Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe: Evidence from the 2019 National Multiple Indicator Cluster Survey


  • G N Musuka Innovative Public Health and Development Solutions, Harare, Zimbabwe
  • G Murewanhema Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  • H Herrera School of Pharmacy and Biomedical Science, University of Portsmouth, UK
  • E Mbunge Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Eswatini
  • R Birri-Makota Department of Biological Sciences and Ecology, Faculty of Science, University of Zimbabwe, Harare, Zimbabwe
  • T Dzinamarira School of Health Systems and Public Health, University of Pretoria, South Africa
  • D Cuadros Digital Epidemiology Laboratory, University of Cincinnati, USA
  • I Chingombe Innovative Public Health and Development Solutions, Harare, Zimbabwe
  • A Mpofu National AIDS Council, Harare, Zimbabwe
  • M Mapingure Innovative Public Health and Development Solutions, Harare, Zimbabwe



Caesarean Section, Women, MICS 2019 , Zimbabwe


Caesarean sections (CSs) have increased globally, with concerns being raised involving overutilisation and inequalities in access. In Zimbabwe, where healthcare access varies greatly, we aimed to analyse factors associated with ever having a CS using the 2019 National Multiple Indicator Cluster Survey. The weighted national CS rate was 10.3%, and CS happened more commonly among women in urban than rural areas (15.7% v. 7.4%; odds ratio (OR) 2.34; (95% confidence interval (CI)) 1.71 - 3.20; p=0.001). Percentages of those having a CS significantly increased with education: overall χ2 for a trend of p=0.001 and wealth quintile, and overall χ2 for a trend of p=0.001. Women with insurance coverage were more likely to have had a CS than those without: 26.7% v. 8.7%; OR 3.82; 95% CI 2.51 - 5.83; p=0.001. The same was the case for women with access to the internet: 15.4% v. 7.0%, OR 2.42; 95%CI 1.71 - 3.41; p=0.001). These findings show an association that could indicate this being overutilised by insured women in urban settings, rather than being accessible based on clinical needs. Further research should explore reasons for these disparities and inform interventions to ensure equitable access to optimum childbirth in Zimbabwe.


Zakerihamidi M, Roudsari RL, Khoei EM. Vaginal delivery vs. cesarean section: A focused ethnographic study of women’s perceptions in The North of Iran. Int J Community-Based Nurs Midwifery 2015;3(1):39.

Lori JR, Boyle JS. Cultural childbirth practices, beliefs, and traditions in post-conflict Liberia. Health Care Women Int 2011;32(6):454-473.

World Health Organization. Indicators to monitor maternal health goals. Geneva: WHO, 1994.

Dumont A, De Bernis L, Bouvier-olle M-H, Bréart G, Group MS. Caesarean section rate for maternal indication in sub-Saharan Africa: A systematic review. Lancet 2001;358(9290):1328-1333. https://doi.


Haider MR, Rahman MM, Moinuddin M, Rahman AE, Ahmed S, Khan MM. Ever-increasing caesarean section and its economic burden in Bangladesh. PLoS ONE 2018;13(12):e0208623. https://

Farmer TW, Estell DB, Leung M-C, Trott H, Bishop J, Cairns BD. Individual characteristics, early adolescent peer affiliations, and school dropout: An examination of aggressive and popular group types. J School Psychol 2003;41(3):217-232.

Hasan MN, Chowdhury MAB, Jahan J, Jahan S, Ahme, NU, Jamal Uddin MJ. Cesarean delivery and early childhood diseases in Bangladesh: An analysis of Demographic and Health Survey (BDHS) and Multiple Indicator Cluster Survey (MICS). PLoS ONE 2020;15(12):e0242864. journal.pone.0242864

Zimbabwe National Statistics Agency and United Nations Children’s Fund. Zimbabwe Multiple Indicator Cluster Survey 2019, survey findings report. Harare, Zimbabwe: ZIMSTAT and UNICEF.

Savage W. The caesarean section epidemic. J Obstet Gynaecol 2000;20:223-225. https://doi.


World Health Organization Appropriate technology for birth. Lancet 1985;2(8452):436-437. https://

Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: Global, regional and national estimates: 1990 - 2014. PLoS ONE 2016;11(2):e0148343.

Huang K, Tao F, Faragher B, et al. A mixed-method study of factors associated with differences in caesarean section rates at community level: The case of rural China. Midwifery 2013;29(8):911-920.

Skalkidis Y, Petridou E, Papathoma E, Revinthi K, Tong D, Trichopoulos D. Are operative delivery procedures in Greece socially conditioned? Int J Qual Health Care 1996;8(2):159-165. https://doi. org/10.1093/intqhc/8.2.159

Tatar M, Gunalp S, Somunoglu S, Demirol A. Women’s perceptions of caesarean section: Reflections from a Turkish teaching hospital. Soc Sci Med 2000;50:1227-1233. 9536(99)00315-9

Stanton CK, Holtz SA. Levels and trends in caesarean birth in the developing world. Stud Fam Plan 2006;37(1):41-48.

Walker R, Turnbull D, Wilkinson C. Strategies to address global cesarean section rates: A review of the evidence. Birth 2002;29(1):28-39.

Aminu M, Utz B, Halim A, van den Broek N. Reasons for performing a caesarean section in public hospitals in rural Bangladesh. BMC Preg Childbirth 2014;14(1):130. 10.1186/1471- 2393-14-130

Omole-Ohonsi A, Attah R. Risk factors for ruptured uterus in a developing country. Gynecol Obstetric 2011;21:102.

Motomura K, Ganchimeg T, Nagata C, et al. Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO multicountry survey on maternal and newborn health. Sci Rep 2017;7:44093.







How to Cite

Musuka GN, Murewanhema G, Herrera H, Mbunge E, Birri-Makota R, Dzinamarira T, et al. Rural-urban disparities and socioeconomic determinants of caesarean delivery rates in Zimbabwe: Evidence from the 2019 National Multiple Indicator Cluster Survey. S Afr Med J [Internet]. 2024 Jul. 1 [cited 2024 Jul. 18];114(7):e1882. Available from:

Similar Articles

1-10 of 166

You may also start an advanced similarity search for this article.