Percentage of deliveries by caesarean section

The proportion of all deliveries by caesarean section in a geographical area is a measure of access to and use of a common obstetric interventions for averting maternal and neonatal deaths and for preventing complications such as obstetric fistula. Of all the procedures used to treat major obstetric complications, caesarean section is one of the commonest, and reporting is relatively reliable.

Numerator

Number of births by Caesarean section in a defined administrative or health area in a given period of time

Denominator

Estimated total number of births in the same administrative or health area in the same period of time

Disaggregation

Administrative area; health area;

Indicator used for response monitoring ?

Yes

Types

Baseline

Output

Threshold / Standard

>=5% and <=15% of deliveries by ceasarian section Follow-up of trends

General guidance

Calculation: Denominator should be calculated by using the fertility rate by age class and region (e.g. obtained via demographic and health surveys). In Sub-Saharan Africa, for instance, the expected proportion of births is between 4 and 5 % of the total population. Alternatively, percentage of deliveries by Caesarean section can be assessed through household surveys where the numerator is the number of reported deliveries by Caesarian section over a certain period of time and the denominator is the reported number of births over the same period of time. Interpretation: This indicator can serve as a proxy for monitoring progress in the health response. Limitations: Both administrative and household survey methods have limitations. The calculation of the number of births from administrative population number and fertility rates can be very imprecise. Reporting bias in houshold surveys can lead to imprecision in the estimate.

Guidance on phases

There is a differing level of quality of data which can be collected at different phases of the emergency depending on the context, eg the data available and the systems for data collection in place before the crisis, the accessibility of the affected areas, the resources on the ground, etc... Periodical household surveys should be considered. Households surveys will be more doable in later phases of the emergency.

Phase applicability

Pre-crisis/Baseline

Phase 1

Phase 2

Phase 3

Phase 4

Data Sources

Numerator: routine health faicility reporting system; Denominator: administrative boundaries; health areas boundaries; population per administrative area; population per health areas; fertility rate (from DHS, for example) Alternatively numerator and denominator can be recorded through household surveys

Comments

Further guidance: Monitoring Emergency Obstetric Care (http://www.who.int/reproductivehealth/publications/monitoring/9789241547734/en/)