Unmet Needs of Caesarean Section in Nigeria: What are the Prevalence and Regional Inequalities

Background: Caesarean section (CS) is a lifesaving obstetric technique, particularly when the mother or foetus is at risk due to complications. The World Health Organization (WHO) recommended a prevalence of CS between 5% and 15% as acceptable, for which a prevalence less than 5% indicates the unmet need and a prevalence exceeding 15% pose risk to the mother or foetus. This study, therefore, aimed to estimate the prevalence of CS in the different regions of residence in Nigeria.

Methodology: Data were analysed from the 2018 Nigeria Demographic and Health Survey (NDHS) of a representative sample of women of reproductive age (n =21702) who delivered a baby between 2013 and 2018. Prevalence and its 95% confidence interval (CI) were estimated.

Results: Overall prevalence of CS in Nigeria was 3.0% (95% CI=1.7% - 3.2%). Women residing in the urban areas had a higher prevalence of 5.8% (95% CI=5.3% - 6.3%), compared to rural areas 1.5% (95% CI=1.3% - 1.7%). Similarly, the southern region residents had a prevalence of 5.7% (95% CI=5.1% - 6.3%), while the Northern region had 1.7% (95% CI=1.4% - 1.9%). The prevalence across the geo-political regions were North-Central (prevalence = 3.5%, 95% CI=2.9% - 4.2%), North-East (prevalence = 1.3%, 95% CI=1.0% - 1.7%), North-West (prevalence = 0.8%, 95% CI=0.6% - 1.0%), South-East (prevalence = 5.8%, 95% CI=4.9% - 46.9%), South-South (prevalence = 4.5%, 95% CI= 3.7% - 5.4%), South-West (prevalence = 6.7%, 95% CI=5.8% - 7.7%).

Conclusion: These results clearly suggest unmet needs and regional inequalities in the rate of CS in Nigeria. There should be intense intervention efforts in Nigeria by encouraging women’s education and optimal utilization of obstetric care, especially for women residing in rural areas and northern regions.