Abstract
Caesarean delivery rates in Mexico are among the highest in the world. Given heightened public and professional awareness of this problem and the updated 2014 national guidelines to reduce the frequency of caesarean delivery, we analysed trends in caesarean delivery by type of facility in Mexico from 2008 to 2017. We obtained birth-certificate data from the Mexican General Directorate for Health Information and grouped the total number of vaginal and caesarean deliveries into five categories of facility: health-ministry hospitals; private hospitals; government employment-based insurance hospitals; military hospitals; and other facilities. Delivery rates were calculated for each category nationally and for each state. On average, 2 114 630 (95% confidence interval, CI: 2 061 487–2 167 773) live births occurred nationally each year between 2008 and 2017. Of these births, 53.5% (1 130 570; 95% CI: 1 108 068–1 153 072) were vaginal deliveries, and 45.3% (957 105; 95% CI: 922 936–991 274) were caesarean deliveries, with little variation over time. During the study period, the number of live births increased by 4.4% (from 1 978 380 to 2 064 507). The vaginal delivery rate decreased from 54.8% (1 083 331/1 978 380) to 52.9% (1 091 958/2 064 507), giving a relative percentage decrease in the rate of 3.5%. The caesarean delivery rate increased from 43.9% (869 018/1 978 380) to 45.5% (940 206/2 064 507), giving a relative percentage increase in the rate of 3.7%. The biggest change in delivery rates was in private-sector hospitals. Since 2014, rates of caesarean delivery have fallen slightly in all sectors, but they remain high at 45.5%. Policies with appropriate interventions are needed to reduce the caesarean delivery rate in Mexico, particularly in private-sector hospitals.
Highlights
Caesarean delivery is a vital procedure to reduce maternal and neonatal mortality.[1]
No clear optimal rate has been established as a threshold, a caesarean delivery rate of up to 19 per 100 live births is associated with the lowest rates of maternal and neonatal mortality at a population level.[2]
There were on average 2 114 630 (95% confidence interval, CI: 2 061 487– 2 167 773) live births a year nationally between 2008 and 2017, of which 1 130 570 were vaginal deliveries and 957 105 were caesarean deliveries
Summary
Caesarean delivery is a vital procedure to reduce maternal and neonatal mortality.[1]. Caesarean delivery rates in Mexico, a country with the second largest economy in Latin America[3] and with a population of nearly 120 million[4], are among the highest in the world. Two newspaper articles[10,11] described several cases of unnecessary caesarean delivery, those performed without medical indication,[12,13] and subsequent morbidity. These cases indicate that Mexico has a high burden of harmful overtreatment during childbirth
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