Are Cesarean Deliveries More Likely for Poorly Educated Parents? A Brief Report from Italy

Abstract

Although debate on factors associated with a high risk of cesarean delivery has continued for many years, only a few studies have explored the role of socioeconomic position. We studied the effect of educational level on risk of cesarean section in particular the different roles of maternal and paternal education. We analyzed all 88,698 firstborn live births registered between 1990 and 1996 to mothers who were residents of Rome at the time of delivery. Logistic regression was used to investigate the association between cesarean section and parent education, taking possible confounding factors into consideration. During the study period, the cesarean section rate was 32.5 percent. The direct association between level of education and cesarean delivery, found in the crude analysis, was completely reversed once maternal age was taken into account. Multivariate analyses showed that women with a primary school degree had a 24 percent (95% CI = 12-37) higher risk of cesarean delivery than those with a university degree. The association was even stronger for deliveries in public hospitals. Although both parents' level of education had an effect on the cesarean section rate, maternal education had a stronger effect than and was independent from paternal education. Mothers with little education were consistently more likely to deliver by cesarean section than highly educated women, even when their partner's level of education was taken into account. Effective interventions aimed at reducing cesarean delivery rates in women of lower social class should be a priority for national health services, particularly in countries where the cesarean rate has been increasing.