Women’s knowledge on cesarean section and vaginal delivery in the Kanyakumari District of Tamil Nadu, India

Abstract

In the modern era, Cesarean section (C-section) is one of the major and most common surgeries performed worldwide. Its rate is tremendously increasing across the globe. Around the world, China tops the first place in C-section rate at 42%. In India, C-section rates fluctuate across its states. India is the second most populated country in the world, where two-third of its population (which is mostly under middle-income category) faces tremendous expenditure on health care. Among these, birth delivery charges are climbing high especially in private hospitals. Out-of-pocket expenses increase even more for deliveries done through C-section which is a big public health issue in terms of Indian Economy. According to the 2015-16, National Family Health Survey (NFHS-4), Telengana, a newly formed former state of Andhra Pradesh had a high rate of C-section at 58%, followed by Andhra Pradesh, Kerala and Tamil Nadu at 40.1%, 35.8%, 34.1%, respectively in the South. In India, the C-section rate is higher among South Indian women, as compared to North Indian women. At South, Kanyakumari district of Tamil Nadu tops first place in C-section at a rate of over 50%. Of these, 54.6% were conducted among private hospitals. A lack of proper knowledge on use of healthcare resources could increase avoidable financial burden in the families. There should be official mandates on maintaining a complete transparency between the patients and health care providers on every resource spent and utilized. Thus, improving health care quality and reducing the overuse of resources. An educational decision aid support and counseling services to the pregnant women, during their period of gestation, could improve their knowledge on strengths and weakness of modes of delivery. In addition, this will also decrease the anxiety of pregnant women toward natural mode of delivery. Thus, the aim of this proposal is to focus on increasing the pregnant women’s (13-28 weeks) knowledge on C-section and vaginal delivery. The specific objectives of the proposed program used for evaluation are: 1. At the end of the two month educational program, there will be 22% absolute increase in the average knowledge percent score from the baseline in the intervention group. 2. By the end of six-months after the implementation of the educational training program, the rate of caesarean section in the intervention group will be 14% (relative) lower compared to the control group. The study sample population estimates to around 705. This study incorporates the knowledge, attitude and socio-demographic instruments that were used in previous similar studies. SPSS software will be used for data entry and descriptive analysis will be used for analytical purposes. The study received approval from the Institutional Review Board of the American University of Armenia. The budget of the proposed study is USD26,843 (INR1, 900,990). This study will carve evidence for future research and development in this particular arena of public health.