The relationship between indicators of socioeconomic status and cesarean section in public hospitals

Abstract

OBJECTIVE To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care.METHODS This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother’s characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status.RESULTS Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section.CONCLUSIONS In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions.

Brazilian regional differences and factors associated with the prevalence of cesarean sections

“…Concerning the maternal level of education and its relation in C-section rates, this variable was verified as a probable factor that increases the chance of women having C-sections, where, as the level of education increases, there is a greater chance of women to have C-sections. Similar results were found by Rattner and Moura [14], which showed a proportion of C-sections being lower among women with no schooling (25.2%) and among single women (42.0%), tending to increase as the level of education improves, and by Faisal-Cury et al [24], who in one of their analyzes showed that C-sections were associated with higher per capita family income, higher level of education, lower household crowding, pregnancy planning, white skin color, having a partner and older maternal age.…”

Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia

“…People with no formal education or just primary school level education were 1.30 times more likely to have a caesarean section than their more educated counterparts as shown in Table 1 (p < 0.0001). While some previous studies have shown that women with higher education or higher socioeconomic status were more likely to have a caesarean section 29 – 31 , other studies have shown the opposite 32 , 33 . The EFSTH is a public health facility that offers free comprehensive maternity care.…”

The Effect of Cesarean Delivery on Child Survival and Early Breastfeeding Practices: Global Data from 103 Provinces in the Eastern Mediterranean Region

“…In conclusion the study shows that delivery by CS has a controversial role in influencing infant mortality (39,40) . The socioeconomic status plays an important role especially in middle and low income groups (41,42) whereas unnecessary CS is definitely associated with mortality especially when associated with poorly skilled health professionals and lack of early breastfeeding support. Early and exclusive breastfeeding continue to have protective effects against the adverse effects on mortality and morbidity that can result from the increasing rates of CS, especially when unnecessary (43) .…”