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

Harrison, Margo S.; Garces, Ana L.; Goudar, Shivaprasad S.; Saleem, Sarah; Moore, Janet L.; Esamai, Fabian; Patel, Archana B.; Chomba, Elwyn; Bose, Carl L.; Liechty, Edward A.; Krebs, Nancy F.; Derman, Richard J.; Hibberd, Patricia L.; Carlo, Waldemar A.; Tshefu, Antoinette; Koso-Thomas, Marion; McClure, Elizabeth M.; Goldenberg, Robert L.

doi:10.1186/s12978-020-01021-7

Reproductive Health

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 value^a	Cesarean/total deliveries (%)	RR (95% CI)^a	p value^a	Cesarean/total deliveries (%)	RR (95% CI)^a	p value^a
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/FLP^b	< 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/EC^c	< 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

^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
^bOL/PL/FTP represents obstructed labor, prolonged labor, failure to progress
^cHTN/PEC/EC represents hypertension, pre-eclampsia, eclampsia

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