{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:00:43Z","timestamp":1772690443968,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T00:00:00Z","timestamp":1630368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The rate of caesarean delivery has increased markedly both globally and within India. However, there is considerable variation within countries. No previous studies have examined the relative importance of multiple geographic levels in shaping the distribution of caesarean delivery and to what extent they can be explained by individual\u2010level risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe geographic variation in caesarean delivery and quantify the contribution of individual\u2010level risk factors to the variation in India.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted four\u2010level logistic regression analysis to partition total variation in caesarean delivery to three geographic levels (states, districts and communities) and quantify the extent to which variance at each level was explained by a set of 20\u00a0sociodemographic, medical and institutional risk factors. Stratified analyses were conducted by the type of delivery facility (public\/private).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall prevalence of caesarean delivery was 19.3% in India in 2016. Most geographic variation was attributable to states (44%), followed by communities (32%), and lastly districts (24%). Adjustment for all risk factors explained 44%, 52% and 46% of variance for states, districts and communities, respectively. The proportion explained by individual risk factors was larger in public facilities than in private facilities at all three levels. A substantial proportion of between\u2010population variation still existed even after clustering of individual risk factors was comprehensively adjusted for.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Diverse contextual factors driving high or low rate of caesarean delivery at each geographic level should be explored in future studies so that tailored intervention can be implemented to reduce the overall variation in caesarean delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12807","type":"journal-article","created":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T13:09:57Z","timestamp":1630415397000},"page":"92-103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Geographic variation in caesarean delivery in India"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5018-8684","authenticated-orcid":false,"given":"Justin","family":"Rodgers","sequence":"first","affiliation":[{"name":"Center for Population and Development Studies Harvard University  Cambridge MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2591-1436","authenticated-orcid":false,"given":"Hwa\u2010Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston MA USA"},{"name":"Institute of Convergence Science (ICONS), Convergence Science Academy Yonsei University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rockli","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, College of Health Sciences Korea University  Seoul Korea"},{"name":"Interdisciplinary Program in Precision Public Health Department of Public Health Sciences Graduate School of Korea University  Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nachiket","family":"Mor","sequence":"additional","affiliation":[{"name":"The Banyan Academy of Leadership in Mental Health  Thiruvidandai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2365-4165","authenticated-orcid":false,"given":"S. V.","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Center for Population and Development Studies Harvard University  Cambridge MA USA"},{"name":"Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,31]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0044484"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31930-5"},{"key":"e_1_2_10_4_1","volume-title":"WHO Statement on Caesarean Section Rates","author":"WHO","year":"2015"},{"key":"e_1_2_10_5_1","unstructured":"GibbonsL Beliz\u00e1nJM LauerJA Betr\u00e1nAP MerialdiM&AlthabeF.The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. 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