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

Table 3 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 Mali

	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	8247	4163	11,588
% delivery by C-section	1.10	2.02	2.83
% FBD	37.04	47.04	53.66
Women by zone of residence
Urban	1794	1355	3215
% delivery by C-section	3.34	4.13	6.28
% FBD	80.42	79.57	87.15
Rural	6453	2808	8373
% delivery by C-section	0.48	1.00	1.50
% FBD	24.99	31.30	40.80
Urban/rural inequalities
aOR (95% CI) for C-section^a	4.68 (2.09; 10.46)***	1.96 (0.58; 6.61)	2.05 (1.40; 3.00)***	0.032
aOR (95% CI) for FBD^b	4.37 (2.93; 6.53)***	3.22 (2.14; 4.86)***	2.60 (1.91; 3.55)***	0.121
Women by level of education
Educated	1310	701	2103
% delivery by C-section	2.75	4.42	5.85
% FBD	64.74	80.54	81.53
Non-educated	6937	3462	9485
% delivery by C-section	0.79	1.53	2.16
% FBD	31.80	40.27	47.49
Educated/non-educated inequalities
aOR (95% CI) for C-section^a	2.01 (1.23; 3.30)**	2.02 (0.99; 4.14)*m	1.39 (1.02; 1.89)*	0.043
aOR (95% CI) for FBD^b	2.18 (1.74; 2.72)***	3.68 (2.57; 5.29)***	2.06 (1.74; 2.43)***	0.702
Women by wealth quintiles of households (Q1 and Q5)
Q1 - Poorest	1702	731	2211
% delivery by C-section	0.47	1.09	1.09
% FBD	21.16	29.26	30.76
Q5 - Richest	1353	830	2360
% delivery by C-section	3.77	4.58	6.95
% FBD	86.03	86.64	92.37
Poorest/Richest inequalities
aOR (95% CI) for C-section^a	0.91 (0.13; 6.27)	13.86 (3.36; 7.30)***	2.45 (1.04; 5.78)*	0.743
aOR (95% CI) for FBD^b	5.54 (3.32; 9.26)***	2.21 (1.17; 4.16)*	8.58 (5.42; 13.56)***	0.449

aOR adjusted odds ratio C-section caesarean section, and FBD facility based delivery
Period 1 = February 1996 to May 2001; Period 2 = June 2001 to December 2004; and Period 3 = January 2005 to January 2013
*p ≤ 0.05; **p ≤ 0.01; ***p ≤ 0.001; *m marginal level of significance (0.05 < m < 0.10)
^aThe aORs for C-section access were estimated with the use of the 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 the 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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