A Higher Maternal Education Level Could Be a Critical Factor in the Exceeded Cesarean Section Delivery in Indonesia.

Background: Cesarean section (CS) could be life-saving with medically indicated, but without it, both women and children could be at risk. The maximum rate for CS is 15%, but it tends to exceed globally.

Objective: We aimed to analyze the education level's role in the delivery of CS in Indonesia.

Methods: We used the 2017 Indonesia Demographic and Health Survey data. The study sampled 15,357 women who delivered in five last years. Besides delivery mode and education level, the study also used nine control variables: residence, age, marital, employment, parity, wealth, insurance, antenatal care, and birth type. The study employed a binary logistics regression.

Results: The results show women with secondary education (16.5% CS) are 2.174 times (AOR 2.174; 95% CI 1.095-4.316), and higher education (33% CS) are 3.241 (AOR 3.241; 95% CI 1.624-6.469) times more likely to deliver by CS than no-school education (4.4% CS). There was no significant difference between primary (9.1%) and no-education women. Apart from education, primiparous women, age 34-34 yr, attending antenatal care ≥4 times, non-poorest, having insurance, living in the city, and being unemployed also related to higher risk of CS.

Conclusion: Exceeded CS in Indonesia occurs mostly in higher education women. Higher education women were more likely to access more information and technology, therefore health promotion on healthy normal birth on social media or m-Health (mobile device-based health promotion) and involving health authorities at every level were suitable to reduce the overuse of the CS.