C-Section Deliveries Linked to Higher Child Undernutrition and Mortality: NFHS-5 Study
India: Data from the National Family Health Survey in India indicate higher risks of stunting, wasting, and underweight among children born via C-section compared to those delivered vaginally. The analysis, which included 200,794 births, also found an increased likelihood of neonatal mortality in C-section births.
Additionally, children born to mothers with third or higher-order pregnancies faced greater risks of both neonatal and infant mortality. These findings, published in BMC Pediatrics, highlight the need to address delivery methods and maternal factors in improving child health outcomes.
Child undernutrition and mortality remain critical health challenges in low- and middle-income countries like India. A 2017 global report found that 22% of children were stunted, and 45% of child deaths occurred in those under five. Undernutrition, infectious diseases, and delivery methods (C-section vs. vaginal) are major contributors to these issues. C-sections, especially when overused, are linked to negative maternal and child health outcomes. Excessive C-section rates can increase risks of mortality, financial burden, and clinical complications.
Against the above background, Ujjwal Das & Nihar Ranjan Rout from Fakir Mohan University, Balasore, Odisha, India, examined the impact of delivery methods on child health in children aged 0–59 months in India.
For this purpose, the researchers used 200,794 samples in the study. Of these, 45,784 births were delivered by C-section, while the remaining 150,010 were delivered through normal vaginal delivery.
To assess the association between child health and mode of delivery, life table estimation of mortality and bivariate and multivariate logistic regression were applied to data from the fifth round of the National Family Health Survey conducted in 2019-21.
The study led to the following findings:
- Children born via normal delivery had significantly lower rates of stunting, wasting, and underweight compared to those born by C-section.
- The likelihood of neonatal death was higher for newborns delivered by C-section than for those delivered vaginally, across various background characteristics.
- Mothers with a third or higher-order birth who deliver via C-section face a higher risk of neonatal and infant mortality compared to those with a second-order birth.
The study highlights that C-section deliveries are linked to delayed breastfeeding, higher financial burdens, and shorter breastfeeding durations compared to vaginal births. Additionally, C-sections increase the risk of child undernutrition, mortality, and complications, especially in emergency C-sections and those with previous C-sections. Neonatal and infant mortality rates are higher among C-section births.
"These findings stress the importance of antenatal and postnatal care visits. Low maternal healthcare coverage in rural areas exacerbates these issues. Health policies should focus on improving obstetric care quality and promoting vaginal deliveries to reduce mortality and improve child health outcomes," the researchers concluded.
Reference:
Das, U., Rout, N.R. Impact of normal vs. caesarean deliveries on child nutritional status and mortality in India: insights from NFHS-5 data. BMC Pediatr 24, 781 (2024). https://doi.org/10.1186/s12887-024-05149-4
