title: Explaining caesarean section in Salvador da Bahia, Brazil.
abstract: In Salvador da Bahia the caesarean section rate is excessive, as it is in Brazil as a whole. It is the standard form of delivery in private hospitals, though vaginal delivery still predominates in the public sector. This paper investigates the social context of these styles of childbirth, arguing that the connections between both sectors sustain this situation. Exploring the factors leading to the preference in private and insurance-funded maternity wards, it examines critically two diverging positions on the cause of the rate: that women's cultural preferences for abdominal birth lie behind it; or that obstetricians' self-interest is to blame. The paper critiques the theory of culture behind the first stance and questions the theoretical weight placed on individual action in the second. It argues that no particular social group is the principal cause of the excessive use of caesarean section to deliver babies. Rather, a host of factors converge in sustaining this practice. Finally, the paper stresses that the system as a whole, not any particular group, must be changed if the rate is to be lowered significantly. For this, political will is required.
authors.affiliation: Institute de Saúde Coletiva, Federal University of Bahia, Brazil. cecilia.mccallum@uol.com.br
authors.forename: Cecilia
authors.initials: C
authors.lastname: McCallum
mesh_terms: D001291:Attitude of Health Personnel; D001938:Brazil; D002585:Cesarean Section / Q000523:psychology / Q000706:statistics & numerical data*; D003469:Culture; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D009035:Mothers / Q000523:psychology; D009774:Obstetrics; D036801:Parturition / Q000523:psychology; D011247:Pregnancy; D017149:Private Sector / Q000706:statistics & numerical data; D012959:Socioeconomic Factors