Abstract
ABSTRACTOBJECTIVE To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care.METHODS This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother’s characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status.RESULTS Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section.CONCLUSIONS In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.
Highlights
Cesarean section is a surgical intervention performed in situations of significant risk to mother or fetus during pregnancy or labor
In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions
Cesarean rates are above 30.0% in many countries such as Portugal, Mexico, Chile, and Italy[23], well above the 15.0% recommended by WHO29
Summary
Cesarean section is a surgical intervention performed in situations of significant risk to mother or fetus during pregnancy or labor. This procedure has been associated with higher rates of maternal and infant morbidity and mortality[28]. A large cross-sectional study conducted between 2004 and 2008 by the World Health Organization (WHO) across 24 countries showed that cesarean section is associated with increased risk of severe maternal outcomes such as death, admission to intensive care unit, blood transfusion, and hysterectomy[27]. The increase was partly associated with the higher rates of cesarean deliveries in the public sector. In 2004, among births in the private healthcare sector, 79.7% (246.264) were by cesarean section. The Brazilian Unified Health System (SUS) reported a 27.5% cesarean delivery rateb
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
