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Examining inequalities in access to delivery by caesarean section in Nigeria
Authors: Boniface Ayanbekongshie Ushie, Ekerette Emmanuel Udoh, and Anthony Idowu Ajayi
Source: PLOS ONE , 14(8): e0221778; DOI: 10.1371/journal.pone.0221778
Topic(s): Cesarean section
Delivery care
Health care utilization
Health equity
Institutional births
Maternal health
Maternal mortality
Country: Africa
Published: AUG 2019
Abstract: BACKGROUND:Maternal deaths are far too common in Nigeria, and this is in part due to lack of access to lifesaving emergency obstetric care, especially among women in the poorest strata in Nigeria. Data on the extent of inequality in access to such lifesaving intervention could convince policymakers in developing an appropriate intervention. This study examines inequality in access to births by caesarean section in Nigeria. METHODS:Data for 20,468 women who gave birth in the five years preceding 2013 Nigerian Demographic and Health Survey (DHS) were used for this study. Inequality in caesarean delivery was assessed using the concentration curve and multiple logistic regression models. RESULTS:There was a high concentration in the utilisation of caesarean section among the women in the relatively high wealth quintile. Overall, delivery by caesarean section was 2.1%, but the rate was highest among women who had higher education and belonged to the richest wealth quintile (13.6%) and lowest among women without formal education and who belonged to the poorest wealth quintile (0.4%). Belonging to the poorest wealth quintile and having no formal education were associated with lower odds of having delivery by caesarean section. CONCLUSION:In conclusion, women in the richest households are within the WHO's recommended level of 10-15% for caesarean birth utilisation, but women in the poorest households are so far away from the recommended rate. Equity in healthcare is still a promise, its realisation will entail making care available to those in need not only those who can afford it.