Beyond the scar: a qualitative study on the physical, psychosocial and economic impacts of caesarean section in Keonjhar District of Odisha

Abstract

Background

According to the World Health Organization, cesarean section rates are rising globally, with 21% of deliveries and an expected increase to 29% by 2030. While lifesaving, CS often brings physical, psychological, and financial challenges, especially in rural and tribal areas with limited healthcare access. This study examines these impacts in Keonjhar, Odisha, focusing on recovery, psychosocial well-being, and economic burden.

Methods

This qualitative study explored women’s experiences after cesarean delivery in Keonjhar, Odisha. Thirty-five women, within two weeks post-CS, were purposively selected. Data were collected through face-to-face semi-structured interviews conducted at their homes during November to December 2024. Interviews covered physical, psychosocial, and economic aspects. Data were audio-recorded, transcribed, and analyzed using thematic content analysis with MaxQDA. Ethical approval and informed consent were obtained.

Results

The findings identified three key dimensions of post-CS experiences: physical, psychosocial, and economic. Women reported prolonged recovery, pain, limited mobility, and inadequate care. Many experienced emotional distress, stigma, bonding difficulties, and signs of postpartum depression. Financially, CS led to high out-of-pocket expenses and debt, especially in private care. These challenges were further shaped by rural conditions, limited access to services, and socio-cultural factors.

Conclusions

Cesarean deliveries in Keonjhar pose significant physical, emotional, and economic challenges for women. The findings stress the need to strengthen postpartum care, include mental health support, and improve financial protection. Context-specific efforts such as community awareness, better follow-up care, and culturally sensitive services are important to improve maternal outcomes after CS.

Background

The birth of a child is a pivotal moment in a woman’s life, profoundly shaping her physical and emotional well-being [1]. A positive delivery experience fosters feelings of empowerment, self-worth, and confidence, while a negative one can led to maternal distress, postpartum depression, or even post-traumatic stress disorder (PTSD) [2]. Cesarean section (CS) deliveries, increasingly prevalent worldwide, including in rural and semi-urban areas like Keonjhar, Odisha, are lifesaving in critical cases but carry significant physical, psychosocial, and economic consequences. Qualitative research is essential to understand these impacts and inform better maternal healthcare policies. Physically, CSs often involve extended recovery times, post-operative complications, and long-term health risks [3]. Psychosocially, they can affect a mother’s emotional health, self-esteem, and bonding with her newborn [4]. Economically, the costs of medical care, lost income, and financial strain on families are often substantial yet overlooked [5].

Globally, the rise in CS rates sparks concern. While essential for severe complications, CSs have prevented an estimated 287,000 maternal deaths and 2.9 million neonatal deaths annually by addressing obstetric issues. However, the World Health Organization (WHO) suggests an optimal CS rate of 5–15%, with no additional benefits to maternal or neonatal mortality beyond 15%, though some studies extend this to 19% [6]. In 2016, about 19% of global deliveries were via CS, often without medical necessity, particularly in low- and middle-income countries’ urban areas [7]. The concept of “Too Much, Too Soon” (TMTS), introduced by Miller et al. in The Lancet Global Health, critiques the over-medicalization of childbirth through unnecessary interventions [8]. With rising facility-based births, TMTS contributes to excessive procedures, higher healthcare costs, and, in some cases, disrespect or abuse during labor. Addressing these trends is critical to improving maternal care and outcomes.

In India, CS deliveries have become increasingly common. According to the National Family Health Survey (NFHS-5), The rate of CS deliveries increased from 17% in 2015-16 to 22% in 2019-21. CSs are particularly common in private sector health facilities (48% of deliveries). Notably, most CS deliveries in India take place in private healthcare facilities. Studies conducted in India and globally have identified several factors correlated with CS deliveries, including maternal age at first childbirth, parity, multiple pregnancies, maternal weight gain, and birth weight [9]. However, there is a lack of research exploring the birth experience of CSs in India. Given the rapid rise of CS deliveries, understanding an in-depth analysis on women’s health such as Physical, Psychosocial and Economic Impacts of CS is crucial in Keonjhar district, Odisha to better understand the CS post-delivery recovery and provide more targeted support to women and their family. Figure 1 shows Despite the increase in CS deliveries in regions like Keonjhar—from 12.1% to 15.3% overall, along with a twofold rise in deliveries at private health facilities—there remains a lack of qualitative research exploring women’s lived experiences and perceptions of these issues. This study aims to bridge that gap by exploring the experiences of mothers who have undergone CS deliveries. Through in-depth narratives, the research will provide insights into the complex impact of CSs, offering valuable perspectives for healthcare professionals, policymakers, and maternal health advocates.

Fig. 1.

Caesarean section delivery in Keonjhar, 2015–2021

Methods

Study design

This study adopted a qualitative research design to explore women’s experiences following CS delivery. Qualitative methods were considered appropriate for capturing women’s perceptions, emotions, and lived experiences related to the physical, psychosocial, and economic effects of CS.

Study setting and participants

The study was conducted in Keonjhar district of Odisha, India, between November and December 2024. The choice of the best time to collect the women’s testimony was based on results and recommendations from previous studies [10, 11]. Women who had delivered through CS within the previous two weeks. Information on CS deliveries was obtained from both public and private health facilities in the district. Women who met the inclusion criteria were traced and invited to participate in the study.

A total of 35 women participated in the study. The sample size was determined based on data saturation, when no new themes emerged from additional interviews.

Procedure

After reading the information sheet and providing written informed consent, participants underwent interviews conducted at their homes (35 interviews in total). Standardized, face-to-face, semi-structured interviews were used, with open-ended questions designed to elicit women’s perspectives on the importance and consequences of the mode of delivery, as well as their views on the physical, psychosocial, and economic impacts of CS. An interview guide was developed to structure the discussions around general topics related to the delivery experience.

Analyses

The interviews were audio-recorded and subsequently transcribed. To organize and analyze the qualitative data, we utilized “MaxQDA 07” software (Maxqda 2007, http://www.maxqda.com). A thematic content analysis was then conducted on the transcribed interviews by reviewing exiasting literature [12]. The qualitative analysis began with individual readings of the transcripts and continued throughout data collection and coding, following the constant comparative method. This approach involved analyzing each interview by continuously comparing new responses with previously reported ones [13]. This analysis was then used to develop analytical categories, which served as the foundation for the final coding grid applied by the researchers to analyze the transcripts, aiming to enhance theoretical sensitivity and ensure analytical rigour [14]. Research methods to ensure credibility, confirmability, and transferability were adapted from methodologies employed in previous comparable studies [15]. In line with the stated objectives, the analyses centered on identifying key elements of the delivery experience, as well as noting similarities and differences across studies. Emerging data were cross-verified with existing theories and compared with findings from previous research to assess their level of conformity. Additionally, background information was provided to contextualize the study and facilitate comparisons.

Ethical considerations

This study upheld ethical integrity throughout its execution. Ethical clearance was obtained from the Departmental Ethics Committee of the institute prior to commencing the research. In addition, informed consent was secured from all eligible participants after clearly explaining the purpose and relevance of the study. The anonymity and confidentiality of participants were strictly maintained at all stages of the research.

Table 1 categorizes the birth experiences of women who underwent CS into three main themes: physical health impacts, psychosocial effects, and economic implications. Physically, women reported challenges in recovery, ongoing health issues, and inadequate postpartum care. Psychosocially, many experienced emotional distress, societal judgment, difficulties in bonding with their newborns, and symptoms of post-partum depression. Economically, caesarean births led to high direct costs, unexpected hidden expenses, and broader financial strain on families. These themes reflect the complex and multifaceted impact of CS on women’s lives beyond the clinical setting (Fig. 2).

Table 1.

Main categories and themes of birth experiences of caesarean section birth

Category	Themes
i. Physical Health Impacts	Recovery Challenges
	Health Difficulties
	Postpartum Care
ii. Psychosocial Effects	Emotional Well-being
	Social Perceptions
	Maternal Bonding
	Post-Partum Depression
iii. Economic Implications	Economic Burden of CS
	Direct and In-direct expenditure
	Out-of-Pocket Expenditure (OOPE)

Fig. 2.

Conceptual framework of impact of caesarean section birth on women

Results

The analysis of the interviews revealed three major dimensions of women’s experiences after CS: physical health effects, psychosocial effects, and economic implications. These themes emerged consistently across participants’ narratives and reflect the multiple challenges faced by women during the postpartum period. Table 2 presents the socio-demographic profile of the respondents. The majority were aged between 25 and 30 years (42.9%), followed by those in the 31–35 age group (22.9%). Most women had at least secondary education, with 31.4% having completed secondary level and 28.6% higher secondary or above, while 17.1% had no formal education. A significant proportion (74.3%) resided in rural areas. Over half (57.1%) were married between the ages of 18–21, and 25.7% were married before 18. In terms of occupation, 54.3% were homemakers, and the rest were engaged in wage labor, self-employment, or service sectors. Regarding family size, 40% had one child, 37.1% had two, and 22.9% had three or more children. These characteristics provide a foundational understanding of the participants’ backgrounds in the study.

Table 2.

Background characteristics of respondents

Variable	Category	Frequency (n)	Percentage (%)
Age (in years)	18–24	7	20
	25–30	15	42.9
	31–35	8	22.9
	36 and above	5	14.2
Education	No formal education	6	17.1
	Primary	8	22.9
	Secondary	11	31.4
	Higher Secondary & above	10	28.6
Place of Residence	Rural	26	74.3
	Urban	9	25.7
Age at Marriage	Below 18	9	25.7
	18–21	20	57.1
	22 and above	6	17.1
Occupation	Homemaker	19	54.3
	Daily wage laborer	6	17.1
	Government/Private service	4	11.4
	Self-employed	6	17.1
Number of Children	1	14	40
	2	13	37.1
	3 or more	8	22.9

Physical health impacts

Many women reported experiencing considerable physical discomfort following their CS. The recovery process was often described as slow and physically demanding, particularly because most women resumed household responsibilities shortly after returning home. CS, while often lifesaving, are major surgical procedures that carry significant implications for a woman’s physical health [16]. In the context of Keonjhar, a district where access to consistent healthcare services may vary, the physical aftermath of CSs demands careful exploration. Understanding these impacts is critical, as they shape not only the immediate postpartum experience but also influence long-term health outcomes for mothers [17]. Recovery from a CS is often more complicated and prolonged than recovery from a vaginal birth. Women commonly experience extended periods of physical immobility, surgical pain, and difficulty performing everyday activities [18].In Keonjhar, where household responsibilities are traditionally demanding, slow recovery can place additional strain on women, affecting both their physical and emotional well-being. Inadequate support systems and insufficient medical follow-up can further complicate the recovery process, often resulting in incomplete healing and extended periods of suffering [19]. Women described prolonged recovery and complications. As one participant shared, “I couldn’t even sit up properly for weeks after the surgery—it felt like I was trapped in my own body.” (aged 26, Naranpur) Another one said “Even after months, I still feel pain, but I can’t keep telling everyone. They expect me to be normal.” (aged 28, Keonjhar Town).

Health difficulties

Beyond physical recovery, many participants described emotional and social challenges following CS. Feelings of disappointment, guilt, and self-doubt were common among several women who had expected a vaginal birth. Post-operative health issues, including infections, excessive bleeding, blood clots, and chronic pelvic pain, are common risks associated with CS [20]. Women have also experience complications such as uterine scarring, which can impact future pregnancies and overall reproductive health. Additionally, the general strain on the body caused by surgery can lead to lasting fatigue, weakness, and increased vulnerability to other health issues, significantly affecting women’s quality of life. Issues like fatigue and mobility challenges were frequent. A respondent mentioned, “Walking even a short distance felt like a battle; I was exhausted all the time.” (aged 31, Dimbo) Another Responded shared; “I had an infection after my CS, but no one explained properly how to take care of it. It made my recovery much harder.” (aged 28, Tangarapada). Similarly other women experienced “There is a pain in my lower stomach that never fully goes away. I worry what will happen if I become pregnant again.” (aged 32, Ghasipura).

Postpartum care

Effective postpartum care is crucial to ensuring a woman’s full recovery after a CS [21, 22]. However, in Keonjhar, challenges such as limited healthcare infrastructure, financial barriers, and lack of awareness often result in inadequate postpartum support. Women may not receive necessary follow-up checkups, counselling, or guidance on wound care, nutrition, and physical rehabilitation. This neglect can prolong recovery time, increase the risk of complications, and hinder women’s ability to return to their normal routines, affecting not only their health but also their socio-economic participation. Many women highlighted inadequate follow-up services, with one saying, “After the surgery, no one at the clinic asked about my pain or my healing process they just gave me medicines and sent me home.” (aged 26, Baria), Other women stated about the inadequate knowledge about the recovery “They gave me medicine for pain, but no one explained how to take care of myself after the surgery. I didn’t know what was normal or not.” (aged 28, Baria). Likewise, other women regret that “If someone had told me how to eat better or exercise, maybe I would have recovered faster. But no one mentioned that.” (aged 31, Salapada).

Psychosocial effects

While the physical consequences of CS deliveries are well-documented, the psychosocial impacts can be equally significant, influencing women’s emotional well-being, social interactions, and maternal bonding [23]. In the context of Keonjhar, where traditional beliefs about childbirth and maternal roles hold considerable influence, the psychological toll of undergoing a CS is often intensified by societal and personal expectations.

Emotional well-being

The emotional aftermath of a CS can be profoundly challenging. Many women experience feelings of inadequacy, stress, and anxiety, especially when their birth experience does not align with societal expectations or their personal desires [24]. One participant in the study confessed, “I felt like a failure because I couldn’t deliver naturally. It made me question if I was good enough as a mother.” (aged 22, Anandpur) Such sentiments are not uncommon and highlight the emotional strain that accompanies a CS. The inability to fulfil traditional expectations of a natural birth often leads to self-doubt and a sense of loss, which can persist long after the physical recovery has taken place. “It’s like I lost something I can’t explain. I recovered physically, but emotionally, I still feel like I failed at the first step of being a mother” (aged 26, Naranpur) – Said by a mother. It reflects a deep sense of grief or intangible loss often experienced by women who undergo a CS, particularly when it deviates from their envisioned birth plan or societal ideals of a “natural” birth.

Social perceptions

Social perceptions of CS vary widely across cultures and communities. In some societies, CSs are seen as a modern, safer option, while in others, they may be viewed negatively, as a failure or a departure from natural childbirth [5, 25]. There can be social stigma for women who don’t have vaginal births, and some may feel disappointed or guilty about their delivery method [5]. On the other hand, CSs can also be seen as a sign of privilege, especially in higher-income groups with access to private healthcare [26]. These perceptions are influenced by cultural norms, media portrayals, and the attitudes of healthcare providers, all of which shape how women experience and feel about their childbirth choices. Social attitudes towards CSs in Keonjhar are mixed, creating an environment where women may face judgment or conflicting opinions about their birthing experiences. While some in the community expressed relief for a woman who avoids labor pain, others criticize her for not having a “normal” birth. As one participant shared, “Some people said I was lucky to avoid labor pain, while others judged me for not having a ‘normal’ birth.” (aged 29, Saharpada). This divide in community opinions can lead to feelings of isolation or shame, especially when a mother senses that her birthing experience is under scrutiny. Such perceptions can intensify mental health challenges, leaving women struggling with conflicting expectations of what it means to be a ‘good’ mother.

Maternal bonding

The bond between a mother and her newborn is often a profound source of joy, yet for many women who undergo CSs, this connection can be complicated by physical challenges [4, 25]. One common difficulty is breastfeeding, with many mothers facing issues such as pain, difficulty with latching, and low milk supply. Breastfeeding struggles were common, One mother recalled “My baby wouldn’t latch properly, and I blamed myself for choosing the surgery.” (aged 27, Keonjhar Town). Such struggles can lead to feelings of guilt, frustration, and emotional distress, as women may feel that their inability to breastfeed or bond in the “traditional” manner is a direct consequence of their surgical delivery. These emotional barriers can affect the early maternal bond, leading to a sense of distance or disconnection from the newborn. “I wanted to hold and feed my baby right away, but the pain from the surgery made it so hard. I felt like I was failing as a mother.” (aged 23, Baria). “I tried for hours to get my baby to latch, but every time it hurt so much. I cried more than my baby did.” (aged 31, Saharpada).

Post-partum depression

The combined emotional stress and social difficulties linked to CSs can greatly increase the risk of developing PostPartum Depression (PPD) [27]. The psychosocial impact of CSs is often deep and far-reaching, with many women facing anxiety, sadness, or a diminished sense of joy in their new role as mothers. This emotional distress can be intensified by insufficient emotional support or a lack of understanding from healthcare providers and family members [3]. The study found that there is a strong need for timely interventions, including counselling and peer support, to alleviate the effects of PPD and help women navigate the complex emotional terrain following a CS. One mother shared with a heavy heart; “Everyone expected me to be happy, but inside I felt empty and alone. No one understood what I was going through.” (aged 32, Dimbo) Another Said “There was so much pressure to ‘move on’ quickly, but my body and mind weren’t ready. I needed someone to just listen without judging.” (aged 31, Saharpada) “After the surgery, I needed support, not advice. But everyone kept telling me to ‘be strong’ — it made me feel even more isolated.” (aged 24, Saharpada).

Economic implications

Participants frequently highlighted the financial burden associated with CS. Many families reported significant expenses related to hospital care, medicines, transportation, and follow-up visits. CS deliveries, especially in resource-limited settings like Keonjhar, not only affect women’s health and emotions but also impose a substantial financial burden on families. The economic impact of surgical childbirth can be both immediate and enduring, affecting household stability and shaping future financial planning [28].

Economic Burden of CS

The financial burden of CS deliveries is especially severe when the procedures are conducted in private healthcare facilities [29]. In contrast to public hospitals, where some costs may be subsidized, private institutions typically impose much higher fees for surgical procedures, hospital stays, and post-operative care [30]. A respondent shared, “We spent more than we could afford, just to ensure the best care during the surgery.” (aged 24, Keonjhar Road) This highlights the difficult choices families are forced to make between ensuring quality healthcare and preserving their financial security. The pursuit of better medical facilities often comes at the expense of depleting household resources. “We chose a private hospital thinking it would be safer, but the bill was much more than we had expected. It left us in a tough spot financially.” (aged 22, Baria).

Direct and In-direct expenditure on CS

In addition to the primary costs of the surgery itself, families often encounter various hidden expenses that further contribute to the economic strain [30, 31].Transportation to health centers, often located far from rural villages, costs for additional medications, special post-surgical diets, and follow-up consultations can quickly accumulate. One woman stated, “Transporting me to the hospital and buying extra medicines wiped out our savings.” (aged 34, Bhagamunda) These unanticipated expenditures frequently catch families unprepared, leaving them vulnerable to financial instability even after the immediate health crisis has passed. Responded shared with disappointed “Every day there was something new to buy — medicines, injections, extra tests — and none of it was planned for. It drained whatever little savings we had.” (aged 23, Saharpada) Likewise, another said “The surgery itself was expensive, but no one told us about the other costs — travel, food, even staying near the hospital. It all added up so quickly.” (aged 20, Naranpur). Many of them have reported that they have paid at least 1500 for buying sweet for staff involved in CS procedure even at public health facility and they don’t have any objection on it. As it is seen as a act of saving life, which is ultimately contributing towards hidden expenses.

Out-of-Pocket Expenditure (OOPE) on CS

The economic impact of a CS extends beyond the individual, influencing the financial wellbeing of the entire household [32]. Many families are compelled to take loans, sell assets, or borrow money from informal lenders to cover delivery-related costs. A participant reflected, “We had to take a loan to pay for the delivery, and now we’re struggling to repay it.” (aged 32, Keonjhar Town)Such financial pressures can lead to prolonged cycles of debt, limit future spending on essential needs like education or food and contribute to ongoing economic insecurity. In Keonjhar, where livelihoods are often fragile, the economic repercussions of CS deliveries can have deep and lasting effects on family prosperity and resilience. “After the delivery, we had to borrow money from relatives. Even months later, we are still paying back the debt.” (aged 23, Baria) Another Women added “We had to cut down on other household expenses just to manage the hospital costs. It’s been a financial burden we are still carrying.” (aged 27, Ghasipura).

Discussion

The women in this study reported significant physical hardships after their CS. Common complaints were intense abdominal pain, difficulty with basic movements (sitting, walking, breastfeeding), and concerns about wound healing. Such early postoperative pain is well documented; for example, Danish mothers described the first days after a CS as “very painful” and the surgery itself as “a disturbing experience” [33]. In Keonjhar, these problems were often magnified by rural living conditions. Many mothers were expected to resume household chores or field work soon after surgery, hindering rest and recovery. This contrasts with WHO guidance, which explicitly recommends that postpartum women take gentle exercise but also make time to rest and avoid strenuous work, with family members (mothers-in-law, spouses) assisting with chores [34]. In our setting, lack of such support delayed healing and sometimes led to wound infections or anemia. In line with global recommendations, strengthening postpartum care is crucial. Home visits by trained health workers (ASHA/ANM) in the first week could monitor vital signs and wound sites, ensure proper nutrition and iron supplementation, and remind families about danger signs. Indeed, WHO advises that all women be counselled on postpartum recovery and warning signs (e.g. hemorrhage, infection, eclampsia) during postnatal contacts [2, 33]. Incorporating these practices could help prevent the physical complications our respondents experienced.

The psychological toll of CS emerged as a key theme. Many participants described fear of surgery and anesthesia, anxiety about their baby’s health, and later feelings of guilt or failure for “not delivering normally.” These emotional strains mirror evidence from India and beyond. In rural eastern India, having a CS was an independent predictor of maternal psychological distress at 6 weeks postpartum [35]. Similarly, our data reflect a raised risk of postpartum depression after surgery: comparable studies in Indian cohorts found higher rates of depressive symptoms among women who had CS (adjusted OR ≈ 1.9) [36]. A study in urban Odisha noted a greater prevalence of depression among post-CS mothers, but women in Keonjhar often had few outlets to express these concerns. Many lacked opportunities to debrief their birth experience (hospital staff rushed discharges) due to low mental health literacy [37]. This aligns with WHO’s recommendation that women at high risk of depression receive psychosocial support by trained providers [34]. To address this, postpartum services in Keonjhar should integrate mental health screening and counselling. For example, ASHAs or ANMs could administer a simple depression screen during home visits and refer troubled mothers to primary care or community counsellors. Community education campaigns (via Anganwadi meetings or local media) could raise awareness of “baby blues” and destigmatize seeking help. Establishing peer support groups or mothers’ clubs may also give women a forum to share experiences. In these ways, the psychosocial burden revealed by our study can be mitigated through targeted support.

The financial strain of CS was profound. Virtually all women incurred high out-of-pocket payments for hospital fees, medicines, and travel, then further costs for follow-up visits. This confirms national data: NFHS-5 found that the average OOP cost of a CS in India was about US$133 overall (US$498 in private facilities, US$99 in public) [38] and roughly 15% of families used debt or asset sales to cope (distress financing). In Keonjhar, where incomes are low and insurance coverage spotty, many households falls into debt or delay paying other bills to afford the CS These burdens often compounded postpartum stress and sometimes delayed care (e.g. reluctance to return to hospital for complications). Unique to Keonjhar, however, are socio-cultural and logistical factors. Many participants were from tribal backgrounds with distinct languages and beliefs about childbirth. Some trusted traditional remedies or religious practices in parallel with biomedical care, which could delay seeking professional help. Geographic isolation (long, difficult journeys to the district hospital) and erratic phone connectivity also affected timely follow-up. Unlike urban settings, most of our participants lacked educational attainment, compounding challenges in understanding consent and recovery instructions. These local factors underscore that place-based solutions are needed: for example, recruiting tribal health workers or translators, and tailoring health messages to local dialects and customs.

Conclusions

In summary, our study reveals that CS in Keonjhar is associated with substantial physical pain, psychosocial stress, and economic hardship for women and their families. These burdens echo national and international evidence of increased postpartum depression and financial distress after CS [35, 38]. Importantly, the Keonjhar context adds layers of complexity (tribal customs, rural poverty, limited infrastructure) that amplify these impacts. Addressing them will require an integrated strategy: improving postpartum medical and psychosocial care, educating communities about recovery, and reinforcing financial safety nets and provider accountability. Implementing such context-sensitive interventions – as recommended by WHO and observed in comparable settings [34, 35, 38]– is essential to support maternal well-being. By noting these findings, policymakers and health practitioners can help ensure that no woman is left without the care and support she needs after a CS.

Limitations

This study has some limitations that should be acknowledged. First, the sample size was relatively small and limited to women from Keonjhar district, which may restrict the generalizability of the findings to other settings. Second, interviews were conducted within two weeks after delivery, and participants’ experiences may reflect early recovery rather than long-term postpartum outcomes. Third, although interviews were conducted in the local language and later translated into English, some nuances may have been lost during translation. Despite these limitations, the study provides valuable insights into the physical, psychosocial, and economic challenges experienced by women following caesarean delivery in a rural context.

Authors’ contributions

All authors have participated in the design of the study. SKJ was involved in data collection. MA supervised the conduct of the study. SKJ analyzed the data. SKJ wrote the first draft of the paper. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the final draft of the manuscript and approved the decision to submit the manuscript for publication.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to confidentiality and ethical restrictions but are available from the corresponding author on reasonable request and with permission from the Institutional Ethics Committee.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was obtained from the Departmental Ethics Committee of Department of Population Studies, Fakir Mohan University.

Informed consent was obtained from all participants prior to data collection. Each participant was briefed about the study’s objectives, their right to withdraw at any time, and the measures taken to ensure confidentiality and anonymity.All data were stored securely and used solely for research purposes.

Consent for publication

Participants were informed that the findings of the study may be published in academic journals, reports, or presentations. All participants gave their consent for the anonymous use of their data in publications. Any identifying information has been removed or anonymized to protect participant confidentiality.

Competing interests

The authors declare no competing interests.