title: Cesarean section rate differences by migration indicators.
abstract: OBJECTIVE
  To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators?
  
  
  METHODS
  Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed.
  
  
  RESULTS
  Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %).
  
  
  CONCLUSIONS
  Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.
authors.affiliation: Ingram School of Nursing and Department of Obstetrics and Gynecology, McGill University, Montreal, Canada. anita.gagnon@mcgill.ca
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Gagnon
authors.forename: Andrea
authors.initials: A
authors.lastname: Van Hulst
authors.forename: Lisa
authors.initials: L
authors.lastname: Merry
authors.forename: Anne
authors.initials: A
authors.lastname: George
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Saucier
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stanger
authors.forename: Olive
authors.initials: O
authors.lastname: Wahoush
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D002170:Canada; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002947:Cities / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012036:Refugees / Q000706:statistics & numerical data*