Trends and Determinants of Cesarean Section Deliveries in South Asia: A Comparative Study of Medicalization and Socioeconomic Disparities

Cesarean section (C-section) is a lifesaving obstetric procedure when medically required.In recent decades, cesarean births have increased sharply across South Asia, raising concerns about over medicalization and growing socioeconomic gaps in maternal care.This study assessed trends and determinants of cesarean deliveries across six South Asian countries using nationally representative Demographic and Health Survey (DHS) data.Cesarean delivery for the most recent birth was the outcome variable.Key predictors included maternal age, education, residence, and type of health facility.Comparative analyses were conducted across countries and population subgroups.Results show a marked rise in cesarean rates across the region.Bangladesh (44.5%) and the Maldives (42.6%) reported the highest prevalence, while Afghanistan had very low utilization (3.6%).Higher rates were observed among older, educated, urban, and wealthier women.Private facilities consistently reported substantially higher cesarean use than public institutions.Clear urban rural and wealth based inequalities indicate uneven access to obstetric services.In several countries, cesarean rates exceed recommended levels, suggesting overuse among advantaged groups alongside underuse among disadvantaged populations.Overall, South Asia faces a dual burden of excessive cesarean use among wealthier groups and limited access among poorer women.Stronger regulation of private providers, promotion of evidence-based practices, and improved equitable access to maternal health services are essential to ensure safe and appropriate cesarean use and better maternal and neonatal outcomes.