Distribution and Determinant of Caesarean Section Among Women of Reproductive Age

Caesarean section (CS) delivery remains one of the most important lifesaving obstetric interventions for reducing maternal and neonatal morbidity and mortality when medically indicated. Irrespective of global efforts to improve access to emergency obstetric care, the utilization of caesarean section in Nigeria remains low and unevenly distributed across socioeconomic, residential, and regional populations. This study therefore examined the distribution and determinants of caesarean section among women of Reproductive Age. Data for the study were obtained from the Nigeria Demographic and Health Survey (NDHS 2023 24), a nationally representative survey involving 42,000 women aged 15–49 years. The survey adopted a stratified two-stage cluster sampling technique to ensure national representativeness. Descriptive statistics were used to examine the distribution of caesarean section delivery across selected socio-demographic characteristics, while multilevel logistic regression analysis was employed to identify individual-, household-, and community-level determinants of caesarean section delivery. Measures of inequality were used to assess rural–urban differentials in caesarean section utilization. The findings revealed that a majority of the respondents were aged 35–39 years (21.64%), 46.56% had no formal education, while 59.38% had five or more children. The prevalence of caesarean section delivery in Nigeria was 5.60% (95% CI: 5.25–5.96). Caesarean section delivery was significantly higher among urban women (10.02%; 95% CI: 9.29–10.79) compared to rural women (2.81%; 95% CI: 2.50–3.16). The inequality analysis further showed an absolute rural–urban difference of 6.97 percentage points (RD = 6.97; 95% CI: 5.48–8.45), while urban women were approximately four times more likely to undergo caesarean delivery than rural women (PR = 3.68; 95% CI: 2.88–4.70). At the multivariate level, women with higher education were significantly more likely to undergo caesarean section delivery (aIRR = 5.73; 95% CI: 4.56–7.19) compared with women with no formal education. Community-level media exposure also significantly increased the likelihood of caesarean section delivery, particularly among women residing in communities with medium media exposure (AOR = 1.60; 95% CI: 1.24–2.05; p < 0.001). Conversely, women who received skilled antenatal care had lower odds of caesarean section delivery (aIRR = 0.17; 95% CI: 0.04–0.86) compared with those who received unskilled care. The study concludes that caesarean section delivery in Nigeria is shaped by individual, household, and community-level factors, with pronounced rural–urban inequalities in utilization. The persistently low prevalence of caesarean section delivery, particularly in rural areas, reflects inequitable access to essential maternal healthcare services. Therefore, strengthening emergency obstetric care, improving women’s education, expanding skilled maternal healthcare services, and addressingsocioeconomic and geographic disparities are critical to improving equitable access to caesarean section delivery and enhancing maternal and neonatal health outcomes in Nigeria.