Explaining rising caesarean section rates in urban Nepal: A mixed-methods study.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Services Research

Background:

• Caesarean section (CS) rates are increasing in urban Nepalese hospitals.
• The underlying causes for this rise are not well understood, necessitating further investigation.

Purpose of the Study:

• To explore the factors contributing to escalating CS rates in two urban Nepalese hospitals.
• To identify strategies for the rational utilization of Caesarean sections.

Main Methods:

• A 2021 cross-sectional mixed-methods study in one public and one private hospital in Kathmandu.
• Quantitative analysis of 661 birth records (2018/19) and qualitative analysis of interviews with 14 health professionals, 5 key informants, and 4 focus groups with pregnant women.

Main Results:

• Overall CS rate was 50.2%, with the private hospital rate (68.5%) nearly double the public hospital rate (37.1%).
• Key factors identified include previous CS, maternal request, advanced maternal age, hospital type, and lack of resources. Robson groups 5, 1, 2, 3, and 6 were major contributors.
• Identified strategies include enhancing labor support resources, increasing awareness of childbirth risks/benefits, reforming CS policies, and promoting physiological birth.

Conclusions:

• The high CS rate, particularly in private hospitals, signifies the medicalization of childbirth, posing a public health concern.
• Addressing the multifactorial drivers of rising CS rates requires comprehensive strategies for rational use in urban healthcare settings.