Determinants of Choice of Cesarean Section Among Women of Child-bearing Age in Kenya

Abstract

Improving the availability, accessibility, quality and, use of maternal health services is an important WHO policy to reduce maternal mortality globally. The WHO sets a threshold of 10% -15% of live births as a quality indicator for adequate access to maternal health services. This threshold is assumed by the WHO to be representative of the proportion of pregnancies with medical risk indicators that would warrant surgical births in any given country. In Kenya, the rapid increase in c-section births over the past decade has been highlighted as an area of concern for health policy makers and healthcare providers. The aim of this study was to determine the factors that influence choice of c-section births among women of child-bearing age in Kenya. Data was obtained from the Kenya Demographic and Household Survey 2014. A Binary Probit Model was estimated to examine the effect of the following determinants on choice of c-section delivery in Kenya. Statistically significant predictors of c-section births were maternal age, educational attainment, residence, health insurance, place of delivery and multiple pregnancy order. Higher maternal age, increased wealth status, educational attainment, choice of delivery place, number of Antenatal clinic visits and, multiple pregnancy order increased the probability of choice of c-section delivery while being widowed and living in a rural area reduced the probability of choice of c-section delivery. Rural women, widowed women, less wealthy and less educated women were found to be less likely to choose c-section births regardless of the existing ‘no-user-fee’ government policy. Based on these study findings, the study recommends- 1. A c-section policy framework to regulate and standardize the threshold for medical indications that warrant c-section delivery 2. That private insurers consider introducing a reimbursement scheme to curb the increase in incentive for provider induced demand for c-section deliveries 3. That the allocation from the Ministry of Health Capitation fund be increased to meet the WHO threshold for c-section delivery rate especially given the evidence of possible inequity in the utilization of c-section delivery services among richer and higher educated women relative to the poorest and un-educated women as well as among rural residing women relative to urban residing women 4. That public and private sector health policy makers create policies that target rising maternal preferences for CS delivery and professional attitudes biased towards CS deliveries.