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220 Das et al. | Journal of Clinical and Translational Research 2024; 10(3): 219-228
Conversely, cesarean rates above 15% suggest an increased 2. Methods
risk of mortality, financial burden, and clinical risks on the
health of both mother and baby, as well as the health-care 2.1. Data collection
system [20-22]. The previous studies conducted in high-income The present study utilized data from NFHS-4, which was
countries have examined how women with various obstetric conducted in 2015 – 2016 by the Ministry of Health and
histories may influence the likelihood of cesarean delivery and its Family Welfare. The NFHS is one of the important large-
impact on neonatal and infant mortality rates [23,24]. Polidano scale biodemographic and health surveys in India, providing
et al. suggested that cesarean birth is associated with negative sufficient information on fertility, mortality, nutritional status,
cognitive growth of the child [25], such as the development of family planning, and health-care utilization. The sample
asthma, Type I diabetes, allergies [26-28], and obesity [29], size of the survey included 259,627 birth records from the
and is also correlated with poor academic performance [30,31]. 5 years preceding the survey. During the survey, all women
Infants born vaginally pass through the birth canal directly, (aged 15 – 49 years) provided comprehensive birth histories,
whereas cesarean-born infants come into contact with the including the sex, delivery date, and survival status of each
mother’s skin through assistance from doctors or nurses in the newborn. Detailed information on the survey is available in the
hospital. An early study by Rowe-Murray and Fisher found that national report [38].
cesarean-born infants are less likely to immediately come into
contact with the mother’s skin after birth, and they also reported 2.2. Outcome variables
delayed breastfeeding, that is, after 24 h in post-delivery [32]. Neonatal and infant mortalities were two dependent variables
Globally, cesarean birth rates have increased and vary across
different countries due to diverse socioeconomic factors and evaluated in the study. Neonatal mortality is defined as the death
of newborn babies within 28 days of birth. Infant mortality
differential health-care services. Moreover, cesarean birth rates is defined as the death of newborn babies before reaching
are higher in Asian countries compared to other countries. 12 months. Another dependent variable evaluated in the
In Ghana, the cesarean birth rate increased from 3% to 23% study was child growth, which was categorized into stunting,
between 2003 and 2014 [33,34]; in Iran, cesarean section wasting, and underweight. Stunting refers to children (aged
operations contribute to 40.0% of all births [35]; in China, 0 – 59 months) whose height-for-age Z-score is <−2 standard
the cesarean birth rate has reached 34.9% [36]; and in Brazil, deviation (−2SD) (i.e., Z < −2SD) below the median of the
the cesarean birth rate accounts for 56%, corresponding to reference population. Likewise, underweight and wasting refer
approximately 90% in the private sector [37]. In India, the Fourth to children (aged 0 – 59 months) whose weight for age and
National Family Health Survey (NFHS-4) reported an increase height Z-scores are <−2SD (i.e., Z < −2SD) below the median
in cesarean delivery rates from 8.5% to 17.2% between 2005 of the reference population. These indicative Z-scores were
and 2016, but this was still lower compared to other developing
countries such as Brazil and China [38]. As reported in an earlier then computed based on the WHO-recommended reference
study, women from higher-educated and wealthier backgrounds population [44]. The above variables were classified as absent if
are more likely to undergo cesarean sections than women from Z ≥ −2SD. The mortality variables were coded as 1 if the baby
less-educated and lower-income families. Furthermore, women had died and 0 if the baby survived.
admitted to private health institutions are more likely to have 2.3. Explanatory variables
cesarean births than those admitted to government-owned
health facilities [39]. The place of delivery was considered a primary independent
There are currently more debates on the surgical procedures variable in the study. According to NFHS-4, the place of delivery
involved in birth delivery among women in private and could be categorized into: (i) Public hospital (government
public health institutions. Some studies suggested normal hospital, government health center, government health post,
vaginal delivery [40,41], whereas others recommended or other public sector) and (ii) private medical sector (private
cesarean delivery [42]. Vaginal delivery is reportedly more hospital or clinic and other private medical facility). We also
commonly associated with postpartum hemorrhage [41], categorized the delivery method accordingly: Cesarean section
whereas postpartum morbidity occurs more often in cesarean or normal vaginal delivery. Based on the reviewed literature,
delivery [40]. In comparison with cesarean delivery, normal we investigated several biodemographic and socioeconomic
vaginal delivery is a physiological process of human variables that could also significantly impact a child’s
reproduction and has many positive effects. For example, first health [45-48], including the mother’s age during childbirth
contact with the mother and early breastfeeding is important (15 – 19, 20 – 29, 30 – 39 years, or 40 – 49 years), preceding
for the child’s psychological development [43]. Conversely, birth interval (<24 or ≥24 months), birth order (1, 2, or 3), place
cesarean birth is an unnatural mode of delivery and is of residence (urban or rural), household wealth (poorest, poorer,
associated with an increased risk of endometritis, pneumonia, middle, richer, or richest), and birth attendant (doctors or nurses).
and other conditions, leading to poorer psychological 2.4. Statistical analysis
development of newborns [5,41]. Therefore, the present paper
aims to identify the impact of different birth delivery methods A comparative analysis was performed to evaluate the effect
on child growth. of different delivery methods (normal vs. cesarean) on child

DOI: https://doi.org/10.36922/jctr.22.00239