11.1% 7.8 (6.4, 9.5)  < 0.001 25.4% 1.7 (1.5, 1.8)  < 0.001
 No 13.5% Ref   1.4% Ref   18.9% Ref  
HTN/PEC/ECc  < 0.001  < 0.001  < 0.001
 Yes 42.5% 3.0 (2.7, 3.4)  < 0.001 13.6% 9.4 (7.3, 12.1)  < 0.001 45.7% 2.6 (2.4, 2.9)  < 0.001
 No 12.8% Ref   1.4% Ref   18.0% Ref  
Preterm 0.9 0.7 1.0
 Yes 12.6% 1.0 (1.0, 1.1) 0.9 1.6% 1.0 (0.9, 1.2) 0.7 17.7% 1.0 (1.0, 1.1) 1.0
 No 13.9% Ref   1.5% Ref   19.3% Ref  
  1. aRelative risks and p values are obtained from log Binomial models as a function of each individual risk factor using generalized estimating equations to account for the correlation of outcomes within cluster
  2. bOL/PL/FTP represents obstructed labor, prolonged labor, failure to progress
  3. cHTN/PEC/EC represents hypertension, pre-eclampsia, eclampsia