Cesarean section prevalence based on prenatal care provider, location, and wealth index: A comparative analysis in peru's healthcare systems

Abstract

BackgroundCesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems. AimTo evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system. MethodsA cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions. FindingsThe highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, “richest” wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the “poorest” or “poorer” wealth index category and when prenatal care was provided by a midwife in a private facility. ConclusionThe prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.