Influences of Pregnancy Outcome, Child’s Weight Recall, and Size at Birth on Caesarean Delivery among Women in Ghana

Caesarean delivery, a surgical operation that is used to deliver a baby through an incision in the abdomen and uterus [1-3]. This procedure may be planned or performed during labour if unexpected complications such as preeclampsia, placenta previa, baby’s position, prolonged labour (if the baby is not tolerating the labour process), or issues with the umbilical cord, and history of cesarean deliveries that put the life of the mother or the baby at risk [1,4-6]. Globally, the number of women who give birth by caesarean delivery has steadily increased from 6% in 1990 to 21% in 2018 and it is estimated to reach 30% in 2030 [7]. Further, projections indicate that 38 million women will give birth by caesarean delivery in 2030, and 88% of these operations will occur in low- and middle-income countries [7]. 

In Ghana, evidence suggests that the prevalence of caesarean delivery stands at 21% [8], higher than the WHO’s recommended 15% benchmark [8,9]. The rising rates suggest that one in every five births end up in caesarean delivery [8], hence, raising notable public health concerns [10]. Of late, Ghana has enjoyed improved access to skilled maternal care [11-13]. Yet, disparities in delivery outcomes still exist [14,15]. Therefore, an understanding of the underlying factors influencing caesarean delivery remains essential. One of the emerging areas of interest is the role of perceived and recorded characteristics of the newborn-particularly birthweight and size-as well as the mother’s perception or recall of these attributes, in influencing decisions around caesarean delivery [9,16,17]. 

Child’s birthweight and perceived size at birth are often used as proxy determinants for foetal health and are recognised to influence clinical decisions regarding the mode of delivery [16,18-21]. Also, pregnancy outcomes-whether successful, complicated, or resulting in loss-may also shape the likelihood of a caesarean delivery in subsequent deliveries [22-25]. Further, out of caution, adverse pregnancy outcomes history might also prompt healthcare providers or expectant mothers to opt for caesarean delivery [26-29]. 

Regarding the increasing caesarean delivery rates and growing concerns over its appropriate use [30-32], there remains limited empirical evidence on how maternal perception of birthweight, child size at birth, and pregnancy outcomes influence the likelihood of caesarean delivery among women in Ghana [10,33]. The limited studies available failed to explore all the four variables (pregnancy outcome, child’s weight recall, size at birth, and caesarean delivery) combined. For instance, Adu-Bonsaffoh, Ntumy, Obed and Seffah [34], and Wuni, Turpin and Dassah [35], explored how previous maternal complications or delivery outcomes (e.g., stillbirth, hemorrhage) affect the likelihood of caesarean delivery. However, they did not include birthweight recall or perceived size at birth in their analysis [34,35]; Dickson, Adde and Amu [36], examined maternal-reported birth size (average, small, large) as a predictor of caesarean delivery. But, pregnancy history (e.g., previous losses or complications) was not a central focus, and actual birthweight was often missing or recalled, not measured [36]; Ampofo, Tagoe-Danso, Asare, Adade and Agyemang [37], used clinical records in Northern Ghana to look at actual birthweight and caesarean section rates, but they did not include maternal perception or recall, nor previous pregnancy outcomes in depth [37]. It is against this assertion that the study attempted to examine the extent to which pregnancy outcome, child’s weight recall, and size at birth influence caesarean delivery among women in Ghana. 

The Study is Guided by the Following Objectives: 

1. Analyse if pregnancy outcome influences caesarean delivery among women in Ghana;
2. Ascertain whether child’s birthweight recall predicts caesarean delivery among women in Ghana;
3. Examine whether child size at birth influences caesarean delivery among women in Ghana. 

The study further hypothesized that women’s caesarean delivery in Ghana is not significantly related with pregnancy outcome, child’s weight recall, and size at birth.

Data Source 

The study made used of data extracted from the 2022 GDHS which was provided by Measure DHS initiative. The data extracted revolved pregnancy outcome, child’s weight recall, size at birth, and caesarean delivery. 

Sample and Sampling Procedure 

A sample of 18,450 households were enrolled in the survey. These sample were selected from 618 clusters, which resulted in 15,014 women age 15-49 years, and 7,044 men age 15-59 years [38]. To reach the participants, the survey employed a two-stage stratified cluster sampling approach, where a probability proportional to size was employed to select 618 target clusters from the sampling frame for both urban and rural areas in each region in the first stage. Further, the targeted number of clusters needed were chosen with equal probability. Furthermore, a systematic random sampling of the clusters chosen was also carried out in the stage 1 for the urban and rural areas in each region [38]. Then, listing and map updating operation of households were also carried out in all the chosen clusters, to advance a list of all the households in the cluster. The list eventually became the sampling frame for selection of the household sample [38]. 

Measures 

In the study, pregnancy outcome, child’s birthweight recall, and child’s size at birth were the explanatory variables while caesarean delivery was the outcome variable. The variables were carefully chosen based on the assumption that studying them might help in identifying risk factors responsible for poor maternal or child health, guide health policies and interventions, and to improve healthcare delivery and equity, especially in vulnerable populations [39-43]. 

Data Collection Instruments and Fieldwork 

The 2022 DHS made used of four separate questionnaires which include (Household, Woman, Man, and the Biomarker) [38]. These questionnaires reflected the specific context of Ghana, and were adapted from The DHS Program’s model questionnaires. Fieldwork begun on 2022, October 17, and ended on 2023, January 14. In all, data collection lasted for three months. In the field, data collectors were assisted with tablet computers to collect the data [38]. 

Data Processing and Analysis 

SPSS version 27 was used to process the data. Further, three levels of analysis were conducted which include descriptive statistics, bivariate, and multivariate. The descriptive statistics analysis was performed with frequency and percentages. This analysis was used to aggregate respondents’ responses into proportions. The bivariate analysis was performed with Pearson’s chi-squared test. This analysis was also used to assess the association between the explanatory variables and the outcome variable. With the bivariate analysis, significant was set at three different levels (p=0.001, p=0.05, & p=0.10). However, the multivariate analysis was also performed with the binary logistic regression with significant level at 0.05 with 95 confidence intervals. This analysis was conducted to determine the predictors of women’s caesarean section delivery. 

Ethical Consideration                

To ensure that the survey adheres to ethical standards, ethical approval was sought from both Ghana Health Service Ethical Review Committee and the ICF Institutional Review Board [38].

Descriptive Statistics 

Whereas 4763 (83%) of women never had their birth by caesarean section, 1005 (17%) had their birth by caesarean section. On pregnancy outcome, overwhelming majority 5218 (90.5%) had their most recent live birth by caesarean section, while 550 (9.5%) had prior live birth by caesarean section. Concerning child’s birthweight recall, the dominant category was 3758 (65.2%) a written card followed by not weighed 950 (16.5%), from mother’s recall 738 (12.8%), while the least was do not know 322 (5.6%). Regarding the size of a child at birth, average scored the highest 2329 (40.4%), larger than average 1829 (31.7%), very large 818 (14.2%), smaller than average 534 (9.3%), very small 228 (4.0%), while the least was do not know 30 (0.5%). 

Table 1 presents bivariate results on recall of child’s weight at birth and women’s caesarean delivery. This analysis was performed to ascertain the association between recall of child’s weight at birth and women’s caesarean delivery. Association was observed between recall of child’s weight at birth [Χ²=175.763, p < 0.001] and women’s caesarean delivery. 

Table 1: Bivariate results on recall of child’s weight at birth and women’s caesarean delivery. 

Note: Row percentages in parenthesis, χ² significant at (0.001), (0.05), (0.10)

No: did not deliver by caesarean section; Yes: delivered by caesarean section

Source: GDHS (2022). 

Table 2 shows multivariate analysis results on recall of child’s weight at birth and women’s caesarean delivery. This analysis was done to ascertain the effect of recall of child’s weight at birth on caesarean delivery among women in Ghana. After analysis, the logistic regression model was significant at -2LogL=5110.869; Nagelkerke R² of 0.063; χ²=225.011; p < 0.001 with correct prediction rate of 82.6%. Meaningfully, the Model Summary which reveals a Nagelkerke R² of 0.063 submits that the model describes 6.3% of variance in the probability that women will deliver by caesarean section in Ghana. This significant contribution to the entire model confirmes that the entire model significantly influences women’s caesarean delivery in Ghana. 

It emerged in table 2, that information from written record was significantly related to women’s caesarean delivery at p < 0.001, (OR=6.928, 95%CI ([4.826-9.946]). This variable tag those women to have 6.9 times more likely to deliver by caesarean section compared with their counterparts who reported child was not weighed (Table 2). Further, from mother’s recall was significantly related to women’s caesarean delivery at p < 0.001, (OR=9.876, 95%CI ([6.691-14.576]). This factor identifies those women to have 9.9 times more likely to deliver by caesarean section compared with their counterparts who reported child was not weighed (Table 2). Furthermore, do not know was significantly related to women’s caesarean delivery at p < 0.001, (OR=5.652, 95%CI ([3.570-8.948]). This variable reveals those women to have 5.7 times more likely to deliver by caesarean section compared with their counterparts who reported child was not weighed (Table 2). 

Table 2: Binary logistic regression results on recall of child’s weight at birth and caesarean delivery among women in Ghana. 

Note: Source: GDHS (2022). Significant at 0.05. 

Table 3 presents bivariate analysis results on size of a child at birth and women’s caesarean section delivery. This analysis was performed to determine whether there existed an association between the size of a child at birth and women’s caesarean section delivery. Association was found between the size of a child at birth [χ²=19.376, p=0.002] and women’s caesarean section delivery. 

Table 3: Bivariate analysis results on the size of a child at birth and women’s caesarean section delivery. 

Note: Row percentages in parenthesis, χ² significant at (0.001), (0.05), (0.10)

No: did not deliver by caesarean section; Yes: delivered by caesarean section

Source: GDHS (2022). 

Table 4 presents the results of multivariate analysis on the size of a child at birth and women’s caesarean section delivery. Based on this multivariate analysis, the influence that the size of a child at birth exerts on women’s caesarean section delivery was obtained (Table 4). The results found demonstrates that the logistic regression model was significant at -2LogL=5316.681; Nagelkerke R² of 0.006; χ²= 19.199; p=0.002 with correct prediction rate of 82.6%. Meaningfully, the Model Summary which reveals a Nagelkerke R² of 0.006 recommends that the model describes 0.6% of variance in the possibility that women will deliver by caesarean section. Based on this entire model contribution, the outcome established that the whole model significantly determines women’s caesarean section delivery. 

It emerged in table 4, that larger than average was significantly related to women’s caesarean delivery at p=0.009, (OR=0.758, 95%CI ([0.616-9.0.933]). This variable tag those women to have 0.8times less likely to deliver by caesarean section compared with their counterparts who reported child was very large (Table 4). Further, average was significantly related to women’s caesarean delivery at p < 0.001, (OR=0.710, 95%CI ([0.581-0.868]). This variable classifies those women to have 0.7times less likely to deliver by caesarean section compared with their counterparts who reported child was very large (Table 4). Furthermore, smaller than average was significantly related to women’s caesarean delivery at p=0.046, (OR=0.750, 95%CI ([0.566-8.0.994]). This variable reveals those women to have 0.8times less likely to deliver by caesarean section compared with their counterparts who reported child was very large (Table 4). However, the rest of the variables (very small, and do not know) were not significant which could be as a result of chance. This suggests caesarean delivery among women in Ghana is not dependent on them (Table 4). 

Table 4: Binary logistic regression on size of child at birth and women’s caesarean delivery in Ghana. 

Note: Source: GDHS (2022). Significant at 0.05.

The current study aimed to investigate how maternal perception of birthweight, child size at birth, and pregnancy outcomes influence the likelihood of caesarean delivery among women in Ghana. The findings reveal a positive correlation between child’s birthweight recall and caesarean delivery among women in Ghana. This finding corroborated with previous studies conducted in Ghana which found that higher birthweight babies (4-6kg) were significantly associated with caesarean delivery (adjusted odds ratio ~2.13 for that weight range) [9,10]. On the contrary, the finding disagrees with a previous study conducted in Japan which found that no association existed between cesarean delivery and greater child weight or BMI [44]. This finding suggests that as the likelihood of having a caesarean delivery increases, so does the likelihood or accuracy of recalling the child’s birthweight [45-47]. The plausible explanation to this finding could probably be influenced by factors such as health facility delivery, maternal education, socioeconomic status, birthweight salience, and access to medical records [46-49]. 

The study found that child size at birth was negatively correlated with caesarean delivery. This finding agrees with a previous study which found that babies with smaller birth sizes have lower odds of being delivered via cesarean section [50,51]. On the contrary, the finding disagrees with previous studies which found that caesarean delivery operation was more common among women whose baby’s birth weight was less than 2.5kg, compared to babies of weight at least 2.5kg [10,52,54]. This finding suggests that larger infant size increases the likelihood of caesarean delivery, hence, likely due to clinical complications, while smaller infants are more often delivered vaginally, highlighting fetal size as a key determinant in delivery method decisions [55-59]. 

The study did not find relationship between pregnancy outcome and caesarean delivery among women in Ghana. Therefore, null hypothesis was accepted. This finding suggests that women’s caesarean delivery in Ghana is not dependent on pregnancy outcome. However, the study found that relationship exists between child’s birthweight recall and caesarean delivery among women in Ghana. Therefore, the null hypothesis was not confirmed. A p-value of < 0.001 found is an indication that both the explanatory and the outcome variables are not independence of each other and that they are interdependence. Further, the relationship revealed that child’s birthweight recall is a stronger predictor of caesarean delivery among women in Ghana. This finding corroborated with previous studies conducted in Taiwan and Canada which found that maternal recall of birthweight is highly accurate and strongly associated with caesarean delivery, supporting the finding that the two variables are interdependent and that birthweight recall can be a strong predictor of caesarean delivery [60,61]. 

The study found that relationship exists between size of child at birth and caesarean delivery among women in Ghana due to this, the null hypothesis was ignored. A p value of =0.002 found indicates that child’s size at birth is a determinant of caesarean delivery among women in Ghana. This finding is consistent with previous studies conducted in Ghana which also found that larger infant size at birth is associated with significantly higher odds of caesarean delivery, while smaller infants correspond to lower odds [9,10,33]. 

The study found that overwhelming majority of the women sampled had their most recent live birth by caesarean section. The finding is in line with previous studies which also found that overwhelming majority of women who had caesarean sections were performed [62-66]. On the contrary, the finding contradicted a previous study conducted in Nepal which found only 17.03% caesarean delivery rate [67]. This finding suggests that there is a high rate of cesarean deliveries in Ghana [10]. The plausible explanation to this finding could probably be that these women have an increased access to healthcare, socioeconomic and demographic trends, and regional disparities in healthcare access and quality. Further, it could be due to individual factors like advanced maternal age, higher education, and formal employment [10]. The few that had their prior live birth by caesarean delivery reason could be complications during labor which made vaginal delivery risky [10]. 

 The research found 65.2% of women reporting child’s birth size from a written card, 16.5% had children being not weighed, 12.8% from mother’s recall, and 5.6% did not know. Concerning the size of child at birth, 40.4% of the women indicated average size while 0.5% of them did not know. The study also found that majority (83%) of the women sampled never had caesarean delivery while 7% had. These findings reflect moderate institutional delivery coverage and record-keeping, hence, improving the reliability of reported birth data [69]. However, equity issues remain uneven, particularly, regarding birthweight tracking and caesarean section access [48]. Most mothers were able to recall or reference birthweight, and a growing proportion are delivering via caesarean section-likely shaped by a mix of socioeconomic factors, health system access, and clinical need [68,70]. The findings infer that while most women in the study had access to written records for reporting their child’s birthweight and could assess the size of their newborns, there are still gaps in birthweight documentation and knowledge among a minority [71-75]. Further, the caesarean section rate of 17% indicates increasing access to surgical delivery, suggesting improvements in maternal healthcare services in Ghana [66,76]. However, this also highlights potential disparities in access and utilization, as well as the need for continued investment in record-keeping, maternal education, and equitable obstetric care [11]. Furthermore, the high percentage of women reporting birthweight from written cards (65.2%) reflects increased facility-based deliveries where birth details are recorded by health professionals [20,71]. Moreover, the 17% caesarean delivery rate may be due to factors such as urbanization, older maternal age, higher parity, and increased healthcare-seeking behaviors, which are linked to both elective and emergency caesareans [10,11,68,77-79]. Additionally, regional differences in the availability of obstetric services may explain why some women still rely on recall (12.8%) or report that the child was not weighed (16.5%), indicating gaps in health facility access or postnatal care [71,77,80]. Also, women who delivered outside of formal healthcare settings or who faced barriers such as cost, distance, or traditional beliefs may be less likely to have babies weighed or recorded, contributing to the “don’t know” (5.6%) and “not weighed” categories [68,81,82].

In essence, these findings suggest that both documented and perceived indicators of birthweight and size are significantly associated with the likelihood of caesarean section delivery among women in Ghana. Therefore, the study recommends that healthcare systems could be strengthened to ensure that all newborns are weighed at birth and recorded using standardized health cards. Hence, it might reduce reliance on maternal recall and the “do not know” category, which was significantly associated with higher caesarean section rates. Further, healthcare providers should endeavor to educate women during antenatal visits about the need of knowing and retaining information on their child’s birthweight and size. One weakness of the study is that the DHS relied on self-reported information therefore, the possibility of recall bias is high and this can affect the results of the study. So, the findings should be interpreted with caution. Further, the DHS was conducted cross-sectionally and since it is not a census, generalizability is not possible.

Abbreviations 

DHS: Demographic and Health Survey

GDHS: Ghana Demographic and Health Survey

ICF: International Coaching Federation

IVs: Independent Variables

SPSS: Statistical Package for the Social Sciences

US: United States 

Ethics Approval and Consent to Participate 

The GDHS Program obtained ethical approval from both The Ghana Health Service’s Ethics Review Committee and The ICF The Institutional Review Board for ethical review. This dual approval process assure that the survey adheres to ethical guidelines and protects the rights of participants. 

Consent for publication 

Not applicable. 

Availability of Data and Materials 

The study made used of the 2022 GDHS data. Therefore, it is publicly available online at https://dhsprogram.com/data. This is Measure DHS Initiative or Program. 

Competing Interests 

Authors did not register any conflict of interest. 

Funding 

The study received no fund. 

Author’s Contribution 

Rita Tekpertey: Conceptualise the study, Methodology, Formal analysis, Data curation, and Writing - original draft.

Anthony Edward Boakye: Software, Formal analysis, Writing – original draft, Writing - review & editing.

We acknowledge measure DHS program for making the datasets available to us on 20^th August, 2023.

1. Kamani E (2022) Cesarean section: A brief overview. J Labo Child 5: 108-112.
2. Mitchell B, Vaughn S, Veluri S (2024) The history of the cesarean section. Academic Medicine & Surgery.
3. Sung S, Mikes BA, Martingano DJ, Mahdy H (2025) Cesarean Delivery. StatPearls Publishing, Florida, USA.
4. Gülmezoglu AM, Lawrie TA, Hezelgrave N, Oladapo OT, Souza JP, et al. (2016) Interventions to Reduce Maternal and Newborn Morbidity and Mortality. In: Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). The International Bank for Reconstruction and Development / The World Bank, Washington DC, USA.
5. Anderson-Bagga FM, Sze A (2025) Placenta Previa. StatPearls Publishing, Florida, USA.
6. UNICEF, WHO Africa, SAGO, UNFPA (2022) Recommendations for Clinical Practice of Emergency Obstetrical and Neonatal Care in Africa. WHO Regional Office for Africa, Brazzaville, Africa.
7. World Health Organization (2025) WHO publishes surgical sub-group membership for caesarean section recommendations. World Health Organization, Geneva, Switzerland.
8. Citinewsroom (2024) Ghana Health Service raises alarm over prevalence of C-section during child birth. Comprehensive News in Ghana, Ghana.
9. Apanga PA, Awoonor-Williams JK (2018) Predictors of caesarean section in Northern Ghana: A case-control study. Pan African Medical Journal. 29: 20.
10. Tilahun WM, Simegn MB, Abate A, Golla EB, Ali MA, et al. (2025) Caesarean section delivery and its associated factors in Ghana: A multilevel analysis. PLoS ONE 20: 0318223.
11. Ganle JK, Parker M, Fitzpatrick R, Otupiri E (2014) Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: A descriptive study. Int J Equity Health 13: 89.
12. Dalinjong PA, Wang AY, Homer CSE (2017) The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana. Health Econ Rev 7: 41.
13. Adawudu EA, Aidam K, Oduro E, Miezah D, Vorderstrasse A (2024) The effects of Ghana’s free maternal and healthcare policy on maternal and infant healthcare: A scoping review. Health Services Insights 17: 11786329241274481.
14. Aheto JMK, Gates T, Tetteh I, Babah R (2024) A multilevel analysis of the predictors of health facility delivery in Ghana: Evidence from the 2014 demographic and health survey. PLOS Glob Public Health 4: 0001254.
15. Okyere J, Duah HO, Seidu AA, Ahinkorah BO, Budu E (2022) Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014. BMC Pregnancy Childbirth 22: 64.
16. Khan JR, Bakar KS, Awan N, Muurlink O, Homaira N (2024) Accuracy of Mothers’ Perception of Birth Size to Predict Birth Weight Data in Bangladesh. Matern Child Health J 28: 1677-1684.
17. Gandau, BBN, Nuertey BD, Seneadza NAH, Akaateba D, Azusong E, et al. (2019) Maternal perceptions about caesarean section deliveries and their role in reducing perinatal and neonatal mortality in the Upper West Region of Ghana; a cross-sectional study. BMC Pregnancy Childbirth 19: 350.
18. Nigatu D, Haile D, Gebremichael BM, Tiruneh Y (2019) Predictive accuracy of perceived baby birth size for birth weight: A cross-sectional study from the 2016 Ethiopian Demographic and Health Survey. BMJ Open 9: 031986.
19. Agyekum MW, Codjoe SNA, Dake FAA, Abu M (2022) Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana? PLoS One 17: 0267179.
20. Acharya P, Adhikari S, Adhikari TB (2023) Mother's perception of size at birth is a weak predictor of low birth weight: Evidence from Nepal Demographic and Health Survey. PLoS One 18: 0280788.
21. Lipschuetz M, Cohen SM, Ein-Mor E, Sapir H, Hochner-Celnikier D, et al. (2015) A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol 213: 833e1-833e12.
22. O'Neill SM, Kearney PM, Kenny LC, Khashan AS, Henriksen TB, et al. (2013) Caesarean delivery and subsequent stillbirth or miscarriage: Systematic review and meta-analysis. PLoS One 8: 54588.
23. Ali N, Elbarazi I, Ghazal-Aswad S, Al-Maskari F, Al-Rifai RH, et al. (2020) Impact of Recurrent Miscarriage on Maternal Outcomes in Subsequent Pregnancy: The Mutaba’ah Study. International Journal of Women’s Health 12: 1171-1179.
24. Daltveit AK, Tollånes MC, Pihlstrøm H, Irgens LM (2008) Cesarean delivery and subsequent pregnancies. Obstet Gynecol 111: 1327-1334.
25. Iyoke CA, Ugwu GO, Ezugwu FO, Lawani OL, Onah HE (2014) Risks associated with subsequent pregnancy after one caesarean section: A prospective cohort study in a Nigerian obstetric population. Niger J Clin Pract 17: 442-448.
26. Kietpeerakool C, Lumbiganon P, Laopaiboon M, Rattanakanokchai S, Vogel JP, et al. (2019) Pregnancy outcomes of women with previous caesarean sections: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health. Sci Rep 9: 9748.
27. Xie RH, Zeng S, Zhou L, Wen S, Liao Y, et al. (2021) Comparison of adverse maternal and neonatal outcomes in women affected by placenta previa with and without a history of cesarean delivery: A cohort study. J Obstet Gynaecol Can 43: 1076-1082.
28. Taye H, Kabthymer RH, Hailu S, Meshesha MD, Kanno GG, et al. (2022) Previous adverse pregnancy events as a predictor of gestational diabetes mellitus in Southern Ethiopia: A case control study. Curr Med Res Opin 38: 1259-1266.
29. Adu-Bonsaffoh K, Seffah J (2022) Factors associated with adverse obstetric events following induction of labour: A retrospective study in a tertiary hospital in Ghana. Afr Health Sci 22: 348-356.
30. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, et al. (2016) The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One 11: 0148343.
31. Dhakal-Rai S, Teijlingen E, Regmi PR, Wood J, Dangal G, et al. (2022) Factors contributing to rising cesarean section rates in South Asian countries: A systematic review. Asian Journal of Medical Sciences 13: 143-174.
32. Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B (2013) Increasing caesarean section rates among low-risk groups: A panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth 13: 107.
33. Niyi JL, Li Z, Zumah F (2024) Association between Gestational Weight Gain and Maternal and Birth Outcomes in Northern Ghana. Biomed Res Int 2024: 5526942.
34. Adu-Bonsaffoh K, Ntumy MY, Obed SA, Seffah JD (2017) Perinatal outcomes of hypertensive disorders in pregnancy at a tertiary hospital in Ghana. BMC Pregnancy Childbirth 17: 388.
35. Wuni C, Turpin CA, Dassah ET (2018) Determinants of contraceptive use and future contraceptive intentions of women attending child welfare clinics in urban Ghana. BMC Pregnancy and Childbirth 19: 79.
36. Dickson KS, Adde KS, Amu H (2021) What influences caesarean section deliveries in Ghana? Evidence from the 2014 Ghana Demographic and Health Survey. PLoS ONE 16: 0250206.
37. Ampofo G, Tagoe-Danso E, Asare S, Adade TB, Agyemang R (2022) Determinants of caesarean delivery in Northern Ghana: A case-control study. The Pan African Medical Journal 41: 63.
38. Brizan JB, Amabebe E (2022) Maternal Obesity as a Risk Factor for Caesarean Delivery in Sub-Saharan Africa: A Systematic Review. Life 12: 906.
39. Mengesha MB, Adhanu HH, Weldegeorges DA, Assefa NE, Werid WM, et al. (2017) Maternal and fetal outcomes of cesarean delivery and factors associated with its unfavorable management outcomes; in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. BMC Res Notes 12: 650.
40. Papadopoulou SK, Mentzelou M, Pavlidou E, Vasios GK, Spanoudaki M, et al. (2023) Caesarean Section Delivery Is Associated with Childhood Overweight and Obesity, Low Childbirth Weight and Postnatal Complications: A Cross-Sectional Study. Medicina (Kaunas) 59: 664.
41. Khashan AS, Kenny LC (2009) The effects of maternal body mass index on pregnancy outcome. Eur J Epidemiol 24: 697-705.
42. Sulley I, Saaka M (2022) Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6-23 months in the Tamale Metropolis of Ghana. J Nutr Sci 11: 43.
43. Ghana Statistical Service (2023) Ghana Demographic and Health Survey 2022: Key Indicators Report. Accra, Ghana, and Rockville, Maryland, USA.
44. Miyayama C, Morisaki N, Ogawa K, Tanaka H, Shoji H, et al. (2023) Evaluating the association between caesarean delivery and weight status in early childhood in a Japanese birth cohort study. Sci Rep 13: 19612.
45. Sou SC, Chen WJ, Hsieh WS, Jeng SF (2006) Severe obstetric complications and birth characteristics in preterm or term delivery were accurately recalled by mothers. J Clin Epidemiol 59: 429-435.
46. Shenkin SD, Zhang MG, Der G, Mathur S, Mina TH, et al. (2017) Validity of recalled v. recorded birth weight: A systematic review and meta-analysis. Journal of Developmental Origins of Health and Disease 8: 137-148.
47. Swenne A, Veidebaum T, Tornaritis M, Russo MD, Moreno LA, et al. (2024) Reliability of Parental Recall of Birth Weight, Birth Length and Gestational Age in the Multicenter Cohort Study IDEFICS. Matern Child Health J 28: 2071-2085.
48. Tate AR, Dezateux C, Cole TJ, Davidson L (2005) Factors affecting a mother's recall of her baby's birth weight. Int J Epidemiol 34: 688-695.
49. Swaminathan A, Thomas T, Corsi DJ, Dwarkanath P, Subramanian SV, et al. (2019) Validity of Maternal Report of Birthweight in a Cohort Study and Its Implication on Low Birthweight Rate Using Simulations. Indian Pediatr 56: 923-928.
50. Temerinac D, Chen XI, Sütterlin M, Kehl S (2015) Influence of Fetal Birth Weight on Caesarean Section Rate and Fetal Outcome After Induction of Labor. In Vivo 29: 519-524.
51. Akinola OI, Fabamwo AO, Tayo AO, Rabiu KA, Oshod YA, et al. (2014) Caesarean section-an appraisal of some predictive factors in Lagos Nigeria. BMC Pregnancy Childbirth 14: 217.
52. Saaka M, Hammond AY (2020) Caesarean Section Delivery and Risk of Poor Childhood Growth. J Nutr Metab 2020: 6432754.
53. Boateng E, Bosson-Amedenu S, Nortey E, Abaye D (2019) Non-Medical Determinants of Caesarean Deliveries in Ghana: A Logistic Regression Approach. Open Journal of Applied Sciences 9: 492-505.
54. Blustein J, Attina T, Liu M, Ryan AM, Cox LM, et al. (2013) Association of caesarean delivery with child adiposity from age 6 weeks to 15 years. Int J Obes (Lond) 37: 900-906.
55. Beta J, Khan N, Fiolna M, Khalil A, Ramadan G, et al. (2019) Maternal and neonatal complications of fetal macrosomia: Cohort study. Ultrasound Obstet Gynecol 54: 319-325.
56. Oral E, Cagdas A, Gezer A, Kaleli S, Aydinli K, et al. (2001) Perinatal and maternal outcomes of fetal macrosomia. Eur J Obstet Gynecol Reprod Biol 99: 167-171.
57. Mathew M, Machado L, Al-Ghabshi R, Al-Haddabi R (2005) Fetal macrosomia. Risk factor and outcome. Saudi Med J 26: 96-100.
58. Said AS, Manji KP (2016) Risk factors and outcomes of fetal macrosomia in a tertiary centre in Tanzania: A case-control study. BMC Pregnancy Childbirth 16: 243.
59. Jolly MC, Sebire NJ, Harris JP, Regan L, Robinson S (2003) Risk factors for macrosomia and its clinical consequences: A study of 350,311 pregnancies. Eur J Obstet Gynecol Reprod Biol 111: 9-14.
60. Bat-Erdene U, Metcalfe A, McDonald SW, Tough SC (2013) Validation of Canadian mothers' recall of events in labour and delivery with electronic health records. BMC Pregnancy Childbirth 13: 3.
61. Githens PB, Glass CA, Sloan FA, Entman SS (1993) Maternal recall and medical records: An examination of events during pregnancy, childbirth, and early infancy. Birth 20: 136-141.
62. Ashipala DO, Kandjaba V (2023) Factors associated with caesarean sections among pregnant women admitted to a private academic hospital in Ongwediva, Oshana region, Namibia. J Public Health Afr 14: 2402.
63. Gyaase D, Enuameh YA, Adjei BN, Gyaase S, Kweku E, et al. (2023) Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana. BMC Pregnancy Childbirth 23: 286.
64. Prah J, Kudom A, Afrifa A, Abdulai M, Sirikyi I, et al. (2017) Caesarean section in a primary health facility in Ghana: Clinical indications and feto-maternal outcomes. J Public Health Afr 8: 704.
65. Miovech SM, Knapp H, Borucki L, Roncoli M, Arnold L, et al. (1994) Major concerns of women after cesarean delivery. J Obstet Gynecol Neonatal Nurs 23: 53-59.
66. Manyeh AK, Ofosu A, Kuug AK, Ayi A, Tetteh CD, et al. (2024) Assessing five-year trend and socio-demographic determinants of caesarean section delivery in Ghana. BMC Pregnancy Childbirth 24: 882.
67. Pandit S, Thasineku OC, Karki S, Sharma S (2025) Prevalence and associated factors of caesarean section delivery: Analysis from the Nepal Demographic and Health Survey 2022. BMJ Open 15: 090209.
68. Dankwah E, Kirychuk S, Zeng W, Feng C, Farag M (2019) Socioeconomic inequalities in the use of caesarean section delivery in Ghana: A cross-sectional study using nationally representative data. Int J Equity Health 18: 162.
69. Swenne A, Veidebaum T, Tornaritis M, Russo MD, Moreno LA, et al. (2024) Reliability of Parental Recall of Birth Weight, Birth Length and Gestational Age in the Multicenter Cohort Study IDEFICS. Matern Child Health J 28: 2071-2085.
70. Rauf AA (2022) Prevalence and socioeconomic predictive factors of cesarean section delivery in Ghana. Menoufia Medical Journal 35: 29.
71. Biks GA, Blencowe H, Hardy VP, Geremew BM, Angaw DA, et al. (2021) Birthweight data completeness and quality in population-based surveys: EN-INDEPTH study. Popul Health Metr 19: 17.
72. Chang KT, Mullany LC, Khatry SK, LeClerq SC, Munos MK, et al. (2018) Validation of maternal reports for low birthweight and preterm birth indicators in rural Nepal. J Glob Health 8: 010604.
73. Unisa S, Dhillon P, Anand E, Sahoo H, Agarwal PK (2022) Data quality of birthweight reporting in India: Evidence from cross-sectional surveys and service statistics. SSM Popul Health 19: 101220.
74. Lule SA, Webb EL, Ndibazza J, Nampijja M, Muhangi L, et al. (2012) Maternal recall of birthweight and birth size in Entebbe, Uganda. Trop Med Int Health 17: 1465-1469.
75. Channon AAR, Padmadas SS, McDonald JW (2011) Measuring Birth Weight in Developing Countries: Does the Method of Reporting in Retrospective Surveys Matter?. Matern Child Health J 15: 12-18.
76. Afakorzi SH, Mba OG, Manortey S (2025) Prevalence and determinants of caesarean delivery in Ghana: A systematic review. Frontline Professionals Journal 2: 50-67.
77. Manyeh AK, Amu A, Akpakli DE, Williams J, Gyapong M (2018) Socioeconomic and demographic factors associated with caesarean section delivery in Southern Ghana: Evidence from INDEPTH Network member site. BMC Pregnancy Childbirth 18: 405.
78. Banchani E, Tenkorang EY (2022) Risk factors for Caesarean sections in Ghana: Evidence from the Ghana Maternal Health Survey. J Biosoc Sci 54: 21-38.
79. Okyere J, Duah HO, Seidu AA, Ahinkorah BO, Budu E (2022) Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014. BMC Pregnancy Childbirth 22: 64.
80. Gething PW, Johnson FA, Frempong-Ainguah F, Nyarko P, Baschieri A, et al. (2012) Geographical access to care at birth in Ghana: A barrier to safe motherhood. BMC Public Health 12: 991.
81. Ayanore MA, Pavlova M, Groot W (2016) Focused maternity care in Ghana: Results of a cluster analysis. BMC Health Serv Res 16: 395.
82. Budu, E (2020) Predictors of home births among rural women in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey. BMC Pregnancy Childbirth 20: 523.