Determinants of caesarean section use in Ghana: A trend analysis of 2003-2022 DHS data

The global rise in caesarean section (CS) delivery has raised significant public health concerns, particularly regarding drivers and potential health implications. Although the World Health Organization (WHO) recommends CS rates between 5% and 15%, global averages exceed this range, with regional disparities and medically unjustified procedures contributing to the increase. In Ghana, similar trends are emerging amid infrastructural and referral system limitations, yet limited studies have used nationally representative data to track changes over time. This study used data from the 2003, 2008, 2014, and 2022 Ghana Demographic and Health Surveys (GDHS) to examine trends and determinants of CS among women aged 15-49 years who had a live birth in the five years preceding the survey. Weighted descriptive statistics and multilevel logistic regression were employed to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for predictors, accounting for the complex survey design. Key variables included survey year, antenatal care (ANC) attendance, maternal education, household wealth, birth size, multiple births, maternal age, and birth order. CS prevalence rose from 4.4% in 2003 to 20.1% in 2022 (p < 0.001). Clinical predictors included multiple births (OR≈5.0), first-order births and larger perceived birth size. Non-clinical factors also strongly influenced CS use: higher education, maternal age ≥ 30 years richest wealth quintile (OR≈3.5), frequent antenatal care attendance, and urban residence increased odds, while rural residence reduced odds. Temporal effects remained strong even after adjustment, underscoring a systemic rise in CS. CS delivery in Ghana has risen sharply over two decades, driven by both clinical and non-clinical factors, including socioeconomic status, education, and healthcare access. Policy interventions should focus on monitoring CS indications, ensuring equitable access, and safeguarding against medically unnecessary procedures.