The results of this study provide valuable insights into the factors associated with caesarean section deliveries in Ghana. The findings highlight the importance of considering various demographic, socioeconomic, and healthcare-related factors in the planning and provision of maternal healthcare services.
The C-section rate in this study is 26.87% with regional average of 22.29% for the five (5) years study period. The C-section rate found in this study is relatively high compared to the global average rate. This suggests that C-Section deliveries are being performed at a higher rate in Ghana than in other parts of the world. This is also higher than the finding in latest study with data from 154 countries which reported overall C-section rate of 21.1% with averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean [14].
According to the World Health Organization, it is recommended that countries aim for a C-section delivery rate of 10–15% per 100 live births to achieve the best outcomes for both mothers and newborns [15]. However, a recent study conducted in 194 countries suggests that as the C-section rate at the country level increases up to 19%, there is a decrease in maternal and neonatal mortality rates. Beyond a C-section rate of 19%, there is no further improvement observed in maternal and neonatal mortality rates [16]. This research challenges the previous recommendation and suggests that a higher C-section rate may be necessary to save lives.
The high CS rate in Ghana may be due to the increasing availability and accessibility of C-Section deliveries in both public and private health facilities, as well as the influence of socio-demographic factors such as education and health insurance status. The sharp rise in the C-section rate in 2021 could be explained by peak period of COVID-19. Thus, restriction on physical movement, delayed reporting at health facilities, and low ANC attendance due to COVID-19.
This finding is consistent with previous studies that have highlighted disparities in healthcare access and resources across different regions of Ghana [12, 17]. The regional variations in C-section rates observed in this study could be due to differences in healthcare infrastructure, availability of skilled birth attendants, access to emergency obstetric care, cultural practice disparities across the country and the 16 regional partitioning in 2018.
In this study, older women were more likely to have a caesarean section delivery. Advanced maternal age is often associated with increased medical complications, such as hypertensive disorders or fetal distress, which may necessitate a caesarean section delivery [8, 9].
The current finding is consistent with previous research conducted in Sub-Saharan Africa and elsewhere found that increasing maternal age was a significant predictor of caesarean section deliveries. Advanced maternal age is frequently associated with increased medical complications, such as hypertensive disorders, gestational diabetes or fetal distress, which may necessitate a caesarean section delivery [8, 9, 18,19,20,21,22].
The finding of this current study also corroborates previous Ghanaian studies that have shown an increased likelihood of caesarean section with advancing maternal age [7, 12]. Healthcare providers should be aware of this association and ensure that older women receive appropriate antenatal care and monitoring to mitigate any potential risks.
Another significant finding is the association between higher levels of education and caesarean section deliveries. This finding aligns with previous research from both developed and developing countries [12, 23].
This finding also aligns with research from various countries in Sub-Saharan Africa, including studies conducted in Nigeria [24] and Ethiopia [25]. Women with higher education levels may have better access to information and resources, and they may have different preferences or expectations regarding childbirth [26]. Healthcare providers need to engage in shared decision-making with educated women, providing them with accurate and unbiased information about the risks and benefits of different delivery methods.
The study also found that women employed in the formal sector were more likely to have a C-Section delivery. This finding may reflect the influence of socioeconomic factors on healthcare decision-making. Women in formal employment may have better access to financial resources, which could contribute to a higher likelihood of C-section deliveries [12, 27].
Cultural beliefs, practices, and behavioral factors significantly influence the decision for a C-section in Ghana [28, 29]. Some Ghanaian women view C-sections as a status symbol, associating them with wealth and modernity [29]. Additionally, fear of vaginal delivery pain and complications, fueled by cultural narratives, may lead women to opt for C-Sect. [29]. Traditional birth practices also play a role, with some traditional birth attendants recommending C-sections due to cultural or spiritual beliefs.
Healthcare practices and provider influence are also crucial factors. Over-medicalization, lack of informed consent, and limited access to emergency obstetric care may contribute to unnecessary C-sections. Healthcare providers’ recommendations and biases significantly impact women’s decisions, and affluent women may prioritize C-sections for convenience and perceived safety. Furthermore, women’s education level and socioeconomic status influence their healthcare choices, with higher-educated women more likely to opt for C-sections as established in this study.
Regional and ethnic differences may also affect C-section decisions. Variations in traditional birth practices and cultural beliefs exist across regions and ethnic groups, influencing healthcare choices [30]. Disparities in access to healthcare services and information exacerbate these differences. Addressing these factors requires public education campaigns to promote informed decision-making and training healthcare providers in culturally sensitive care.
To reduce unnecessary C-sections and promote evidence-based maternal healthcare, Ghana needs to improve access to emergency obstetric care, encourage evidence-based practices, and address healthcare disparities and regional differences. By understanding the complex interplay between cultural, practical, and behavioral influences on C-section decisions, policymakers and healthcare providers can develop targeted interventions to support informed decision-making and optimal maternal healthcare outcomes.
The study reveals significant association between having health insurance and 30% reduction in the likelihood of caesarean section delivery. This finding could be explained by fact that, health insurance may provide better access to prenatal care, allowing for early detection and management of potential complications, reducing the need for caesarean sections. Health insurance may reduce financial barriers to seeking medical care, enabling women to opt for vaginal deliveries when medically appropriate. The insured women may also have better health literacy, leading to more informed decisions about delivery options.
The significant association between health insurance and reduced caesarean section delivery suggests that increasing access to health insurance may be an effective strategy to reduce unnecessary caesarean sections.
Overall, the findings of this study underscore the need for a comprehensive and patient-centered approach to maternal healthcare in Ghana. Efforts should be made to strengthen antenatal care services, promote natural childbirth, address regional disparities, and strengthen health insurance coverage. By addressing these recommendations, Ghana can strive towards reducing unnecessary caesarean section deliveries and improving maternal health outcomes for women across the country.