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Abstract
ABSTRACTOBJECTIVE To examine maternal and obstetric factors influencing births by cesarean section according to health care funding.METHODS A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births.RESULTS The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women’s maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system.CONCLUSIONS Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.
Highlights
High rates of caesarean section (CS) are a public health issue
The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications
Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics
Summary
High rates of caesarean section (CS) are a public health issue. Overall CS rates higher than 10% to 15% are not associated with improved maternal or infant outcomes[1]. The high number of CS births in the privately funded healthcare sector makes a significant contribution to the high overall rates in Brazil, with CS rate as high as 80% in these settings[3,5], independent of maternal or fetal complications during pregnancy or labour[5]. The lack of routinely collected data in Brazil on CS clinical indications does not enable planned or emergency CS procedures to be considered separately. Maternal characteristics such as age, being overweight or obese at pregnancy commencement, and ethnicity[6,7] do not explain variations in CS rates within or between countries. The payment to the clinician for assisting either a CS or a vaginal birth does not differ within the private and publicly funded systems, but a scheduled CS is time-saving and enables doctors to better organize their workload in private services[11]
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