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224 Das et al. | Journal of Clinical and Translational Research 2024; 10(3): 219-228
normal deliveries in the private sector are significant issues and maternal, neonatal, and infant survival by 9 – 16%, but the
challenges today. The present study investigated the different different socioeconomic factors could be a varied association
birth delivery methods and their risks to child growth and between cesarean birth and mortality [57]. Betran et al. indicated
mortality in India using the current nationally representative that the risk of newborn mortality is higher when vaginal delivery
data from NFHS-4 (2015 – 2016). Our findings revealed is performed by untrained medical staff (inexperienced or having
disparities in different birth delivery methods across the various inadequate skill), while planned cesarean delivery is the safest
socioeconomic and biodemographic characteristics in India. option for mothers and babies [56]. Our findings revealed that
Women aged 25 – 29 years old were more likely to undergo Indian women do not have adequate access to cesarean services,
cesarean delivery compared to those aged 15 – 19 years old. most likely due to insufficient provision of equipment, lack of
Similarly, pregnant women of more than 24 months of a preceding emergency room for obstetrics services, lack of skilled birth
birth were more likely to opt for cesarean section compared to attendants, untrained medical staff, major geographical barriers
those of <24 months of a preceding birth. Newborns of higher (e.g., long-distance), and lack of transportation [58,59].
birth orders (>3) were less likely to be delivered through cesarean Analysis of child growth (i.e., stunting, wasting, and
section than normal vaginal delivery. In addition, women who underweight) based on different birth delivery methods displayed
only want a single child are more likely to opt for a cesarean a negative association between cesarean births and healthy
section for their pregnancy than those who are expecting two child growth, such as the influence on feeding practices [60].
or more childbirths. This was emphasized in earlier studies The study also revealed a higher prevalence of stunted, wasted,
based on the women’s perceptions regarding the efficacy of the and underweight child growth from cesarean births compared to
cesarean procedure as a means to ensure newborn survival and normal vaginal births. A prior study also suggested that cesarean
to avert the risks of birth complications or stillbirth [49]. Women births may have negative implications related to neuropsychiatric
from urban residences were more likely to opt for cesarean section disorders and mother-infant relationships [5]. Another study
for childbirth compared to rural residences. This preference among implied that schizophrenia and mental disorders were 10 times
urban women could be associated with the easy accessibility and higher among children born through cesarean section [61].
availability of healthcare (public and private hospitals) facilities for A growing number of studies reported that these children born
maternal and child health services [49]. Women from the “richest” through cesarean section had poorer sensory integration ability
household’s preferred cesarean delivery compared to those from than those born by natural vaginal birth [62-65]. A study by
the “poorest” households. Household wealth and education are Evans et al. reported a significantly faster transfer of breast milk
attributed to the female autonomy to develop greater confidence from mother to child in vaginal birth than in cesarean births
and decision-making power regarding their health [50,51]. An in the first 5 days postpartum [66]. Similarly, Scott et al. also
earlier study also suggested that educated women from the “richest” found that delayed onset of lactation was significantly higher for
households have access to higher quality services and health-care cesarean births compared to normal vaginal births [67].
facilities compared to other less-privileged women [52]. Our The logistic regression model examined significant predictors
study also demonstrated that most childbirth in public hospitals of neonatal and infant mortalities based on different birth delivery
was delivered by normal vaginal delivery than cesarean delivery. methods. After adjusting for potential confounding factors, we
In general, in public hospitals, doctors prefer cesarean delivery, identified that the mother’s age during delivery, preceding birth
especially for complicated pregnancies, including abnormal labor interval, birth order, place of residence, wealth index, and skilled
pain and postpartum hemorrhage. In many high- and middle- birth attendants were significantly associated with the decisions
income countries, cesarean births are more common than normal on selecting cesarean or normal vaginal delivery methods. The
births in private institutions [53,54]. An earlier study investigating findings suggest that older mothers during delivery and longer
the short- and long-term effects of cesarean section on women and preceding birth intervals reduced the risk of neonatal and infant
child health suggested that normal vaginal delivery reduced the mortalities from cesarean births. Furthermore, newborns of
length of hospital stay, financial cost, and the risk of hysterectomy higher birth orders had higher risks of dying from cesarean
for postpartum hemorrhage, while cesarean delivery reduced delivery compared to normal vaginal delivery. Consistent with
the risk of vaginal injury, abdominal and perineal pain during previous studies, our findings indicated that women from the
birth and 3 days postpartum, early postpartum hemorrhage, and “richest” wealth quintile had lower risks of infant mortality
obstetric shock [55]. than those from the “poorest” households [68,69]. The study
Our study also analyzed the effect of different birth delivery confirmed that poverty is the major factor responsible for the
methods on neonatal and infant mortalities and revealed that reduced odds of newborn mortality from cesarean births. In
neonatal and infant mortality rates varied across socioeconomic addition, the higher rate of cesarean deliveries is often attributed
characteristics. Neonatal and infant mortality rates were lower to higher costs of healthcare, which also impacts the economic
for cesarean births in private institutions compared to public burden of a household as measured by the wealth index.
institutions. Moreover, cesarean delivery plays a dominant role The major strength of this study is the utilization of nationally
in the survival of newborns and prevents perinatal mortality and representative data, which corresponds to a large sample size
severe morbidity, such as intrapartum asphyxia [56]. Another that evaluates normal and cesarean births in public and private
systematic review validated the association between cesarean institutions. This study had several limitations: (i) the data
birth and mortality and concluded that cesarean birth improves lacked information relating to the clinical indications of cesarean

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