Trends and determinants of cesarean deliveries in Tamil Nadu: a comparative analysis of NFHS-4 and NFHS-5

Background: Global evidence shows rising cesarean deliveries, with India also experiencing a notable rise. Tamil Nadu’s cesarean rates rose from NFHS-4 to NFHS-5, despite strong maternal services; this study analyses trends and determinants using NFHS-4 and NFHS-5 data. Methods: Cesarean rates between NFHS 4 and NFHS 5 were compared for Tamil Nadu and its districts. District wise trends and AARI changes were analysed, and survey weighted logistic regression using NFHS-5 data was applied to identify factors influencing cesarean delivery. Results: The study examined cesarean trends in Tamil Nadu using NFHS-4 and NFHS-5 data. Cesarean rates increased faster in Tamil Nadu (4.7%) than at the national level (3.8%). District-level analysis showed rates above 20% in three districts, 10-20% in eleven districts, 5-10% in twelve districts, and below 5% in six districts, with slight decrease rates observed in a few districts. Cesarean deliveries increased by 9.6% in government hospitals and by 12.7% in private facilities. The likelihood of cesarean delivery was nearly three times higher in private facilities (OR=2.79). First births occurring later in life also increased the likelihood of cesarean delivery (30+: OR=3.02); additionally, certain health conditions, such as thyroid disorders (OR=1.45) and diabetes (OR=3.16), also increased this likelihood. Conclusions: Cesarean deliveries are continuously increasing in Tamil Nadu, with notable district-level variations. The state’s cesarean rate exceeds the national average, highlighting the need for state-specific strategies. Regression analysis identifies place of delivery, maternal age at first birth, and maternal health conditions as key factors, emphasizing the need to monitor trends and strengthen local policy interventions.