Social inequalities in cesarean section rates in primiparae, Southern Brazil
Freitas, P.Fontoura.; Drachler, M.de.Lourdes.; Leite, Jé.Carlos.de.Carvalho.; Grassi, P.Recena.
Revista de Saude Publica 39(5): 761-767
2005
ISSN/ISBN: 0034-8910 PMID: 16254652 Document Number: 266686
A study was carried out to investigate the effect of social inequalities in caesarean section rates among primiparae having a single pregnancy and delivering in maternity hospitals. The study was conducted in Southern Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR) of caesarean sections according to social conditions (maternal age and education, newborn skin colour/ethnicity and macro-regions), duration of pregnancy, and number of prenatal visits. The overall caesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended more than 6 prenatal visits. Crude and adjusted OR showed that caesarean rates were negatively associated with all categories of skin colour/ethnicity when compared to white newborn, particularly those of negative Brazilian (OR=0.43; 95% CI:0.31- 0.59), and they were positively associated with higher maternal education (OR=3.52; 95% CI:3.11-3.99), older age (OR=6.87; 95% CI:5.90-8.00) and greater number of prenatal visits (OR=2.16; 95% CI:1.99-2.35). The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region. High rates of caesarean section in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.