Caesarean deliveries and double burden of malnutrition: a multicountry analysis in South and Southeast Asia

Abstract

Background The increasing prevalence of caesarian section (C-section) births in South and Southeast Asia poses potential public health challenges by influencing maternal and child nutrition. These changes may contribute to the growing double burden of malnutrition (DBM), where maternal overweight/obesity coexists with child undernutrition. This study explores how C-section deliveries are linked to household-level DBM in three countries in this region. Understanding this link is key for developing effective interventions to improve maternal and child nutrition and reduce health burdens. Methods We analysed 2022 Demographic and Health Survey (DHS) data from Bangladesh, Cambodia, and Nepal, including women aged 15–49 with at least one child, with available nutritional and delivery mode data. Chi-square tests, analysis of variance, and two-level logistic regression were used to assess the association between C-sections and DBM. Results C-section deliveries were linked to a significantly higher risk of DBM in Bangladesh and Nepal. Delayed breastfeeding initiation after C-section further increased this risk. Urban households showed higher DBM rates, while longer breastfeeding duration was protective. Conclusion To reduce DBM, policies should focus on limiting unnecessary C-sections, promoting early and sustained breastfeeding, and supporting maternal postpartum health—especially in urban areas where risks are higher. Understanding local factors is crucial for effective interventions.