**3. Results**

**Table 1** presents the results of bivariate analysis of C-section delivery rates, by the place of delivery, among all deliveries and all institutional deliveries by the women's background characteristics. From **Table 1**, it was found that among all deliveries, about 12% of women delivered their last birth by C-section, while it was about 24% among all institutional deliveries. And by place of delivery, it was 58.8 and 15.2% for private and public hospitals, respectively. Among all deliveries, it was observed that the proportion of C-section delivery increased with the increases in the maternal age, while the rate of C-section delivery decreased with the increases in birth order. With an increase in the number of ANC visits, the proportion of C-section delivery also increased. The proportions of C-section delivery were higher for receiving ANC services at only private hospitals and for receiving ANC services at both the private and public hospitals than the categories of not receiving any ANC services, receiving it at home and receiving it at public hospitals only. With the increase in the mother's level of education and household's income, the rates of C-section delivery also increased. The percent of C-section delivery was relatively higher for Hindus than that of Muslims and other minor religious groups. Also, the rate of C-section delivery was higher for other categories (general or nondeprived population) than the deprived communities, that is, Scheduled Caste (SC) and Scheduled Tribe (ST). As compared with rural areas, C-section delivery rate was higher for urban areas. Further, the rate of C-section delivery was quite higher for the women who had health insurance than those who had not. However, the rate of C-section delivery was excessively high for the women who delivered their babies in private health facilities (55.8%) followed by the women who attained higher secondary or more education (50.4%), women who had health insurance (36.4%), women who had received antenatal care service eight or more times (36%), women who had received ANC service in only private health facilities (30.4%) and women who lived in urban areas (29.7%). Besides, women who had only one child, received ANC service four to seven times, received ANC service in both public health facilities and private health facilities, attained upper primary or secondary education and delivered their infants in public health facilities present above 15% of C-section delivery rate in West Bengal. On the other hand, the rates of caesarean delivery were very low, which was lower than 5% for the women who had three children, women who did not receive any ANC service, women who received ANC service at home or elsewhere, illiterate women, poor women and tribal women.

**Table 2** presents the results of the logistic regression analysis and adjusted probabilities which were computed from the coefficients of logistic regression analysis for C-section delivery. The logistic regression analysis included only the women (unweighted no. = 3149) of age 15–49 years who had given live birth in any health facilities since January 1, 2004, in West Bengal because performing of C-section is possible only in health institutions. Women's background characteristics, utilisation of antenatal care and delivery care service were considered as independent variables, and the type of delivery (normal delivery or C-section delivery) was taken as a dependent variable in this analysis. The actual probability of C-section delivery was 24.1% (weighted) for all the women who had given live birth in any health facilities. The results showed that the place of delivery and number of ANC visits were the significant factors of C-section delivery among institutional factors; maternal age and birth order were the significant factors of C-section delivery among demographic factors; and the level of maternal education was the only one factor significantly associated with the C-section delivery among socioeconomic factors. Delivery in private health facility was the strongest predictor of C-section delivery after controlling for other variables. The adjusted probability of having

**63**

*Correlates of Caesarean Section Delivery in West Bengal, India: An Analysis Based on DLHS-3*

<20 years 11.5 43.8 0 **8.4 16** 1756 1759 20–24 years 15.9 56.4 0 **12.5 24.9** 2723 2727 25–29 years 18 62.1 0 **14.3 30.3** 1321 1323 30+ years 21.5 58.8 0 **13.3 34.3** 637 638

1 18.9 57.4 0 **19.6 28.5** 2505 2502 2 13.3 57.7 0 **10.5 22.4** 2029 2029 3+ 7.5 39.7 0 **3.1 12** 1904 1916

Up to 3 times 11.4 43.6 0 **5.3 15.4** 3640 3658 4–7 times 16.6 55 0 **16.7 26.1** 2281 2278 8+ times 25.2 68.4 0 **36 42.8** 517 511

No ANC visits 22.9 0 0 **3.1 20** 258 259 Only public # 12.3 47 0 **6 14.5** 3675 3687 Only private # 22.8 57.3 0 **30.4 41.4** 970 967 Public/private # 17.5 58.4 0 **17 27.1** 1369 1368 Home/elsewhere 12 66.7 0 **3 17.9** 167 166

No schooling 10.6 32.2 0 **3.7 12.6** 2218 2236 Up to 5 years 12.1 42.2 0 **6.7 15.9** 1696 1701 6–10 years 16.3 54.7 0 **16.9 25.4** 2105 2094 11+ years 35.4 69.7 0 **50.2 54** 419 416

Poor 9.6 58.5 0 **3.8 13.2** 1929 1945 Middle 11.8 44.1 0 **6.8 15.7** 2776 2779 Rich 22.4 59 0 **28.9 35.6** 1733 1723

Muslims 15.9 45.5 0 **6.9 20.9** 1976 1988 Hindus 15 57.9 0 **14.1 24.9** 4368 4365 Others 19.2 37.5 0 **8.6 23.5** 93 94

Scheduled Caste 12 50.4 0 **8.2 17.1** 1953 1964 Scheduled Tribe 11.3 41.2 0 **4.4 14.3** 545 548 Others 17.4 57.5 0 **14.7 28.1** 3940 3935

Rural 12.4 54.9 0 **8.7 20** 5466 5474 Urban 25.5 57.4 0 **29.7 36.4** 972 973

**deliveries**

**Place of delivery All** 

**Home/ elsewhere**

**C-section delivery rate (%) Number of women**

**All institutional deliveries**

**Weighted Unweighted**

*DOI: http://dx.doi.org/10.5772/intechopen.88838*

**Public #**

**Private #**

**Background characteristics**

**Age**

**Birth order**

**No. of ANC visits**

**Place of ANC visits**

**Education**

**Income (wealth index)**

**Religion group**

**Social group**

**Place of residence**


*Correlates of Caesarean Section Delivery in West Bengal, India: An Analysis Based on DLHS-3 DOI: http://dx.doi.org/10.5772/intechopen.88838*

*Maternal and Child Health Matters Around the World*

elsewhere, illiterate women, poor women and tribal women.

**Table 2** presents the results of the logistic regression analysis and adjusted probabilities which were computed from the coefficients of logistic regression analysis for C-section delivery. The logistic regression analysis included only the women (unweighted no. = 3149) of age 15–49 years who had given live birth in any health facilities since January 1, 2004, in West Bengal because performing of C-section is possible only in health institutions. Women's background characteristics, utilisation of antenatal care and delivery care service were considered as independent variables, and the type of delivery (normal delivery or C-section delivery) was taken as a dependent variable in this analysis. The actual probability of C-section delivery was 24.1% (weighted) for all the women who had given live birth in any health facilities. The results showed that the place of delivery and number of ANC visits were the significant factors of C-section delivery among institutional factors; maternal age and birth order were the significant factors of C-section delivery among demographic factors; and the level of maternal education was the only one factor significantly associated with the C-section delivery among socioeconomic factors. Delivery in private health facility was the strongest predictor of C-section delivery after controlling for other variables. The adjusted probability of having

**Table 1** presents the results of bivariate analysis of C-section delivery rates, by the place of delivery, among all deliveries and all institutional deliveries by the women's background characteristics. From **Table 1**, it was found that among all deliveries, about 12% of women delivered their last birth by C-section, while it was about 24% among all institutional deliveries. And by place of delivery, it was 58.8 and 15.2% for private and public hospitals, respectively. Among all deliveries, it was observed that the proportion of C-section delivery increased with the increases in the maternal age, while the rate of C-section delivery decreased with the increases in birth order. With an increase in the number of ANC visits, the proportion of C-section delivery also increased. The proportions of C-section delivery were higher for receiving ANC services at only private hospitals and for receiving ANC services at both the private and public hospitals than the categories of not receiving any ANC services, receiving it at home and receiving it at public hospitals only. With the increase in the mother's level of education and household's income, the rates of C-section delivery also increased. The percent of C-section delivery was relatively higher for Hindus than that of Muslims and other minor religious groups. Also, the rate of C-section delivery was higher for other categories (general or nondeprived population) than the deprived communities, that is, Scheduled Caste (SC) and Scheduled Tribe (ST). As compared with rural areas, C-section delivery rate was higher for urban areas. Further, the rate of C-section delivery was quite higher for the women who had health insurance than those who had not. However, the rate of C-section delivery was excessively high for the women who delivered their babies in private health facilities (55.8%) followed by the women who attained higher secondary or more education (50.4%), women who had health insurance (36.4%), women who had received antenatal care service eight or more times (36%), women who had received ANC service in only private health facilities (30.4%) and women who lived in urban areas (29.7%). Besides, women who had only one child, received ANC service four to seven times, received ANC service in both public health facilities and private health facilities, attained upper primary or secondary education and delivered their infants in public health facilities present above 15% of C-section delivery rate in West Bengal. On the other hand, the rates of caesarean delivery were very low, which was lower than 5% for the women who had three children, women who did not receive any ANC service, women who received ANC service at home or

**3. Results**

**62**


*Sources: Computed from DLHS-3 data files.*

#### **Table 1.**

*C-section delivery rates by women's background characteristics, antenatal care service and place of delivery in West Bengal, DLHS-3, 2007–2008.*


**65**

*Correlates of Caesarean Section Delivery in West Bengal, India: An Analysis Based on DLHS-3*

**B Odds** 

No schooling® 655 0 0 12.6 19.8 Up to 5 years 716 0.1659 1.172 15.9 22.4 6–10 years 1392 0.251 1.2985 25.4 24.1 11+ years 386 0.6437 1.9\*\* 54 31.8\*\*

Poor® 557 0 0 13.2 23.7 Middle 1196 −0.133 0.882 15.7 21.5 Rich 1396 0.091 1.1095 35.6 25.4

Muslims® 652 0 0 20.9 25.9 Hindus 2463 −0.154 0.8657 24.9 23.1 Others 34 −0.373 0.6989 23.5 19.4

Scheduled Caste® 938 0 0 17.6 22.8 Scheduled Tribe 168 −0.099 0.9219 14.3 21.4 Others 2043 0.0875 1.078 14.7 24.2

Rural® 2360 0 0 8.7 22.6 Urban 789 0.214 1.2439 29.7 26.6

No® 3003 0 0 23.1 23.6 Yes 146 −0.053 0.9549 45.9 22.7

*The actual probability of C-section delivery in health facilities is about 24% (24.1%, weighted); Cox & Snell R* 

*Note: The analysis is based on institutional delivery, (no. of unweighted cases = 3149).*

*Square = 0.178, Nagelkerke R Square = 0.266; ® Reference category.*

**ratio**

**Unadjusted probabilities (in percent)**

**Predicted probabilities (in percent)**

C-section in private health facilities was 49.6%; that was almost three times higher than public health facilities (18.3%). The place of ANC services did not seem to have a very clear effect on C-section delivery, but the frequency of antenatal visits had a mild effect on C-section delivery; it was mostly found at higher number of ANC visits. The probability of C-section delivery for the older women was higher than younger women after controlling for other variables. With the increase in maternal age, the chances of having C-section delivery also increased. The birth order also was one of the strongest predictors of C-section delivery. With the increase in birth order, the probability of having C-section decreased, which was in the opposite direction to the maternal age. The effect of education was observed,

*Predicted (adjusted) probabilities of C-section delivery in West Bengal, computed from logistic regression,* 

*DOI: http://dx.doi.org/10.5772/intechopen.88838*

**No. of women**

**Background characteristics**

**Education**

*Socioeconomic factors*

**Income (Wealth index)**

**Religion group**

**Social group**

**Place of residence**

*Insurance coverage*

*\*Significant level at 0.05 \*\*Significant level at 0.01 \*\*\*Significant level at 0.001*

*DLHS-3, 2007–2008, India.*

**Table 2.**

*Sources: Computed from DLHS-3 data files.*


*Correlates of Caesarean Section Delivery in West Bengal, India: An Analysis Based on DLHS-3 DOI: http://dx.doi.org/10.5772/intechopen.88838*

*Note: The analysis is based on institutional delivery, (no. of unweighted cases = 3149).*

*The actual probability of C-section delivery in health facilities is about 24% (24.1%, weighted); Cox & Snell R Square = 0.178, Nagelkerke R Square = 0.266; ® Reference category.*

*\*Significant level at 0.05*

*\*\*Significant level at 0.01*

*\*\*\*Significant level at 0.001*

*Sources: Computed from DLHS-3 data files.*

#### **Table 2.**

*Maternal and Child Health Matters Around the World*

**Public #**

**Private #**

**Place of delivery All** 

**Home/ elsewhere**

**No. of women** **B Odds** 

*C-section delivery rates by women's background characteristics, antenatal care service and place of delivery in* 

Private health facilities 689 1.4839 4.4\*\*\* 55.8 49.6\*\*\*

No ANC visits® 40 0 0 20 32.6

Public and private 856 −0.323 0.724 27.1 26 Home/elsewhere 28 −0.31 0.734 17.9 26.2

Up to 3 times® 1260 0 0 15.4 21.1 4–8 times 1459 0.1878 1.194 26.1 24.2 8+ times 430 0.4545 1.6\*\* 42.8 29.5\*\*

<20 years® 921 0 0 16 16.7 20–24 years 1363 0.4766 1.6\*\*\* 24.9 24.2\*\*\* 25–29 years 620 0.8215 2.3\*\*\* 30.3 31.1\*\*\* 30+ years 245 0.932 2.5\*\*\* 34.3 33.7\*\*\*

1® 1713 0 0 28.5 29.8 2 944 −0.451 0.64\*\*\* 22.4 21.3\*\*\* 3+ 492 −1.166 0.3\*\*\* 12 11.7\*\*\*

**ratio**

**deliveries**

No 14.9 55.2 0 **11.1 23.1** 6254 6263 Yes 29 61 0 **36.4 45.9** 184 184 **All 15.2 55.8 0 11.8 24.1 6438 6447**

2460 0 0 15.2 18.3

1516 −0.577 0.5767 14.5 21.6

709 −0.399 0.68 41.4 24.8

**Unadjusted probabilities (in percent)**

**C-section delivery rate (%) Number of women**

**All institutional deliveries**

> **Predicted probabilities (in percent)**

**Weighted Unweighted**

**Background characteristics**

**Table 1.**

**Background characteristics**

**Insurance coverage**

*Note: # = type of health facilities Sources: Computed from DLHS-3 data files.*

*West Bengal, DLHS-3, 2007–2008.*

*Institutional factors* **Place of delivery** Public health facilities®

**Place of ANC services**

Only public health facilities

Only private health

**No. of ANC visits**

*Demographic factors*

**Age**

**Birth order**

facilities

**64**

*Predicted (adjusted) probabilities of C-section delivery in West Bengal, computed from logistic regression, DLHS-3, 2007–2008, India.*

C-section in private health facilities was 49.6%; that was almost three times higher than public health facilities (18.3%). The place of ANC services did not seem to have a very clear effect on C-section delivery, but the frequency of antenatal visits had a mild effect on C-section delivery; it was mostly found at higher number of ANC visits. The probability of C-section delivery for the older women was higher than younger women after controlling for other variables. With the increase in maternal age, the chances of having C-section delivery also increased. The birth order also was one of the strongest predictors of C-section delivery. With the increase in birth order, the probability of having C-section decreased, which was in the opposite direction to the maternal age. The effect of education was observed, which was mostly found at the higher level of education. A small variation in the probability of C-section delivery was observed between the rural and urban residences, but it was an insignificant factor after controlling for others. The effect of level of income on C-section delivery was mild, so were the effects of religion and caste. Besides, the insurance coverage did not show any significant effect on C-section delivery in this analysis, although it had a large gross effect on C-section delivery in bivariate analysis.
