Antenatal care and caesarean sections: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

Abstract

BackgroundAntenatal care and correctly indicated caesarean section can positively impact on health outcomes of the mother and newborn. Our objective was to describe how coverage and inequalities for these interventions changed from 1982 to 2015 in Pelotas, Brazil.MethodsUsing perinatal data from the 1982, 1993, 2004 and 2015 Pelotas birth cohorts, we assessed antenatal care coverage and caesarean section rates over time. Antenatal care indicators included the median number of visits, the prevalence of mothers attending at least six visits and the proportion who started antenatal care in the first trimester of pregnancy and attended at least six visits. We described these outcomes according to income quintiles and maternal skin colour, to identify inequalities. We described overall, private sector and public sector caesarean section rates. Differences in prevalence were tested using chi-square testing and median differences using Kruskal-Wallis testing.ResultsFrom 1982 to 2015, the median number of antenatal care visits and the prevalence of mothers attending at least six visits increased in all income quintiles and skin colour groups. Inequalities were reduced, but not eliminated. The overall proportion of caesarean births increased from 27.6% in 1982 to 65.1% in 2015, when 93.9% of the births in the private sector were by caesarean section. Absolute income-related inequalities in caesarean sections increased over time.ConclusionsSpecial attention should be given to the antenatal care of poor and Black women in order to reduce inequalities. The explosive increase in caesarean sections requires radical changes in delivery care policies, in order to reverse the current trend.

Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey

“…Consistent with available literature [ 19 , 35 ], we noticed extensive pro-rich disparities in the utilization of ANC services in Angola. The logical explanation for better ANC uptake among rich/richest women could be that women in the lower wealth quintiles (poorer or poorest) may not be able to afford the medical and non-medical costs associated with using ANC [ 36 , 37 ].…”

Maternal reproductive history: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

“…In contrast to such improvements, there have been marked increases in preterm deliveries and stagnation in the prevalence of low birthweight 17 . The city of Pelotas followed this trend, as described in the accompanying articles in this journal 23 , 44 Specifically, preterm births rose from 6.3% in 1982 to 15.5% in 2015 46 . The increased prevalence of histories of preterm births among the poor, and of low birthweight among the rich, are consistent with the results for the children born in the four cohorts 46 and are likely related to changes in obstetric practices, particularly the remarkable increase in caesarean sections.…”

Incisional hernia after cesarean section: A systematic review

“…In Brazil the proportion of cesarean sections has risen from 28 % to 65 % between 1982 and 2015. In the Brazilian private sector cesarean section rates as high as 94 % have been reported in birth cohorts from 2015 [12], and the World Health Organization have stated that the cesarean section rates are increasing worldwide [13]. Despite the high number of cesarean sections, the occurrence of incisional hernia is uncertain.…”