Abstract

Pregnancy related factors play an important role in mothers' health condition, specially in the later stage of their reproductive period. One of such factors, cesarean section (CS) delivery, a life-saving procedure for the mother and newborn, could affect mothers' later-life health as it involves a major surgical procedure.
It was reported in many studies conducted with Bangladeshi survey data that over the last 15 years, the rate of cesarean section (CS) delivery is increasing with that of the institutional delivery. The prevalence of CS delivery is found to be significantly higher in Bangladesh than the comparable standard rate suggested by the World Health Organization. The alarming high rate of CS is an important public health concern for Bangladesh as it affects not only the women's later-life health condition, but also contributes significantly to the country’s total health expenditure. A number of studies are found in the literature on identifying important factors associated with CS and also the consequences of CS on maternal health and household expenditure. Among the factors that could be affected by CS delivery, women BMI is considered in this study as the prevalence of obesity is also increasing among Bangladeshi women of older reproductive age groups. The main objective of this study is to estimate the causal effect of CS delivery on body mass index (BMI) for Bangladeshi women from a nationally representative survey data obtained from open sources (e.g. demographic health surveys, multiple indicator cluster surveys, etc.).

Estimating causal effect from an observational study requires adjusting associated confounders, and different propensity score and IP weighting based methods are used for estimating the causal effect of CS on BMI. Women and their husband's education level, wealth index, number of ante-natal care visits during pregnancy, total number of ever-born children, and place of residence are considered as covariates for the treatment model. The analysis shows a significant causal effect of cesarean section on BMI, more specifically the odds of being obese is found to be about 13 percent higher among women who had cesarean section compared to others.