High cesarean prevalence in a national population-based study in Brazil: the role of private practice.
BACKGROUND
Excessive use of cesarean sections (CSs) is a serious problem worldwide.


OBJECTIVE
To estimate the frequency and identify factors associated with cesarean deliveries in Brazil.


METHODS
Cross-sectional study conducted in 2006-2007 as part of the third edition of the Children's and Women's National Demographic and Health Survey.


METHODS
Brazil.


METHODS
Brazilian women in reproductive age.


METHODS
Socioeconomic and demographic data were utilized, including maternal age, education level, per capita income, skin color, smoking habit, marital status, age at first delivery, parity, and type of prenatal services.


METHODS
Adjusted estimate of the prevalence ratios of the type of delivery performed (cesarean or vaginal).


RESULTS
Cesarean prevalence was 43.9% (95% CI: 40.9-46.9), 68.7% for women who had per capita income greater than US$ 125 per month, and 77.2% for those who had attended private or privately insured prenatal services. In the adjusted analysis, the variables that presented significant prevalence ratios (95% confidence interval) were macro-region [southeast = 1.45 (1.21-1.73); south = 1.48 (1.24-1.77), and midwest = 1.43 (1.21-1.71)], maternal age above 25 years [26-30 years = 1.57 (1.25-1.97); > or = 31 years = 1.77 (1.39-2.27)], education levels > or = 9 years (PR = 1.86, 95% CI: 1.55-2.23), and having attended private or privately insured prenatal services (PR = 1.87, 95% CI: 1.65-2.12) and parity [primipara = 1.87 (1.47-2.36)].


CONCLUSIONS
CS rates are generally very high in Brazil. They are significantly higher than the average among women attending private/insured antenatal care, among the highly educated, and in provinces with higher socioeconomic levels.
Rebelo
Fernanda
F
Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.
da Rocha
Camilla Medeiros Macedo
CM
Cortes
Taísa Rodrigues
TR
Dutra
Carmem Lúcia
CL
Kac
Gilberto
G
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008423:Maternal Age; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008428:Maternal Mortality / Q000639:trends; D010298:Parity; D016012:Poisson Distribution; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011331:Private Practice / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors