Factors affecting the likelihood of receiving cesarean section among low and high socio-economic group in public health facilities in Mali

Abstract

Mali free cesarean policy benefits more to the rich women than to the poor ones. Thus the purpose of the study is to determine the non-medical factors affecting the likelihood of receiving cesarean among low and high socio-economic groups in public health facilities in Mali; and to draw some recommendations which will favor more indigent women for a safe motherhood. Data from a cross sectional survey by USAID funded program ATN plus conducted from February to September 2010 was used as secondary data. Three thousand nine hundred and sixty eight women delivering in forty one randomly selected health facilities were evaluated on their socio-economic, demographic and medical factors affecting the cesarean probability. A binomial probit and multinomial probit models were used to figure out first the factors affecting the C-section rate; then to determine the relationship between the medical and the non-medical factors of women. The proportion of C-section is 62.4 % with a predominance of elective cesarean. Most of women were 25 years old with 3 parities, uneducated, unemployed and belonging to a rich household. The majority of women coming themselves by foot (31.5 %) delivered normally, 15.7 % arriving themselves by taxi had elective cesarean and those who were evacuated by ambulance (23.7 %) had emergency cesarean Except Mopti, the highest proportion of C-section was done among the rich group mainly in Bamako and Kidal. Region, mother age, occupation and education, quintile, number of obstetricians and admission mode are the factors affecting cesarean. The mother’s parity and father’s occupation do not matter. The indigent people (unemployed, self-employed, uneducated or low education, poor and poorest women) are either more likely to deliver normally or to have emergency cesarean, especially in the northern regions and benefit less from the free cesarean policy. Further, the cesarean probability increases steadily after the age of 25 years and with a rise of number of obstetricians in the facilities. Compare to the referred women, the evacuated ones are more exposed to emergency cesarean and have a lowest chance to deliver normally. Bergson social welfare is needed through some policies to favor more the neediest women for a better access to health care services. Girls’ education, and safe delivery in health facilities should be promoted. The amelioration of transportation system and maternal referral system can also improve delivery outcomes and provide a safer motherhood.