Cesarean delivery and its social determinants in women of childbearing age: analysis of Benin’s DHS

Abstract Background Caesarean delivery, usually performed on a medical indication, is intended for maternal or fetal rescue. Accessibility issues justify setting up a so-called model of “free caesarean” in several developing countries, including Benin, in order to reduce social inequalities and contribute to the reduction of maternal and neonatal mortality. The study aimed to identify the determinants associated with caesarean delivery in women aged 15-49 in Benin. Methods This is a secondary analysis of data from Benin’s Demographic and Health Survey (DHS) 2017 - 2018. It was limited to mothers aged 15 to 49 who gave birth to at least one child in the 5 years preceding the survey. The socio-demographic characteristics of the mother and the variables related to pregnancy were the independent variables. Association between cesarean delivery and its determinants was assessed by odds ratios and their 95% confidence interval using a logistic regression. Results The percentage of mothers who gave birth by caesarean was 6.84%, 95% CI = [6.07; 7.59]. The average age was 29.37 years, 95% CI = [29.20; 29.55]. The probability of cesarean delivery was higher with women aged 45 years and older (OR = 3.33, 95% CI = [1.85, 6.01]), living in urban areas (OR = 1.41, 95% CI = [1.08 1.84]), from rich or very rich households (OR = 1.98, 95% CI = [1.29, 3.05], OR = 1.87, 95% CI = [1.19, 2.96] respectively) and educated (OR = 1.63 95% CI = [1.19, 2.24] and OR = 1.81, 95% CI = [0.97, 3.39] for the secondary and upper levels respectively). Conclusions This analysis shows that cesarean delivery remains associated with the socio-demographic characteristics of the mother, including the level of economic well-being. The current financing model of cesarean should be evaluated for effectiveness and further interventions need to be implemented to account for other factors of disparity. Key messages Benin health authorities should improve the geographical accessibility of Cesarean section, especially in rural areas. The strategies proposed to improve the financial accessibility of cesarean section do not seem effective, so the Beninese authorities should think about revising them.