title: High caesarean rates in Madras (India): a population-based cross sectional study.
abstract: OBJECTIVE
  To estimate the population caesarean section rate in urban India.
  
  
  METHODS
  Population-based cross sectional study.
  
  
  METHODS
  Madras City (Chennai), India. Seven hundred and eighty resident women who delivered in Madras between June 1997 and May 1999.
  
  
  METHODS
  Cluster sampling was done using streets as cluster units. Thirty clusters were selected from 1255 clusters by the probability proportion to size method and 26 women were selected randomly from each cluster.
  
  
  METHODS
  Total and primary caesarean rates.
  
  
  RESULTS
  Total population caesarean section rate was 32.6% (95% CI 27-38) and primary caesarean section rate was 25% (95% CI 20-30). Total caesarean section rates in the public, charitable and private sectors were 20%, 38% and 47%, respectively. Private sector deliveries had an odds ratio of 2.4 (95% CI 1.5, 3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mother and educational status.
  
  
  CONCLUSIONS
  Forty-seven percent of births by caesarean section in the private sector is alarming and could implicate private sector care as the main contributing factor behind the high population caesarean section rates. Policymakers should urgently institute systems for accountability and ethical practice and regularly monitor all medical interventions, before large scale exploitation of the rural markets begins.
authors.affiliation: Epidemiology Unit, Tata Institute of Fundamental Research, Deemed University, Mumbai, India.
authors.forename: S
authors.initials: S
authors.lastname: Sreevidya
authors.forename: B W C
authors.initials: BW
authors.lastname: Sathiyasekaran
mesh_terms: D000328:Adult; D017677:Age Distribution; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007194:India / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D017149:Private Sector; D017150:Public Sector; D012959:Socioeconomic Factors; D014504:Urban Health