Do free caesarean section policies increase inequalities in Benin and Mali?

Table 2 Rate of delivery by C-section and in a facility for the most recent birth of each woman within 5 years prior to their interview in Benin

	Before implementation of the policy		After implementation of the policy	Trends in inequalities between period 1 and period 3
	Period 1	Period 2	Period 3	p-value^c
Total
All pregnant women	3614	12,760	6837
% delivery by C-section	3.87	4.33	5.35
% FBD	77.44	81.00	87.25
Women by zone of residence
Urban	1137	4723	2574
% delivery by C-section	7.04	6.39	7.85
% FBD	85.44	86.97	92.02
Rural	2477	8037	4263
% delivery by C-section	2.42	3.11	3.85
% FBD	73.78	77.48	84.37
Urban/rural inequalities
aOR (95% CI) for C-section^a	1.44 (0.88; 2.35)	1.18 (0.96; 1.45)	1.24 (0.92; 1.66)	0.135
aOR (95% CI) for FBD^b	0.75 (0.47; 1.21)	0.85 (0.65; 1.12)	0.97 (0.70; 1.35)	0.244
Women by level of education
Educated	977	3280	1896
% delivery by C-section	6.55	8.14	8.49
% FBD	90.79	95.53	97.36
Non-educated	2637	9480	4941
% delivery by C-section	2.88	3.01	4.15
% FBD	72.48	75.97	83.36
Educated/non-educated inequalities
aOR (95% CI) for C-section^a	1.02 (0.71; 1.48)	1.87 (1.50; 2.33)***	1.21 (0.92; 1.59)	0.665
aOR (95% CI) for FBD^b	1.58 (1.21; 2.05)**	3.31 (2.71; 4.06)***	3.13 (2.27; 4.33)***	0.001
Women by wealth quintiles of households (Q1 and Q5)
Q1 - Poorest	816	2842	1532
% delivery by C-section	2.45	1.97	3.33
% FBD	56.81	60.57	72.17
Q5 - Richest	568	2073	1060
% delivery by C-section	11.62	10.08	12.17
% FBD	98.24	98.41	99.24
Poorest/richest inequalities
aOR (95% CI) for C-section^a	4.08 (1.96; 8.43)***	3.01 (1.96; 4.64)***	2.86 (1.69; 4.83)***	0.487
aOR (95% CI) for FBD^b	58.63 (23.09148.89)***	35.02 (21.52; 57.01)***	37.57 (16.55; 85.28)***	0.525

aOR adjusted odds ratio: C-section caesarean section, and FBD facility based delivery
Period 1 = September 1996 to November 2001; Period 2 = December 2001 to March 2009; and Period 3 = April 2009 to March 2012
*p ≤ 0.05; **p ≤ 0.01; and ***p ≤ 0.001
^aThe aORs for C-section access were estimated with the use of multivariate logistic regression models (adjusted based on age, education, wealth quintile of household, zone of residence, parity, and multiple pregnancy, as well as sampling weight, clustering and strata)
^bThe aORs for FBD access were estimated with the use of multivariate logistic regression models (adjusted based on age, education, wealth quintile of household, zone of residence, parity, and multiple pregnancy, as well as sampling weight, clustering and strata)
^cp-values of the interaction between categories (urban vs rural or educated vs non-educated) and period (period 1 vs period 3) were estimated with the use of the multivariate logistic regression models (adjusted based on age, education, wealth quintile of household, parity, and multiple pregnancy, as well as sampling weight, clustering and strata)

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