Role of private and public health institution in Caesarean delivery in the districts of Andhra Pradesh, India
Authors: Malla Venkata Raja , R.S Reshmi 
Published: March 2022

Abstract
Background Now a-days Caesarean section has been considered as a common surgery. In India, over the past decade an increasing trend of the same has been observed, from around eight percent during NFHS-3 (2005-06) to as high as 17 percentage during NFHS-4 (2015-16). India has a colossal disparity in Caesarean Section rates across the country. Caesarean section in Andhra Pradesh (40.1%) has been increasing. This study is an attempt to investigate the dynamics of prevalence of caesarean section in Andhra Pradesh and its districts, which will provide a better understanding about the existing situation.We used the secondary data collected from the National family Health survey (NFHS-4) data conducted by the International Institute for Population Sciences; Mumbai is designated as the central agency to implement the survey. National Family Health Survey is a large-scale multi-round survey conducted in a nationally representative sample of households which covers about 99% of Indian population. For the first time the National Family Health Survey-4 (NFHS-4), provided district level estimates for a number of important indicators, which necessitated expanding the sample size nearly six-fold as compared to NFHS-3. Statistical software package used in the study to carry out the analysis was Stata14, to prepare map ArcGIS was used, besides these two, we also used MS Excel. Descriptive statistics and bivariate analysis were used to find the preliminary results. Since the data of the prevalence of caesarean deliveries across ‘Public’ and ‘Private’ is continuous, we have used T-test to compare the means across public and private hospitals. Further, multivariate analysis (binary logistic) was done to fulfil the objective of the study. The outcome variables used for analysis were caesarean section delivery (0 “no” and 1 “yes”), Place of Delivery (0 “Public” and 1 “Private”) and Complications faced during delivery (0 “No” and 1 “Yes”), psychological health (0 “high” and 1 “low”), subjective well-being (0 “high” and 1 “low”) and cognitive ability (0 “high” and 1 “low”). The results were presented in the form of odds ratio (OR) with a 95% confidence interval (CI). Where β0,….., βM are regression coefficients indicating the relative effect of a particular explanatory variable on the outcome. These coefficients change as per the context in the analysis in the study.ResultsWe found wide variations in the prevalence estimate of caesarean section deliveries across different districts in the state, ranging from 27 percentage to 61 percentage. Among the district, the maximum prevalence has been found in districts are West Godavari, Sri Potti Sriramulu Nellore, Guntur and Krishna in Andhra Pradesh. Caesarean in private hospitals as the prime driver of this high trend. We found Around 25 percentage women were undergoing c-section in public institutions whereas the prevalence of women having c-section in private institution was as high as 74 percentage. A substantial proportion of women in various districts of Andhra Pradesh chose private health care facility over public institutions for the performing c-section delivery. While considering religion and place of delivery, Christian women preferred public health facilities whereas more Hindu women underwent c-section in private health facilities.ConclusionsThe study found that the place of delivery (private or public medical institution) is becoming the strongest one influencing C-section. Complications among C-section deliveries are more than normal deliveries; women going for voluntary caesarean section deliveries should be discouraged. Unless medical necessity is there, it should not be performed. The number of C-sections continues to be high in Andhra Pradesh and Telangana as there are issues of Muhurtham, unwillingness to go for labour and also IVF complications which make normal birthing a difficult process. In Andhra Pradesh women come with the mindset that they will not bear the pain and want a surgical delivery only. With this new trend, it is becoming very difficult to convince them to opt for labour.Caesarean section deliveries should have special provision of maternity benefits, further improvement in the service delivery of JSY is highly recommended. There should be extra financial support given to those who are below poverty line. Hospitals should be regulated with rules to promote Normal vaginal deliveries and Prevent Unnecessary C-section deliveries. Hospital records should be regularly Checked for the number of deliveries and C-section the reasons for performing C-section delivers should be thoroughly inspected. Government should reward or help the people who have undergone Normal vaginal delivery