AB082. Nutritional consequences of cesarean births: exploring the link to the double burden of malnutrition in South and Southeast Asia

Background: The rising prevalence of caesarean section (C-section) deliveries in South and Southeast Asia may be an emerging driver of the double burden of malnutrition (DBM), defined as the coexistence of maternal overweight/obesity and child undernutrition within the same household. Although concerns about this potential link are growing, empirical evidence on the association between C-section births and DBM in this region remains limited. The aim of this study is to examine the association between C-section births and DBM in selected South and Southeast Asian countries.

Methods: We used nationally representative data from the 2022 Demographic and Health Surveys of Bangladesh, Cambodia, and Nepal. The analysis included mother-child pairs involving women aged 15–49 years with at least one child, both having valid anthropometric measurements and reported delivery methods. We used Chi-squared tests and analysis of variance (ANOVA) for initial analysis and then applied a two-level logistic regression to account for household-level clustering.

Results: Our sample consisted of 4,132 pairs from Bangladesh, 3,836 from Cambodia, and 2,596 from Nepal. The results showed that C-section deliveries were associated with higher likelihood of DBM in Bangladesh [adjusted odds ratio (AOR) =2.60; 95% confidence interval (CI): 1.55, 4.37] and Nepal (AOR =1.72; 95% CI: 1.09, 2.70). This relationship was particularly evident when breastfeeding was delayed, whereas longer breastfeeding durations appeared to have a protective effect. Additionally, DBM was more prevalent in urban areas across all three countries.

Conclusions: Our study found that C-section deliveries increase the risk of DBM, especially when breastfeeding was delayed. This evidence suggests that C-sections can influence long-term nutritional outcomes for both mothers and children, potentially worsening malnutrition in South and Southeast Asian countries. Addressing this issue requires reducing unnecessary C-sections, encouraging early breastfeeding, and supporting postpartum weight management. Strengthening integrated maternal and nutrition care, particularly in urban areas, is vital to advancing global nutrition goals and promoting intergenerational health equity. Further country-specific research is needed to inform culturally appropriate, evidence-based interventions.

Keywords: Cesarean section (C-section); South and Southeast Asia; double burden of malnutrition (DBM); maternal obesity; multilevel logistic regression