International Journal of Gynecology & Obstetrics
Volume 107, Issue 3 , Pages 198-201, December 2009

Inequalities in cesarean delivery rates by ethnicity and hospital accessibility in Brazil

  • Paulo Fontoura Freitas

      Affiliations

    • Programa de Pós Graduação em Ciências Médicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
    • Núcleo de Orientação em Epidemiologia, Universidade do Sul de Santa Catarina, Tubarão, SC, Brazil
    • Corresponding Author InformationCorresponding author. Beco da Lua 232, Lagoa da Conceição, CEP 88062-490, Florianópolis, SC, Brazil.
    • ,
  • Maria de Lourdes Drachler

      Affiliations

    • School of Allied Health Professions, Faculty of Health, University of East Anglia, Norwich, UK
    • ,
  • José Carlos de Carvalho Leite

      Affiliations

    • Faculdade de Psicologia, PUCRS, Porto Alegre, Brazil
    • ,
  • Tom Marshall

      Affiliations

    • London School of Hygiene and Tropical Medicine, Department of Epidemiology and Population Health, University of London, UK

Received 2 March 2009; received in revised form 18 July 2009; accepted 27 August 2009. published online 28 September 2009.

Abstract 

Objective

To investigate inequalities in cesarean delivery rates in Brazil according to ethnic group and level of access to hospital delivery.

Methods

Cross-sectional analysis of data for primiparous women with singleton deliveries between 2003 and 2004 from the National Information System of Live-Births (6064799 live births). Robust Poisson regression modeling was applied to estimate prevalence ratios of cesarean deliveries for ethnic group and level of access to hospital delivery according to residence.

Results

There were 2438180 primiparous deliveries and the cesarean rate was 45.8%. Ethnic inequalities in cesarean delivery rates showed lower rates for all ethnic groups compared with white women, with the lowest rates recorded for indigenous women. The association between ethnicity and cesarean delivery was higher in states with lower access to hospital (P<0.001). Multiple regression models showed that this association was, in part, explained by older maternal age and higher levels of education and prenatal care.

Conclusions

Overuse of cesarean delivery and strong evidence of ethnic inequalities in cesarean rates exist in Brazil. The inequalities are greater in states with lower access to hospital and were partially explained by socioeconomic factors and prenatal care, suggesting a misuse of medical technology at birth.

Keywords: Cesarean delivery, Ethnicity, Health inequalities, Indigenous population, Socioeconomic factors, Women's health

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PII: S0020-7292(09)00475-5

doi:10.1016/j.ijgo.2009.08.017

International Journal of Gynecology & Obstetrics
Volume 107, Issue 3 , Pages 198-201, December 2009

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