From birth canal to classroom: a comparative analysis of academic performance among pupils born through vaginal and cesarean deliveries in Ogbomoso, Oyo State, Nigeria

BACKGROUND: Many studies have investigated the relationship between vaginal and cesarean births and child developmental outcomes. However, evidence on whether mode of delivery influences long-term academic performance remains inconsistent, especially within Nigerian primary school populations. The present study assessed whether mode of delivery (vaginal vs. cesarean section) influences academic performance among primary school pupils in Ogbomoso, Oyo State, Nigeria. METHODS: This descriptive school-based cross-sectional study recruited 481 pupils using a multistage sampling technique. Data were collected using a structured, pretested questionnaire and validated academic records. Sociodemographic and perinatal variables were obtained from parents/guardians. Academic performance was calculated using weighted continuous assessments and end-of-term examinations. Statistical analysis was conducted using SPSS v26. Chi-square tests and multivariable logistic regression assessed associations, with significance set at 5%. RESULTS: The mean maternal age at delivery was 30.7 ± 5.5 years. Overall mean academic score was 74.4 ± 16.6, and 63.0% met the threshold for good performance. Vaginally delivered pupils recorded a higher proportion of good performance (67.6%) compared with cesarean-delivered pupils. However, after adjustment, maternal occupation, birth weight, and exclusive breastfeeding, but not mode of delivery, remained significant predictors of academic outcomes. Exclusive breastfeeding doubled the odds of good performance (AOR: 2.00; 95% CI: 1.18–3.38). CONCLUSION: Although vaginal delivery showed crude association with better performance, this effect disappeared after adjustment. Academic achievement was more strongly influenced by maternal education, birth weight, early childhood nutrition, and household socioeconomic conditions. Public health policies should strengthen maternal nutrition, breastfeeding promotion, perinatal care, and early learning support while ensuring safe delivery practices.