title: Are Brazilian women really choosing to deliver by cesarean?
abstract: Brazil has among the highest cesarean section rates in the world, with 36% of women in the country delivering surgically. Women, especially those who deliver in private hospitals with cesarean rates in the 80-90% range, are often portrayed as actively choosing to deliver surgically. Doctors typically promote this view, also common in the popular understanding of the phenomenon, that it is women's demand for a cesarean that is behind the high rates. Academic analyses tend to present a more balanced view with doctors' motives for wanting to perform cesareans included alongside descriptions of women's motives for the procedures. What is typically missing from such analyses is a discussion of the power differences between women and doctors. Doctors clearly have more decision-making power in the hospital birthing situation, and their medical expertise and authority is often marshaled to convince a woman to "choose" a cesarean. Using data collected from a postpartum survey, participant observation in hospital obstetrics wards, and in-depth interviews. I offer evidence which refutes many of the hypotheses associated with why women might prefer to deliver by cesarean. I also show that the majority of women surveyed in two cities in Brazil, particularly first-time mothers, do not seek to deliver by cesarean. Through an analysis of conversations between doctors and women during labor and delivery, and through women's narratives of their delivery experiences, I also show some of the mechanisms that doctors use in order to induce so-called demand for surgical delivery and argue that they are very active participants in the ongoing construction of the culture of cesarean section in Brazil.
authors.affiliation: Population Council, Latin America & the Caribbean--Regional office, Col. Villa Coyocan, Mexico, DF. khopkins@popcouncil.org.mx
authors.forename: K
authors.initials: K
authors.lastname: Hopkins
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003625:Data Collection; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy