Peer-reviewed article

Impact of Elective Caesarean Delivery on Double Burden of Malnutrition and Its Contribution to Wealth-Based Inequality: A Decomposition Analysis Across South Asian Countries.

Mahazabin M, Islam KN, Sarder MA · 9 Apr 2026

Abstract

Background The double burden of malnutrition at household level (DBMHL), which denotes the coexistence of undernutrition and overweight or obesity within the same household, underscores the complex and multifaceted nature of malnutrition. DBMHL is a critical issue in South Asia (SA) and mostly influenced by dietary transitions and healthcare access disparities as well as intricately linked to socioeconomic inequality. The primary aim of this research is to determine the impact and contribution of elective C-section to the wealth-based inequality in DBMHL. Methods Participants (208,822) were taken from the most recent Demographic and Health Survey (DHS) datasets for the analysis. We applied bivariate statistics, binary logistic regression, concentration curve, concentration index (CIX), and decomposition analysis to determine the factors and socioeconomic inequalities related to DBMHL in the selected SA countries. Results The overall prevalence of DBMHL was 7.80% in the selected SA countries, and the extent of disparity exists much among affluent groups (CIX: 0.217; p < 0.001). The decomposition analysis revealed that elective C-section delivery contributed 10.91% to the pro-rich socioeconomic inequality in DBMHL. Mothers who opted for elective caesarean sections (CSs) (adjusted odds ratios [AOR]: 1.77; 95% CI: 1.63-1.91) were more likely to report DBMHL than mothers who opted for normal vaginal delivery. Conclusion Our findings suggest elective cesarean section is an important contributor to wealth-related inequality in DBMHL, strengthening clinical governance and counseling around nonmedically indicated elective CS may help to improve maternal and child health outcomes in SA. Public health practitioners and policymakers should promote awareness among women of reproductive age through mass media regarding healthy weight management before pregnancy and the potential implications of elective CS for the overall well-being of mother-child dyads.