Socioeconomic and Geographical Inequalities of prevalence in birth by caesarean section among women in Ghana, 2014-2022

Abstract

Objective

To analyse the socioeconomic and geographic inequalities in births by cesarean section (CS) among women in Ghana between 2014 and 2022.

Methods

We analysed data from the Ghana Demographic and Health Surveys (GDHS) (2014, 2017, and 2022) using the WHO’s Health Equity Assessment Toolkit (HEAT). To assess inequalities, two simple unweighted measures: Difference (D) and Ratio (R), and two complex weighted measures: Population Attributable Risk (PAR) and Population Attributable Fraction (PAF) were selected. Socioeconomic inequalities were evaluated based on household wealth and education level, while geographical inequalities were examined by place of residence and subnational regions. Statistical significance was reported using 95% confidence intervals for all point estimates.

Results

Between 2014 and 2022, the rate of CS among women increased drastically, rising from just 12.8% to 20.3%. The highest CS rates were observed in 2022 among women from the richest wealth quintile (37.7%), those with higher education (43.4%), and living in urban areas (26.5%). Regional differences were also evident, with women in the Greater Accra Region persistently showing higher CS rates. The PAR for the region rose from 8.7 (95% CI: 5.6–11.8) in 2014 to 10.9 (95% CI: 7.6–14.2) by 2022.

Conclusion

Our analysis revealed persistent socioeconomic and regional disparities in CS rates between 2014 and 2022 in Ghana. To effectively address the inequity gaps, it is crucial to design and implement targeted interventions and health policies. Ensuring equitable access to medically necessary CS procedures, regardless of socioeconomic status or geographic location, should be a national health priority.