Rate of caesarean section in a rural community of North Kerala: A cross-sectional study

Increasing rate of Caesarean births in developing countries is an issue of public health concern. There are very few Kerala-based studies relating to Caesarean section (CS). This study was conducted to determine the CS rate in a rural community and to identify factors associated with it.

A community-based, cross-sectional study was done in rural north Kerala, among women who had a child-birth in the past 5 years. Cluster sampling was adopted to select 209 mothers. Data was collected using pre tested questionnaire.

The CS rate in our study was 36.8% (77/209), which is almost double the national rate. 76% of deliveries were in private institutions, though there was no significant difference in CS rates between private and government hospitals. The most common indication for CS, 49.3% (38/77), was previous caesarean; with all 38 cases culminating in repeat CS. Failed induction was the most frequent cause for a primary CS, 46.7% (36/77), which included the indication for the primary surgical intervention in repeat CS cases (21/38). Contraceptive use in the study population was very low, 6.7% (14/209), which resulted in lack of spacing between pregnancies. Thus 52.7% (20/38) previous CS cases were ineligible for a VBAC trial. Out of the 18 eligible cases only 4 were offered a VBAC trial (p < 0.05).

Adequate spacing between pregnancies and offering VBAC trials to eligible cases is necessary to curb increasing CS rates.