On Yıllık Süreçteki Anne-Bebek Sağlığı Üzerine Denklem: Sezaryen Doğumun Belirleyicileri ve Sonuçları

Abstract

Amaç: Bu çalışmanın amacı, sezaryen doğumu etkileyen sosyodemografik ve sosyoekonomik faktörleri belirlemektir. Yöntemler: Analizlerde, 2003 ve 2013 Türkiye Nüfus ve Sağlık Araştırması verilerinden toplam 6073 son doğum kaydı için En Küçük Kareler Regresyonu (OLS) ve Lojistik Regresyon teknikleri kullanılmıştır. Bulgular: Çalışmada, yenidoğan boyutunun, annenin yaşının, annenin eğitim düzeyinin, özel bir sağlık kurumunda doğum yapmanın, sigorta sahibi olmanın, Türkiye'nin gelişmiş bir bölgesinde yaşamanın, yeterli antenatal ziyaretlerin ve sigara kullanımının sezaryen doğumu artırıcı etkisi olduğu bulunmuştur. Sonuç: Çalışma sonucunda, sezaryen doğumu etkileyen sosyodemografik ve sosyoekonomik belirleyiciler ortaya çıkarılmıştır.

Keywords

• Kadın Sağlığı
• Anne Sağlığı
• Sezaryen Doğum
• Doğum

Socioeconomic and Demographic Factors of Caesarean Birth Rates: Insights from Türkiye

Abstract

Objective: The study aims to examine the sociodemographic and socioeconomic factors influencing caesarean section rates. Methods: Ordinary Least Squares Regression and Logistic Regression techniques are employed to analyse a total of 6073 last birth of records from the Turkish Demographic and Health Survey 2003 and 2013. Results: It was found that size of the neonatal, maternal age, maternal education, giving birth in a private health institution, having insurance, living in a developed region of Türkiye, adequate antenatal visits, and smoking had an increasing effect on caesarean section. Conclusion: Caesarean section in Türkiye is shaped not only by medical needs but also by sociodemographic and socioeconomic determinants. Older maternal age, smaller neonatal size, higher levels of antenatal care, multiple births, and maternal smoking significantly raise the probability of caesarean delivery. Moreover, those living in developed regions, insured women, and those delivering in private or university hospitals were more likely to undergo caesarean section, while lower education and welfare were associated with lower caesarean rates. These findings highlight the multifactorial nature of caesarean delivery and the need for policy approaches considering both clinical and social determinants.

Keywords

• Caesarean section
• childbirth
• maternity health

References

1. Abebe, F. E., Gebeyehu, A. W., Kidane, A. N., & Eyassu, G. A. (2016). Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: A retrospective record review. Reproductive Health,13(6),1–7.
2. Alonso-Colón, M., Pérez-Gómez, B., & Ramis, R. (2025). Determinants of cesarean section rates: A cross-sectional study of 4.9 million deliveries over 10 years. European Journal of Obstetrics & Gynecology and Reproductive Biology, 114527.
3. Baig, J. R., Jamal, M. M., Ashfaq, T. (2016). A Two Year Analysıs of Cesarean Delıvery at Cmh Hyderabad. Pakistan Armed Forces Medical Journal, 66(1),25–29.
4. Basendowah, M., Alabdulqader, M. H., Abdulqader, O., Hakami, M. (2020). Cecal Volvulus Post Cesarean Section: A Case Report. Cureus, 12(1),e6644.
5. Begum, T., Rahman, A., Nababan, H., Hoque, D. M. dE., Khan, A. F., Ali, T., & Anwar, I. (2017). Indications and determinants of caesarean section delivery in Matlab, Bangladesh. PLoS One. 12(11),1–16.
6. Betrán, A. P., Merialdi, M., Lauer, J. A., Shun, W. B., Thomas, J., Look, P. V., & Wagner, M. (2007). Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology, 21(2),98–113.
7. Betran, A. P., Ye, J., Moller, A. B., Souza, J. P., & Zhang, J. (2021). Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health, 6(6),e005671.
8. Biler, A., Ekin, A., Ozcan, A., Inan, A. H., Vural, T., Toz, E. (2017). Is it safe to have multiple repeat cesarean sections? A high volume tertiary care center experience. Pakistan Journal of Medical Sciences, 33(5), 1074–1079.

9. Brown, H. L. (2012). Informing the Patient and the Community About the Implications of Primary Cesarean. Seminars Perinatology, 36(5),403–406.
10. Carayol, M., Zeitlin, J., Roman, H., Le Ray, C., Breart, G., Goffinet, F., & Premoda Study Group. (2007). Non-clinical determinants of planned cesarean delivery in cases of term breech presentation in France. Acta Obstetricia et Gynecologica Scandinavica,86(9), 1071–1078.
11. Cegolon, L., Mastrangelo, G., Maso, G., Dal Pozzo, G., Ronfani, L., Cegolon, A., Heymann, W. C., & Barbone, F.(2020). Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005–2015. Scientific Reports, 10(1),1–18.
12. Chen, Y., Wu, L., Zhang, W., Zou, L., Li, G., & Fan, L. (2016). Delivery modes and pregnancy outcomes of low birth weight infants in China. Journal of Perinatology,36(1),41–46.
13. de Paepe, P., Echeverría Tapia, R., Aguilar Santacruz, E., Unger, J. P. (2012). Ecuador’s silent health reform. International Journal of Health Services, 42(2),219–233.
14. Fan, H., Gu, H., You, H., Xu, X., Kou, Y., & Yang, N. (2019). Social determinants of delivery mode in Jiangsu, China. BMC Pregnancy Childbirth, 19(1),1–7.
15. Gibbons, L., Belizan, J. M., Lauer, J. A., Betran, A. P., Merialdi, M., & Althabe, F. (2012). Inequities in the use of cesarean section deliveries in the world. American Journal of Obstetrics & Gynecology,206(4),331.e1-331.e19.
16. Greene, W. (2020). Econometric Analysis. Eighth Edition. Pearson.
17. Hannah, M. E. (2002). Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at Term:The International Randomized Term Breech Trial. JAMA,287(14),1822.
18. Harer, W. (2000). Patient choice cesarian. ACOG Clinical Review,5(2),1.
19. Herstad, L., Klungsøyr, K., Skjærven, R., Tanbo, T., Forsen, L., Åbyholm, T., Vangen, S. (2016). Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy and Childbirth, 16(1),230.
20. Hoxha, I., Braha, M., Syrogiannouli, L., Goodman, D. C., & Jüni, P. (2019). Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open, 9(3), e02535.
21. Jahnke, J. R., Houck, K. M., Bentley, M. E., & Thompson, A. L. (2019). Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades. Birth,46(2),335–343.
22. Joseph, K. S., Young, D. C., Dodds, L., O’Connell, C. M., Allen, V. M., Chandra, S., & Allen, A. A. (2003). Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery. Obstetrics and Gynecology, 102(4),791–800.
23. Kaboré, C., Ridde, V., Kouanda, S., Agier, I., Queuille, L., & Dumont, A. (2016). Determinants of non-medically indicated cesarean deliveries in Burkina Faso. International Journal of Gynecology & Obstetrics, 135(S1),58–63.
24. Karlström, A., Nystedt, A., Johansson, M., Hildingsson, I. (2011). Behind the myth – few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery, 27(5), 620–627.
25. Kasai, K. E., Nomura, R. M. Y., Benute, G. R. G., de Lucia, M. C. S., & Zugaib, M. (2010). Women’s opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital. Midwifery, 26(3),319–326.
26. Keag, O. E., Norman, J. E., & Stock, S. J. (2018). Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Medicine, 15(1), e1002494.
27. Kıllı, B. (2011). Denizli Honaz İlçesi 2009 Yılı Doğumlarının Değerlendirilmesi, Sezaryen Sıklığı ve Buna Etkili Etmenler (Tez No: 293325). [Yükseklisans Tezi, Pamukkale Üniversitesi Sağlık Bilimleri Enstitüsü]. YÖK Ulusal Tez Merkezi.
28. Klemetti, R., Che, X., Gao, Y., Raven, J., Wu, Z., Tang, S., Hemminki, E. (2010). Cesarean section delivery among primiparous women in rural China: an emerging epidemic. American Journal of Obstetrics & Gynecology, 202(1),65. e1-65. e6.
29. Liu, T. C., Chen, C. S., & Lin, H. C. (2008). Does Elective Caesarean Section Increase Utilization of Postpartum Maternal Medical Care? Med Care,46(4),440–443.
30. López Bernal, A., & Norwitz, E. R. (2012). The normal mechanisms of labour. In: Edmonds DK, editor. Dewhurst’s Textbook of Obstetrics & Gynaecology. Eighth Edition. London, UK: John Wiley & Sons; p. 245–268.
31. Mache, G. A., Halil, H. M., & Abdo, R. A. (2021). The Rate, Indications and Contributing Factors of Cesarean Delivery in Southern Nation Nationalities and People ’s Region, Ethiopia. Journal of Midwifery and Reproductive Health, 9(1),2541–2547.
32. Maroufizadeh, S., Amini, P., Hosseini, M., Almasi-Hashiani, A., Mohammadi, M., Navid, B., & Omani-Samani, R. (2018). Determinants of cesarean section among primiparas: A comparison of classification methods. Iranian Journal of Public Health,47(12),1913–1922.
33. Martinson, M. L., & Reichman, N. E. (2016). Socioeconomic Inequalities in Low Birth Weight in the United States, the United Kingdom, Canada, and Australia. American Journal of Public Health, 106(4),748–754.
34. Organisation for Economic Co-operation and Development. (2019). Health at a Glance 2019: OECD Indicators. OECD Publishing. OECD.
35. Padlilah, R., Yulianti, I., & Ariyanti, R. (2021). Factors Leading to Cesarean Section Delivery at Tarakan Hospital, North Kalimantan. Journal of Maternal and Child Health, 6(1),77–83.
36. Sağlık Bakanlığı. (2010). Doğum ve Sezaryen Eylemi Yönetim Rehberi. Damla Matbaacılık.
37. Sağlık Bakanlığı. (2022). Sağlık istatistikleri yıllığı 2020.
38. Salihu, H. M., Sharma, P. P., Kristensen, S., Blot, C., Alio, A. P., Ananth, C. V., & Kirby, R. (2006). Risk of Stillbirth Following a Cesarean Delivery. Obstetrics & Gynecology,107(2, Part 1),383–390.
39. Sebastião, Y. V., Womack, L., Vamos, C. A., Louis, J. M., Olaoye, F., Caragan, T., Bubu, O. M., Detman, L. A., Curran, J. S., & Sappenfield, W. M. (2016). Hospital variation in cesarean delivery rates: Contribution of individual and hospital factors in Florida. American Journal of Obstetrics & Gynecology,214(1),123.e1-123.e18.
40. Shearer, E. L. (1993). Cesarean Section: Medical benefits and costs. Social Science & Medicine, 37(10),1223–1231.
41. TNSA. (2003). 2003 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü.
42. TNSA. (2013). 2013 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Universitesi Nüfus Etütleri Enstitüsü, T.C.Kalkınma Bakanlığı ve TÜBİTAK.
43. Verma, V., Vishwakarma, R. K., Nath, D. C., Khan, H. T. A., Prakash, R., & Abid, O. (2020). Prevalence and determinants of caesarean section in South and South-East Asian women. PLoS One, 15(3),1–15.
44. Vieira, G. O., Fernandes, L. G., de Oliveira, N. F., Silva, L. R., & Vieira, T. de O. (2015). Factors associated with cesarean delivery in public and private hospitals in a city of northeastern Brazil: A cross-sectional study. BMC Pregnancy and Childbirth, 15(132),1–9.
45. Wagner, M. (2000). Choosing caesarean section. The Lancet, 356(9242),1677–1680.
46. Witt, W. P., Wisk, L. E., Cheng, E. R., Mandell, K., Chatterjee, D., Wakeel, F., Godecker, A. L., & Zarak, D. (2015). Determinants of Cesarean Delivery in the US: A Lifecourse Approach. Maternal and Child Health Journal, 19(1),84–93.
47. Wondie, A. G., Zeleke, A. A., Yenus, H., & Tessema, G. A. (2019). Cesarean delivery among women who gave birth in Dessie town hospitals, Northeast Ethiopia. PLoS One, 14(5),1–13.
48. Wooldridge, J. M. (2010). Econometric Analysis of Cross Section and Panel Data. Second Edition. The MIT Press.
49. World Health Organization (WHO). (1985). Appropriate technology for birth. Lancet, 2,436–437.
50. Yaya, S., Uthman, O. A., Amouzou, A., & Bishwajit, G. (2018). Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Global Health Research and Policy,3(19),1–9.