title: [Social inequalities in cesarean section rates in primiparae, Southern Brazil].
abstract: OBJECTIVE
  To investigate the effect of social inequalities in cesarean section rates among primiparae having single pregnancy and delivering in maternity hospitals.
  
  
  METHODS
  The study was carried out in Southern Brazil in 1996, 1998 and 2000. Data from the Live Birth National Information System were used to estimate annual rates and crude and adjusted odds ratios (OR) of cesarean sections according to social conditions (maternal age and education, newborn skin color/ethnicity and macro-regions), duration of pregnancy, and number of prenatal visits.
  
  
  RESULTS
  The overall cesarean section rate was 45%, and above 37% in all macro-regions. Increased rates were seen among native and black mothers, aged 30 years or more, living in metropolitan, river valley and mountain macro-regions and having attended to more than six prenatal visits. Crude and adjusted OR show that cesarean rates were negatively associated with all categories of skin color/ethnicity when compared to white newborns, particularly those of native Brazilian (ORadj=0.43; 95% CI: 0.31-0.59), and they were positively associated with higher maternal education (ORadj=3.52; 95% CI: 3.11-3.99), older age (ORadj=6.87; 95% CI: 5.90-8.00) and greater number of prenatal visits (ORadj=2.16; 95% CI: 1.99-2.35). The effects of age and education were partly mediated by the greater number of prenatal visits among higher educated older women. The OR varied among macro-regions but were greater for the wealthier mountain region.
  
  
  CONCLUSIONS
  High rates of cesarean section rates in Southern Brazil are a public health concern. They are associated with social, economic and cultural factors which can lead to misuse of medical technology during labor and delivery.
authors.affiliation: Programa de Pós Graduação em Saúde Pública, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil. pfreitas@ccs.ufsc.br
authors.forename: Paulo Fontoura
authors.initials: PF
authors.lastname: Freitas
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Drachler
authors.forename: José Carlos de Carvalho
authors.initials: JC
authors.lastname: Leite
authors.forename: Paulo Recena
authors.initials: PR
authors.lastname: Grassi
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D012935:Social Justice; D012959:Socioeconomic Factors