title: Caesarean section rates in Mozambique.
abstract: BACKGROUND
  The Caesarean section (C-section) rate is used as an indicator for availability and utilization of life-saving obstetric services. The purpose of the present study was to explore changes in C-section rates between 1995 and 2011 by area, place of delivery and maternal socioeconomic factors in Mozambique.
  
  
  METHODS
  Cross-sectional data from the Demographic and Health Surveys conducted in Mozambique in 1997, 2003 and 2011 were used, including women having a live birth within 3 years prior to the survey. Descriptive statistics and logistic regressions were used to identify factors associated with having a C-section.
  
  
  RESULTS
  The C-section rate decreased slightly from 2.5% in 1995-1997 to 2.1% in 2001-2003 and then increased to 4.7% in 2009-2011. In 2009-2011, C-section rates ranged in urban areas from 4.6% in the northern region to 12.2% in the southern region and in rural areas from 1.6% in the northern region to 3.9% in the southern region. 12.3% of the richest women had had a C-section, compared to 1.7% of the poorest women. C-sections were the most common at public hospitals (12.6% in 2009-2011), but C-sections at health centers increased from the second to the third period. The likelihood of having a C-section was associated with living in urban areas and in the southern region, having a formal education and living in a rich household, even adjusting for age and parity (and study periods). The strongest relationship was for the richest household wealth quintile [OR (95% CI): 9.8 (6.3-15.3)]. The highest rate (20.6%) was found among the richest women giving birth at public hospitals in the southern region in 2009-2011.
  
  
  CONCLUSIONS
  In Mozambique, underuse of C-section was likely among the poor and in rural areas, but overuse in the most advantaged groups seemed to be emerging.
authors.affiliation: Global Health Research Centre, Duke Kunshan University, No. 8 Duke Avenue, 215316, Kunshan City, Jiangsu Province, P.R.China. qian.long@dku.edu.cn.|National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland. qian.long@dku.edu.cn.
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: Family Federation of Finland, PO Box 849, FI-00101, Helsinki, Finland. tainakempas@hotmail.com.
authors.forename: Taina
authors.initials: T
authors.lastname: Kempas
authors.affiliation: Department of Community Health, Eduardo Mondlane University, 702 Salvador Allende Ave, C.P, 257, Maputo, Mozambique. tmadede@gmail.com.
authors.forename: Tavares
authors.initials: T
authors.lastname: Madede
authors.affiliation: National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland. reija.klemetti@thl.fi.
authors.forename: Reija
authors.initials: R
authors.lastname: Klemetti
authors.affiliation: National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland. elina.hemminki@thl.fi.
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends*; D003151:Community Health Centers / Q000706:statistics & numerical data* / Q000639:trends; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D009073:Mozambique; D011203:Poverty; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult