Materials and Methods
Data Source
The data for this study comes from the seventh round of the IDHS
conducted in 2012 by Statistics Indonesia (Badan Pusat Statistik– BPS) in collaboration with the National Population and Family
Planning Board (BKKBN) and the Indonesia Ministry of Health (MoH). The
2012 IDHS covered a nationally representative sample from households
sampled using a multistage stratified cluster sampling design
(Statistics Indonesia, BKKBN, MOH, & ICF
International, 2013). Although previous studies have demonstrated the
limitations of CS delivery data from DHS
(Holtz & Stanton, 2007;
Stanton, Dubourg, De Brouwere, Pujades, &
Ronsmans, 2005), this is one of the most reliable sources of
information of nationally representative CS rate in Indonesia.
Ethics Statement
This study is a further analysis of a publicly available de-identified
secondary data. We download the dataset from the DHS program website
<www.dhsprogram.com/Data> after obtaining
permission. Hence, we deem that a further ethical review is unnecessary.
Study Population and Sample
Size
We used a sample of 18,021 births that occurred during the five years
preceding the survey. Following Khawaja et al. (2004), we restrict the
analysis to the most recent births during the five years preceding the
survey to reduce recall bias. The initial sample size is 15,262 births
(Statistics Indonesia et al., 2013).
Births with missing information on the dependent and independent
variables were excluded from the analysis (n = 383). As such, the final
analytic sample included 14,879 most recent births (97.49% of the
initial sample).
Variables
The outcome variable, CS delivery, is measured by a binary variable that
takes the value of one if the delivery method for the latest pregnancy
was a caesarean section, and zero otherwise. The independent variables
in this study consist of socio-demographic and spatial characteristics.
As socio-demographic characteristics, maternal age, parity, any
complications during pregnancy, number of prenatal care (PNC) visits,
delivery took place in a private health facility, mother’s and father’s
years of formal schooling (in years), ownership of health insurance, and
quintiles of wealth index have been included in the analysis. We use the
provided wealth index that was created through three steps
(Statistics Indonesia et al., 2013).
Moreover, we also use two spatial characteristics, namely region (Java,
Sumatera, Bali and Nusa Tenggara, Kalimantan, Sulawesi, and Maluku and
Papua) and place of residence (urban/rural).
Statistical Analysis
We estimate bivariate and multivariate logit regressions, presenting
average marginal effects (AMEs) and 95 % confidence intervals. All
regressions were based on weighted data using sampling weights and
sampling design of the 2012 IDHS. All hypotheses are tested using
two-tailed p values <0.05. As for the descriptive
analysis, we calculate and present descriptive statistics as percentages
or means in Table 1. We conducted all of the analyses using Intercooled
STATA version 13.1 (StataCorp LP, College Station, Texas).