Social determinants of the increasing caesarean section rate in Italy.
OBJECTIVE
Consistent modifications of socio-economic factors may represent crucial non-clinical determinants for the rising rate of caesarean section among primiparae. This increasing trend has been reported in many countries and its relationship with social modifications is widely accepted, though poorly supported by published data.


METHODS
Population-based social and economic data were analyzed between two study periods 30 years apart (1971 vs 2001).


RESULTS
The number of births dropped dramatically within the study period (about -40%). Italian women tend to delay childbearing (25.1 vs 28.8 years of age at first delivery) to pursue a career and a later marriage and motherhood lead to a contraction of the number of members of the family. Older mothers are at higher risk of caesarean (treble over 40 years of age), especially those with high career position. Health expenditures increased significantly between 1971 and 2001. A progressive contraction of the number of women in reproductive age is expected in the next 50 years in Italy.


CONCLUSIONS
Many determinants are involved in the choice of a caesarean section and most of these are not strictly medical. The rapidly mounting number of legal claims may indeed lead to defensive practices. Given these data, a reduction of caesarean section rate seems unlikely to be achieved at present.
Scioscia
M
M
Department of Gynaecology, University of Medical Science of Bari, Bari, Italy. marcoscioscia@gmail.com
Vimercati
A
A
Cito
L
L
Chironna
E
E
Scattarella
D
D
Selvaggi
L E
LE
D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016365:Liability, Legal; D011247:Pregnancy; D011584:Psychology; D012941:Social Responsibility; D012959:Socioeconomic Factors