Maternal Health Care And Determinants Of Caesarean Section In Rural South Anhui

Objectives To describe the situation of antenatal, delivery and postnatal care in rural South Anhui, understand the cesarean section (CS) rate and to analyze the determinants of increasing CS rate.Methods One county in south Anhui was selected as study site. By cluster randomized sampling, 1/3 villages of 12 townships were chosen. Mixed quantitative and qualitative methods were adopted in this study. In quantitative research, women with childbirth between March 1 and December 31, 2008 in selected villages were recruited as participants. A household questionnaire survey was conducted to collect data on socio-economic characteristics, medical and obstetric history, usage of maternal health care as well as caesarean section. Descriptive analysis was used to display the situation of antenatal, delivery and postnatal care, choice and decision-making of caesarean section. Non-conditional multivariate logistic model was performed to explore related factors influencing choice of caesarean section. In qualitative research, pregnant women, women with childbirth, family members, health providers, managers and policy makers were invited to participate in focus group discussions and /or individual in-depth interviews. Topic guide including stakeholders'perception on current CS situation, advantages and disadvantages of vaginal delivery and caesarean section and possible causes of increasing CS rate was developed as study instrument.Results A total of 619 women completed the household survey. With regard to maternal health care services, prenatal examination, hospital delivery, postpartum visit and health education were all carried out in the township hospitals. Coverage of prenatal checkup was 98.9%, in which the rate of prenatal care in first trimester of pregnancy was 73.0%, rate of systematic antenatal care was 45.1%. Rate of hospital delivery was 100.0% and postnatal home visit was 11.8%. The rate of CS was 82.1% (508/619), in which 67.5% (343/508) was determined by maternal request, 28.5% (145/508) by obstetrician's advice. It is found that the two leading reasons for women's request were fear of childbirth and worry about baby's health. Logistic regression model showed that higher education level (OR: 1.10, 95%CI: 1.03-1.18) and delivery in township hospital (OR: 2.11, 95%CI: 3.32-3.39) were risk factors of caesarean sectionIn qualitative study, it showed that factors affecting choice of caesarean section included young puerpera's age, women's fear of pain, recommendations from doctors and elders, hospital's defensive medical care, inappropriate cognition of quality of life after cesarean section and poor skills of young obstetricians and midwives.Conclusion Poor systematic management of maternal health care is observed in study county, especially low coverage of postnatal care. Caesarean section rate, however, is extremely high in the rural area, which is a conjunctive result from increasing demands of health providers (hospitals and doctors) and health consumers (pregnant women and their family members).