Temporal trends and associated factors in cesarean section use in the Philippines: an analysis of Demographic and Health Survey data from 1993 to 2017.

Background: Cesarean section (CS) rate has become increasingly prevalent worldwide, which has raised concerns about the possible risks as they often result in frequently longer recovery periods for mothers and possible complications for both the mother and the child. The World Health Organization (WHO) recommends a 10-15% CS rate to maintain its safe use. Conducting trends analysis of CS and its associated factors is crucial in understanding its utilization. There is currently a limited knowledge on the increasing trends of CS and factors related to it that might help improve procedures and practice standards. The present study examined the trends and associated factors of CS use in the Philippines over the last two decades.

Methods: We utilized the Philippine National Demographic and Health Survey (PNDHS) data collected in 1993, 1998, 2003, 2008, 2013, and 2017. Descriptive and univariate techniques were used to characterize the survey participants and the trends of CS use over time. The data of 2017 PNDHS was used in the logistic regression analysis to assess the associated factors of CS use. Significant factors (p < 0.05) in the univariate analysis were considered in the logistic regression analysis.

Results: The overall use of CS has been significantly higher than the maximum cutoff of the WHO and increased from 15.8% in 1993 to 18.4% in 2017. Women aged 25 years or older, with higher education, belonged to middle or rich household, with newborn at 1 and 2-3 birth order, and with initial antenatal care visits (ANC) in the first or later trimester of pregnancy were significantly associated with CS use.

Conclusion: In the Philippines, the utilization of CS has continuously surpassed the recommended maximum cutoff of 15%. This increased rate is associated with maternal age, educational attainment, family income, birth order, and the timing of antenatal care visits. The socioeconomic factors demonstrate socioeconomic disparities in accessing CS services. Emphasizing the need for performing medically indicated CS can promote better maternal and child outcome and reduce the rate of unnecessary CS deliveries. Prioritizing initiatives to provide equitable access to CS services is imperative.