Sociocultural differences in ethnic diversities might enable or compromise the relevance of CS uptake in emergency obstetric care. To our knowledge, this is the first study that has sought to examine the influence of women’s ethnic identity on CS uptake based on the latest nationally representative survey in Ghana. The study found that ethnicity, maternal age, residence, education, wealth status, parity, and frequency of reading newspapers or magazines had a significant association with delivery by caesarean section. The overall prevalence of delivery by CS was 12.4% which is consistent with previous studies [2, 16]. However, the prevalence was lower than what was found in Ghana by Seidu et al. [15]. The plausible reason for the discrepancy in the study findings could be the different datasets, the sample size used for the study, and the years the surveys were conducted. This rate falls within the WHO recommended optimal rate of not more than 15%. This finding may signify an efficient application of CS delivery in obstetric care in Ghana.
Our finding revealed that Gruma women had a lower likelihood of CS delivery compared to Akan women. The plausible explanation for the lower likelihood of Gruma women opting for CS delivery may be due to some embedded socio-cultural factors associated with this ethnic group which may inhibit CS utilization [31, 32]. This finding is consistent with previous studies that show ethnic diversities between individuals as perceptions, beliefs, attitudes, and practices influence women’s decisions on CS delivery [27, 28, 29]. What remains unclear in this study is the specific socio-cultural factors emanating from the Gruma ethnic group that contributes to women’s lower likelihood of CS uptake during delivery. It is therefore pertinent for further qualitative studies to explore the existing cultural issues likely to influence CS utilization during delivery among the Gruma ethnic group.
The findings revealed an increasing likelihood of CS utilization with the increasing age of women. This result corroborates previous studies [15, 17, 18]. A possible explanation is that the risks of complications associated with pregnancy increase with increasing age [16], hence, CS uptake is expected to increase among older pregnant women. For instance, risks of some medical conditions like hypertension and diabetes increase with increasing age [13, 14], hence, explaining the higher likelihood of CS delivery with increasing maternal age.
Consistent with the findings from previous studies [15, 16], women residing in rural areas have a lower likelihood of CS uptake compared to their counterparts in urban areas. The possible explanation might be the lack of available health facilities that render CS services to pregnant women since health facilities with the capability to render CS services are usually found in urban settings. As such, rural dwelling women are more likely to utilize the services of traditional birth attendants who do not have the expertise and resources to provide CS to women who may need it [2].
Our study further revealed that formal education was important in predicting women’s utilization of CS. Women who had some levels of formal education were more likely to utilize CS delivery compared to those with no education. This finding is consistent with previous studies [2, 11, 22]. According to Okyere et al. [2], women with higher education tend to perceive CS as a safer and few stress means of childbirth as opposed to vaginal birth. Hence, this explaining why women with higher education had higher odds of utilizing CS delivery. Another plausible explanation for the higher likelihood of CS delivery among educated women may be related to their increased autonomy to make decisions concerning their reproductive health or maternal care services including CS delivery compared to their counterparts with no education [38, 39].
As in many other studies, wealth statuses were found to be positively associated with CS delivery [18, 23]. Thus, women from wealthy households are more likely to utilize CS as compared to their counterparts from poorer households. The reason could be that since CS delivery is an out-of-pocket service, women with higher wealth statuses are more likely to afford the service, hence, their higher odds of CS uptake than those with poor wealth status who are less likely to afford the service.
We observed an inverse relationship between parity and CS uptake. Women with 6 and more births had the lowest odds of delivery through CS. This finding is in line with the findings of Seidu et al. [15], and Manyeh et al. [17]. The lower likelihood of CS uptake among women with increasing parity could be due to their unpleasant experience with previous CS delivery which may discourage them to opt for CS delivery again. Another reason could emanate from doctors’ advice against multiple CS delivery due to its associated risks.
Another significant finding of this study was that women who were exposed to newspapers or magazines were more likely to opt for CS delivery. Thus, compared to women who do not read newspapers or magazines at all, women who read newspapers or magazines at least once a week were more likely to utilize CS delivery. This finding corroborates other previous literature [16]. The reason could be that awareness and knowledge of the benefits of CS delivery in emergency obstetric care may be high among women who read newspapers or magazines at least once a week, hence, informing their higher odds of CS delivery.
Strengths And Limitations
The strengths of this study are its large sample size, national representativeness, and hence the power to generalize the findings. Also, being able to examine the diversities in ethnic groups in relation to CS uptake makes this study unique from other studies that examined factors influencing CS delivery in Ghana. This notwithstanding, the study has few limitations. Although the study found a significant negative association between Gruma ethnic group and CS delivery, causality could not be established due to the cross-sectional nature of the data. Despite this limitation, this study provides evidence-based estimates on the association between ethnicity and delivery by CS among women in Ghana.