Author(s): Chacham AS, Perpetuo IH
Brazil has the highest cesarean section delivery rate in the world. In 1996, surgical deliveries represented 36.4% of total deliveries and 41.8% of those in urban areas. The determinants of this phenomenon were investigated in a review of birth records for Belo Horizonte (capital city of Minas Gerais State) in 1994. 23.4%, 66.4%, and 10.2% of births occurred in fully private, partially private, and public hospitals, respectively. The corresponding cesarean section rates were 67.8%, 34.9%, and 36.2%, respectively. Maternal education, used as a proxy for socioeconomic status, was strongly associated with cesarean section delivery. The cesarean section rates were 26.1%, 32.6%, 45.2%, 58.9%, and 71.6% among women with no education, some primary school, primary school, secondary school, and college, respectively. This trend persisted even when age and parity were controlled. According to step-wise logistic regression equations, delivery in a public hospital or a private facility affiliated with the National Health Service versus a private hospital reduced the likelihood of cesarean delivery by more than 20%. Each incremental increase in educational level was associated with a 22% increase in this likelihood. A reduction in unnecessary cesarean sections should be a priority for Brazil's safe motherhood program.