Amaral G, Bushee J, Cordani UG Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting. J Petrology. 2013; 369:(1)1689-1699

Arifin H, Ibrahim K, Rahayuwati L HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15–24 years: regional disparities in Indonesia. BMC Public Health. 2022; 22:(1)

Bakken S, Stone PW, Larson EL. A nursing informatics research agenda for 2008-18: contextual influences and key components. Nurs Outlook. 2008; 56:(5)206-214

Bayou YT, Mashalla YJS, Thupayagale-Tshweneagae G. Patterns of caesarean-section delivery in Addis Ababa, Ethiopia. Afr J Prim Health Care Fam Med. 2016; 8:(2)1-6

Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO statement on caesarean section rates. BJOG. 2016; 123:(5)667-670

Survei Demografi Dan Kesehatan.Kesehatan Reproduksi Remaja: Badan Kependudukan dan Keluarga Berencana Nasional; 2017

Cardwell CR, Stene LC, Joner G Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008; 51:(5)726-735

Claramonte Nieto M, Meler Barrabes E, Garcia Martínez S, Gutiérrez Prat M, Serra Zantop B. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy Childbirth. 2019; 19:(1)1-10

Consumer News and Business Channel Indonesia. Ditanggung BPJS Kesehatan, Persalinan Caesar Pun Tanpa Biaya. 2021. (accessed 12 April 2022)

Croft TN, Marshall AMJ, Allen CK Guide to DHS statistics.Rockville, Maryland: ICF; 2018

de Loenzien M, Schantz C, Luu BN, Dumont A. Magnitude and correlates of caesarean section in urban and rural areas: a multivariate study in Vietnam. PLoS One. 2019; 14:(7)

Dusabe J, Akuze J, Kisakye AN, Kwesiga B, Nsubuga P, Ekirapa E. A case-control study of factors associated with caesarean sections at health facilities in Kabarole district, western Uganda, 2016. Pan Afr Med J. 2018;

Eide KT, Morken NH, Bærøe K. Maternal reasons for requesting planned caesarean section in Norway: a qualitative study. BMC Pregnancy Childbirth. 2019; 19:(1)

Faisal-Cury A, Menezes PR, Quayle J, Santiago K, Matijasevich A. The relationship between indicators of socioeconomic status and caesarean section in public hospitals. Revista de Saúde Pública. 2017; 51

Gebremedhin S. Trend and socio-demographic differentials of Caesarean section rate in Addis Ababa, Ethiopia: analysis based on Ethiopia demographic and health surveys data. Reproductive Health. 2014; 11:(1)

Guendelman S, Gemmill A, Thornton D Prevalence, disparities, and determinants of primary caesarean births among first-time mothers in Mexico. Health Affairs. 2017; 36:(4)714-722

Haines HM, Rubertsson C, Pallant JF, Hildingsson I. The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy Childbirth. 2012; 12:(1)

Age classification based on category.Jakarta: Ditjen Yankes; 2009

Heredia-Pi I, Servan-Mori EE, Wirtz VJ, Avila-Burgos L, Lozano R. Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey. PLOS One. 2014; 9:(8)

Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective caesarean section on maternal request: a systematic review. J Matern-Fetal Neonatal Med. 2019; 1-6

Konlan KD, Baku EK, Japiong M, Dodam Konlan K, Amoah RM. Reasons for women's choice of elective caesarian section in Duayaw Nkwanta Hospital. J Pregnancy. 2019;

Kusnanto K, Arifin H, Kurniawati Y. Determinant of BCG vaccine coverage among Indonesian children aged 0-2 months. Children and Youth Services Review. 2020; 116

Larson CP. Poverty during pregnancy: its effects on child health outcomes. Paediatrics Child Health. 2007; 12:(8)673-677

Lazasniti S, Machmud PB, Ronoatmodjo S. Factors that influence caesarean section deliveries in Indonesia. Jurnal Berkala Epidemiologi. 2020; 8:(2)

Liamputtong P. Birth and social class: northern Thai women's lived experiences of caesarean and vaginal birth. Sociology of Health & Illness. 2005; 27:(2)243-270

Liamputtong P, Naksook C. Perceptions and experiences of motherhood, health and the husband's role among Thai women in Australia. Midwifery. 2003; 19:(1)27-36

Long Q, Kempas T, Madede T, Klemetti R, Hemminki E. Caesarean section rates in Mozambique. BMC Pregnancy Childbirth. 2015; 15:(1)

Mahendradhata Y, Trisnantoro L, Listyadewi S The Republic of Indonesia health system review (Vol. 7).India: World Health Organization; 2017

Manyeh AK, Amu A, Akpakli DE, Williams J, Gyapong M. Correction: socioeconomic and demographic factors associated with caesarean section delivery in Southern Ghana: evidence from INDEPTH Network member site. BMC Pregnancy Childbirth. 2019; 19:(1)1-9

Indonesia Demographic and Health Survey 2017.Jakarta, Indonesia: BKKBN, BPS, Kemenkes, and ICF; 2018

Ogawa K, Urayama KY, Tanigaki S Association between very advanced maternal age and adverse pregnancy outcomes: A cross sectional Japanese study. BMC Pregnancy Childbirth. 2017; 17:(1)1-10

Rahmawati D, Tamtomo D, Budihastuti UR. Analysis of factors affecting childbirth with caesarean in Kediri, Indonesia. J Mat Child Health. 2016; 1:(01)34-40

Sadiq M, Mehmood T, Aslam M. Identifying the factors associated with caesarean section modeled with categorical correlation coefficients in partial least squares. PLoS One. 2019; 14:(7)1-17

Schröders J, Wall S, Kusnanto H, Ng N. Millennium development goal four and child health inequities in Indonesia: a systematic review of the literature. PLoS One. 2015; 10:(5)

Seidu A-A, Hagan JE, Agbemavi W Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study. BMC Pregnancy Childbirth. 2020; 20:(1)

Sihombing N, Saptarini I, Putri DSK. Determinan Persalinan Sectio Caesarea Di Indonesia (Analisis Lanjut Data Riskesdas 2013) Neliti. Jurnal Kesehatan Reproduksi. 2017; 8:(1)63-75

Størksen HT, Garthus-Niegel S, Adams SS, Vangen S, Eberhard-Gran M. Fear of childbirth and elective caesarean section: a population-based study. BMC Pregnancy Childbirth. 2015; 15:(1)

Takegata M, Ronsmans C, Nguyen HAT Socio-demographic factors of caesarean births in Nha Trang city, Vietnam: a community-based survey. Trop Med Int Health. 2020; 48:(1)

Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between caesarean section and childhood asthma. Clin Exp Allergy. 2008; 38:(4)629-633

Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014; 14:(1)

Verma V, Vishwakarma RK, Nath DC, Khan HTA, Prakash R, Abid O. Prevalence and determinants of caesarean section in South and South-East Asian women. PLoS One. 2020; 15:(3)

Vieira GO, Fernandes LG, de Oliveira NF, Silva LR, Vieira TdO. Factors associated with caesarean delivery in public and private hospitals in a city of northeastern Brazil: a cross-sectional study. BMC Pregnancy Childbirth. 2015; 15:(1)

Vogel JP, Betrán AP, Vindevoghel N Use of the robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Global Health. 2015; 3:(5)e260-e270

Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning. 2006; 21:(6)459-468

Weeks FH, Sadler M, Stoll K. Preference for caesarean attitudes toward birth in a Chilean sample of young adults. Women Birth. 2020; 33:(2)e159-e165

World Health Organization. Sustainable development goals (SDGs): Goal 3. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. 2016a. (accessed 12 April 2022)

World Health Organization. Community health workers: a strategy to ensure access to primary health care services. 2016b. (accessed 31 March 2022)

Determinants of caesarean section delivery: a nationwide study in Indonesia

02 May 2022
Volume 30 · Issue 5



The number of caesarean section deliveries among mothers in Indonesia has increased every year.


This study was conducted to identify the prevalence and determinants of caesarean section in Indonesia.


A cross-sectional design using the 2017 Indonesian Demographic Health Survey was conducted. A total of 12 789 mothers were recruited, and bivariate analysis and binary logistic regression were used.


The determinants among women that were significant factors in performing caesarian section deliveries were maternal age >35 years, urban residence, high level of education, poorest wealth index, having more than four visits to antenatal care centres, close proximity to health facilities and first-time birth.


The rate of caesarean section deliveries in Indonesia was 17.7%. Monitoring and evaluation of the increasing number of caesarean sections without medical necessity and the severity of labour is needed.

Reducing maternal mortality remains a major challenge for healthcare systems worldwide. Indonesia has achieved the fourth target of the Millennium Development Goals, to reduce child mortality, but has yet to reach the fifth target, to improve maternal health by reducing the maternal mortality ratio and achieving universal access to reproductive health (Schröders et al, 2015). Problems with maternal and child healthcare are still prevalent in Indonesia. The government has carried out various programmes to improve maternal and child healthcare, one of which requires childbirth to be assisted by competent health personnel (Mahendradhata et al, 2017). This is an effort to achieve the sustainable development goal target of reducing the global maternal mortality rate to less than 70 per 100 000 live births by 2030 (World Health Organization (WHO), 2016a). Type of delivery, including caesarean section, can reduce maternal and infant mortality and delivery complications. However, a caesarean section is generally only performed according to planned medical situations that indicate its necessity, in an emergency setting or electively.

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