SUB-NATIONAL INEQUALITY OF CAESAREAN SECTION IN URBAN-RURAL AREA OF INDONESIA

  • Suparmi Suparmi National Institute of Health Research and Development, Ministry of Health, Indonesia
  • Nunik Kusumawardhani National Institute of Health Research and Development, Ministry of Health, Indonesia
  • Kun Arisanti Susiloretni Semarang Health Polytechnic, Indonesia
Keywords: caesarean section, sub-national, inequality, Indonesia

Abstract

Cesarean section is an important indicator of accessibility to the emergency obstetric care. The study aims to examine urban-rural inequality and determinant of caesarean section in Indonesia. Cross-sectional data from national household health survey (RISKESDAS) conducted in 2013 were used. A total of 49,045 aged 15-49 years having live births in the last 3 years preceding the survey was included into the analysis. We report absolute difference and ratio of caesarean rates between urban and rural for each province. The logistic regressions were used to identify determinant of caesarean section. The caesarean section rates in rural and urban were 5.4% and 13.4%; respectively. Province estimates of caesarean section rates were ranging from 3.1% in Southeast Sulawesi to 19.1% in DKI Jakarta. Sub-national inequality between urban and rural among province occurs, accounted for absolute difference between -0.2% (West Papua) to 16.2% (Gorontalo). The logistic regression indicates determinant of caesarean section includes older ages, higher education level, currently employed, living in urban area, living in rich household, had any complication during pregnancy, first child, post-term pregnancy and twin had higher caesarean section rates. This study provides evidence that sub-national inequalities of caesarean section rates between urban and rural in Indonesia remain. These inequalities might due to inadequate access to emergency obstetric care among rural subgroups. Sub-national specific intervention among rural population is deeded to address these inequalities.

References

Andayasari, L., Muljati, S., Sihombing, M., Arlinda, D., Opitasari, C., Fajar, D. and Widianto, M. (2015) ‘Proporsi Seksio Sesarea dan Faktor yang Berhubungan dengan Seksio Sesarea di Jakarta’, Buletin Penelitian Kesehatan, 43(2), pp. 105–116.

Badan Penelitian dan Pengembangan Kesehatan Kemenkes RI (2011) Laporan Riset Fasilitas Kesehatan (Rifaskes) 2011. Jakarta.

Betrán, A. P., Ye, J., Moller, A.-B., Zhang, J., Gülmezoglu, A. M. and Torloni, M. R. (2016) ‘The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014.’, PloS one, 11(2), p. e0148343. doi: 10.1371/journal.pone.0148343.

Boatin, A. A., Schlotheuber, A., Betran, A. P., Moller, A.-B., Barros, A. J. D., Boerma, T., Torloni, M. R., Victora, C. G. and Hosseinpoor, A. R. (2018) ‘Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries’, BMJ, 360.

Borghi, J., Bastus, S., Belizan, M., Carroli, G., Hutton, G. and Fox-Rushby, J. (2003) ‘Costs of publicly provided maternity services in Rosario, Argentina’, Salud Publica de Mexico, 45(1), pp. 27–34.

Calvello, E. J., Skog, A. P., Tenner, G. and Wallis, L. A. (2015) ‘Applying the lessons of maternal mortality reduction to global emergency health’, Bull World Health Organ, 93(January), pp. 417–423. doi: 10.2471/BLT.14.146571.

Chigbu, C. O. and Iloabachie, G. C. (2007) ‘The burden of caesarean section refusal in a developing country setting’, pp. 1261–1265. doi: 10.1111/j.1471-0528.2007.01440.x.

Feng, X. L., Xu, L., Guo, Y. and Ronsmans, C. (2012) ‘Factors influencing rising caerarean section rates in China between 1988 and 2008’, Bulletin of the World Health Organization, 90(1), pp. 30–39. doi: 10.2471/BLT.11.090399.

Gebremedhin, S. (2014) ‘Trend and socio-demographic differentials of Caesarean section rate in Addis Ababa, Ethiopia: analysis based on Ethiopia demographic and health surveys data.’, Reproductive Health. Reproductive Health, 11(1), p. 14. doi: 10.1186/1742-4755-11-14.

He, Z., Cheng, Z., Wu, T., Zhou, Y., Chen, J., Fu, Q. and Feng, Z. (2016) The Costs and Their Determinant of Cesarean Section and Vaginal Delivery: An Exploratory Study in Chongqing Municipality, China, BioMed Research International. doi: 10.1155/2016/5685261.

Hodge, A., Firth, S., Marthias, T. and Jimenez-Soto, E. (2014) ‘Location matters: Trends in inequalities in child mortality in Indonesia. Evidence from repeated cross-sectional surveys’, PLoS ONE, 9(7). doi: 10.1371/journal.pone.0103597.

Leeb, K., Baibergenova, A., Wen, E., Webster, G. and Zelmer, J. (2005) ‘Are there socio-economic differences in caesarean section rates in Canada?’, Healthcare policy, 1(1), pp. 48–54.

Siti Maisyaroh Fitri Siregar, R. and Jemadi (2013) ‘Karakteristik ibu bersalin dengan sectio caesarea di Rumah Sakit Umum Daerah dr. Pirngadi Medan Tahun 2011-2012’, Jurnal Gizi, Kesehatan Reproduksi dan Epidemiologi, 2(5).

Souza, J. P., Gülmezoglu, A., Lumbiganon, P., Laopaiboon, M., Carroli, G., Fawole, B., Ruyan, P. and WHO Global Survey on Maternal and Perinatal Health Research Group (2010) ‘Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health’, BMC Medicine, 8(71), pp. 1–10. doi: 10.1186/1741-7015-8-71.

Statistics Indonesia (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), Departemen Kesehatan and Macro International. (2008) Indonesia Demographic and Health Survey 2007. Calverton, Maryland, USA.

Statistics Indonesia (Badan Pusat Statistik—BPS), National Population and Family Planning Board (BKKBN), Kementerian Kesehatan (Kemenkes—MOH) and ICF International (2013) Indonesia Demographic and Health Survey 2012. Jakarta: BPS, BKKBN, Kemenkes, and ICF International.

Sufang, G., Padmadas, S. S., Fengmin, Z., Brown, J. J. and Stones, R. W. (2010) ‘Delivery settings and caesarean section rates in China’, Children, 035808(August 2006), pp. 1–5. doi: 10.2471/BLT.06.035808.

Suparmi and Basuki, B. (2011) ‘Signs or symptoms of complications in pregnancy and risk of caesarean section : an Indonesia national study’, Health Science Journal of Indonesia, 2(2), pp. 71–76.

The Royal Australia and New Zealand College of Obstetrician and Gynaecologist. (2016) Caesarean Delivery on Maternal Request ( CDMR ).

The World Health Organization (2015) WHO Statement on Caesarean Section Rates. Geneva.

Toohill, J., Fenwick, J., Gamble, J. and Creedy, D. K. (2014) Prevalence of childbirth fear in an Australian sample of pregnant women, BMC Pregnancy and Childbirth. doi: 10.1186/1471-2393-14-275.

World Health Organization (2018) Intrapartum care for a positive childbirth experience. Available at: http://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/.

Ye, J., Zhang, J., Mikolajczyk, R., Torloni, M. R., Lmezoglu, A. M. and Betran, A. P. (2016) ‘Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: A worldwide population-based ecological study with longitudinal data’, BJOG: An International Journal of Obstetrics and Gynaecology, 123(5), pp. 745–753. doi: 10.1111/1471-0528.13592.

Published
2019-08-26
How to Cite
Suparmi, S., Kusumawardhani, N., & Susiloretni, K. (2019). SUB-NATIONAL INEQUALITY OF CAESAREAN SECTION IN URBAN-RURAL AREA OF INDONESIA. Proceedings of the International Conference on Public Health, 4(1), 23-32. https://doi.org/10.17501/24246735.2018.4103