Robson classification has been recommended by the World Health Organization (WHO) as a monitoring tool for caesarean section (CS), however, it has not been implemented in Indonesia. In this study, we hypothesize that the National Health Insurance (NHI) claims data can be used to classify pregnant women into several obstetric groups. This study aims to examine the use of NHI claims database for analyzing CS according to the WHO manual for Robson classification. This study is a cross-sectional analysis using delivery claims from NHI sample set data from 2017 to 2018. We categorized the International Classification of Diseases (ICD) 10 codes in the claims data according to the Robson classification system using the following variables: multiple pregnancy, fetal presentation, previous obstetric record, previous CS record, gestational age, and onset of labor. Data was analyzed using IBM SPSS Statistics. A total of 31,375 deliveries were included in the analysis. Overall, mean age of mothers was 29.2±5.9 years. The CS rate in this population was 37.0% in 2017 and 38.7% in 2018. Highest CS rate was found in nulliparous (group 2: 26.6%) and multiparous women (group 4: 24.8%) if labour induced or had prelabour CS, followed by multiparous women with previous uterine scar (group 5: 22.5%). We found an alarmingly high rate of CS among Indonesian women. Implementation of Robson classification in the National Health Insurance claims data is feasible and should be considered by the policy makers as an audit tool to identify the groups that contributes the most to the CS rate.

The authors have declared no competing interest.

The study was funded by the Indonesian Social Health Security Agency (BPJS Kesehatan), number 1266/Risbang/1219. The funder had no role in the management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript, and the decision to submit the manuscript for publication.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Health Research Ethics Committee, University of Indonesia and Cipto Mangunkusumo Hospital number KET-472/UN2.F1/ETIK/PPM.00.02/2020.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The sample set of National Health Insurance (JKN) data is available for public upon reasonable request to the Indonesian Social Health Security Agency (BPJS Kesehatan).