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Cesarean section delivery in India: an analysis of maternal factors and infant outcomes

Gondwe, Tamala (2018) Cesarean section delivery in India: an analysis of maternal factors and infant outcomes. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Cesarean section (CS) delivery is increasing globally, in many countries exceeding the World Health Organization recommended upper limit of 15% of births in all regions. The CS rate is also increasing nationally in India, where the factors and outcomes associated with CS have not previously been explored.

We sought to determine maternal factors and infant outcomes associated with mode of delivery in India from two data sources. First, we assessed the independent association of several maternal factors with mode of delivery in the Longitudinal Indian Family hEalth (LIFE) study cohort. Second, we assessed whether mode of delivery in the LIFE study was associated with diarrhea and respiratory infection in infants. Lastly, we assessed the maternal, socioeconomic, and healthcare factors, and infant outcomes associated with mode of delivery in the 2005-2006 India National Family Health Survey.

Of the 1,164 singleton births in the LIFE study between 2010 and 2015, 46% were delivered by CS. Prior pregnancy complications, history of prior CS, pre-pregnancy body mass index, and labor and delivery complications contributed to the high CS rate. In regards to infant outcomes, after adjusting for pre-delivery maternal factors, mode of delivery was not associated with infants having diarrhea or respiratory infection at six months in the LIFE study. In the India national data, 12% of the 35,601 most recent singleton births in the 2005 and 2006 survey were delivered by CS. Factors associated with CS nationally were high wealth index, high level of maternal education, maternal receipt of >5 antenatal care visits, and delivery at a private care facility. After adjusting for these factors, mode of delivery was not associated with infant diarrhea and acute respiratory infection, but an association was found with neonatal death.

Our studies yield public health significance in showing that a range of maternal factors are associated with mode of delivery in India, and that mode of delivery is not a determinant of some adverse infant health outcomes. Further research is needed on the effect of CS delivery on infant and maternal outcomes in India and other countries as the CS rates continue to increase.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Gondwe, Tamalatamala.gondwe@pitt.eduTAG550000-0002-9288-2113
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHaggerty,
Committee MemberBunker,
Committee MemberSimhan,
Committee MemberTang,
Date: 30 January 2018
Date Type: Publication
Defense Date: 30 October 2017
Approval Date: 30 January 2018
Submission Date: 2 November 2017
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 121
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Cesarean section, Obstetrics, Global health, Infant health
Date Deposited: 30 Jan 2018 22:41
Last Modified: 01 Jan 2020 06:15


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