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