DISPARITIES IN CESAREAN SECTION RATES AMONG ROBSONS GROUPS IN HIGH- VS. LOW-RESOURCE SETTINGS

Background and Aims: Cesarean section (CS) rates have significantly increased globally, with both overuse in high-resource settings and underuse in low-resource settings posing maternal and neonatal risks. The World Health Organization (WHO) recommends the Robson Ten-Group Classification System (RTGCS) as a standard for monitoring and comparing CS rates. However, disparities persist, particularly in Groups 1, 2, and 5, where CS may be unnecessarily high in high-resource settings and inadequately available in low-resource settings. This study aimed to analyze disparities in CS rates among Robson groups in high- vs. low-resource settings and identify contributing factors.

Methods: This retrospective observational study was conducted from October 2023 to April 2024 at two tertiary care hospitals—one in a high-resource urban setting and the other in a low-resource rural setting. Data were collected from 200 antenatal patients (100 from each center) who underwent CS. Participants were categorized using the RTGCS, and indications for CS were analyzed. Ethical approval was obtained, and statistical analysis was performed using MedCalc version 6.1, applying Chi-square tests for categorical variables and t-tests for continuous data (p < 0.05).

Results: Significant differences were observed in CS indications and maternal characteristics between the two settings. High-resource hospitals had higher elective CS rates, increased VBAC reluctance, and a lower threshold for fetal distress diagnosis. Conversely, low-resource centers had more emergency CS, higher induction failure rates, and delayed obstetric interventions due to infrastructure limitations.

Conclusion: CS disparities between high- and low-resource settings stem from healthcare accessibility, clinical decision-making, and patient-related factors. Reducing unnecessary CS in high-resource hospitals while improving timely access in low-resource settings requires better antenatal care, labor management, and VBAC promotion.