title: Prevalence, Disparities, And Determinants Of Primary Cesarean Births Among First-Time Mothers In Mexico.
abstract: Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.
authors.affiliation: Sylvia Guendelman (sylviag@berkeley.edu) is a professor and chair of the Maternal and Child Health Program, Division of Community Health Sciences, School of Public Health, University of California, Berkeley.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Guendelman
authors.affiliation: Alison Gemmill is a PhD candidate in demography at the University of California, Berkeley.
authors.forename: Alison
authors.initials: A
authors.lastname: Gemmill
authors.affiliation: Dorothy Thornton is an independent researcher in Berkeley, California.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Thornton
authors.affiliation: Dilys Walker is a professor of obstetrics, gynecology, and reproductive health sciences and global sciences at the University of California, San Francisco.
authors.forename: Dilys
authors.initials: D
authors.lastname: Walker
authors.affiliation: Michael Harvey is a PhD candidate in the School of Public Health, University of California, Berkeley.
authors.forename: Michael
authors.initials: M
authors.lastname: Harvey
authors.affiliation: Julia Walsh is an adjunct professor in the Division of Community Health Sciences, School of Public Health, University of California, Berkeley.
authors.forename: Julia
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Ricardo Perez-Cuevas is social protection and health senior specialist in the Division of Social Protection and Health at the Inter-American Development Bank, in Mexico City.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Perez-Cuevas
mesh_terms: D000293:Adolescent; D000328:Adult; D001719:Birth Certificates; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D017057:Medically Uninsured; D008800:Mexico / Q000453:epidemiology; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors
keywords: Mexico; birth certificate data; non-clinical decision drivers; population based cross-sectional study; primary cesarean births