Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

C Miani,I-M Doyle,J Spallek,C Hoeller-Holtrichter,O Sauzet,A Ludwig,O Razum,J Breckenkamp

doi:10.1186/s12884-020-2725-5

Abstract

BackgroundWomen with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other.MethodsIn 2013–2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section.ResultsOf the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01–3.81; and aOR: 2.36, CI: 1.27–4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups.ConclusionsMigration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

Highlights

Women with a migration background are reportedly at a higher risk of emergency caesarean section
Women with a migration background or from ethnic minorities experience a higher risk of emergency caesarean section [3,4,5,6] for reasons that include the aforementioned suboptimal antenatal care use and quality of care delivery, as well as limited agency in the doctor-patient relationship [7]
Studies considering the socioeconomic position of participants do not necessarily distinguish between elective and emergency caesarean sections, [10,11,12] which may be problematic as the two procedures are the consequences of different pregnancy profiles and approaches to pregnancy care

Summary

Introduction

Women with a migration background are reportedly at a higher risk of emergency caesarean section. Other studies tend to include only one measure of socioeconomic position, namely education or income, potentially missing the effect of other influencing factors This relative lack of evidence is surprising, considering that some of the reasons why women with a migration background might be more at risk of undergoing an emergency caesarean section, may apply to women with lower income [3] or lower educational attainment [13]. It has been shown that lower socioeconomic position may act as a barrier towards medical intervention, as a result of discriminatory clinical decision-making [14] It remains unclear whether and how socioeconomic position impacts emergency caesarean section rates, and whether socioeconomic position interact with migration status. This applies especially to populations where migrant women and descendants of migrants are at risk of socioeconomic disadvantage

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Conclusion