title: High cesarean prevalence in a national population-based study in Brazil: the role of private practice.
abstract: 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.
authors.affiliation: Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rebelo
authors.forename: Camilla Medeiros Macedo
authors.initials: CM
authors.lastname: da Rocha
authors.forename: Taísa Rodrigues
authors.initials: TR
authors.lastname: Cortes
authors.forename: Carmem Lúcia
authors.initials: CL
authors.lastname: Dutra
authors.forename: Gilberto
authors.initials: G
authors.lastname: Kac
mesh_terms: 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