Caesarean section delivery rates in India have doubled from 9% in 2005–06 to 17% in 2015–16, increasing the clinical and economic burden on the health care system. This study applied multilevel models to assess the role of household- and community-level factors in Caesarean section (CS) deliveries among low-risk women in India using data from Round 4 of the National Family Health Survey (NFHS-4) conducted in 2015–16. The sample size was 59,318 low-risk women who had their last birth in an institution during the 5 years preceding the survey. These women were nested in 57,279 households, which were nested in 22,183 communities, which were further nested in 640 districts in India. Around 21% of the low-risk women and 24% of all women who had delivered in an institution had undergone CS. The CS rates among low-risk women were extremely high in private institutions (40%) and in southern India (43%). The explanatory variables age, education of women, household wealth and number of antenatal visits were significantly positively associated, while women’s parity was negatively associated, with CS delivery among low-risk women. The multilevel analysis suggested that the likelihood of a low-risk woman opting for CS was influenced by a similar decision of another woman from the same household (37%) and/or community (18%). Furthermore, women with low-risk pregnancies from higher educated communities were less likely (OR 0.92) to undergo CS. There is therefore a need for a community-level awareness programme on the risks and benefits of low-risk CS and vaginal delivery, particularly in the southern region of India.

中文翻译：

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印度女性低风险剖腹产的家庭和社区层面决定因素

印度的剖宫产率从 2005-06 年的 9% 翻倍至 2015-16 年的 17%，增加了医疗保健系统的临床和经济负担。本研究应用多层次模型，利用 2015 年进行的全国家庭健康调查 (NFHS-4) 第 4 轮数据，评估家庭和社区层面因素在印度低风险妇女剖宫产 (CS) 中的作用–16。样本量为 59,318 名在调查前 5 年内在机构中最后一次生育的低风险女性。这些女性在 57,279 个家庭中筑巢，这些家庭在 22,183 个社区中筑巢，这些社区进一步在印度的 640 个地区筑巢。大约 21% 的低风险女性和 24% 在机构分娩的女性接受了剖腹产。在私营机构（40%）和印度南部（43%），低风险女性的 CS 率非常高。解释变量年龄、女性受教育程度、家庭财富和产前检查次数显着正相关，而女性产次与低风险女性的产科分娩呈负相关。多层次分析表明，低风险女性选择 CS 的可能性受到来自同一家庭 (37%) 和/或社区 (18%) 的另一名女性的类似决定的影响。此外，来自受过高等教育的低风险妊娠的女性不太可能（OR 0.92）接受剖腹产。因此，需要针对低风险剖腹产和阴道分娩的风险和益处开展社区层面的宣传计划，尤其是在印度南部地区。