The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008

Hopkins, Kristine; Amaral, Ernesto F. L.; Mourão, Aline Nogueira Menezes

doi:10.31219/osf.io/qfhxe

Cited by 4 publications

(6 citation statements)

References 15 publications

(29 reference statements)

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“…A number of other studies have found positive associations of cesarean delivery with richer wealth quintiles and higher educational levels . In addition, other studies’ results are consistent with our finding that the place of delivery (ie, public vs private facility) is the most important structural factor in the outcome of birth by vaginal or cesarean delivery …”

Section: Discussionsupporting

confidence: 92%

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Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

et al. 2020

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Key Points Question Are private vs public sector health care facilities associated with increases in cesarean delivery rates among pregnant women in India over time, and what is the avoidable burden of cesarean deliveries in private sector facilities? Findings In this cross-sectional study of 217 976 births at public and private sector institutions in India between 2005 and 2016, the likelihood of having a cesarean delivery in a private facility more than doubled over the period examined. A reduction in the percentage of cesarean deliveries in the private sector to the World Health Organization’s recommended threshold of 15% was associated with a potential cost savings of approximately $321 million. Meaning The study’s findings indicated that private sector facilities were associated with increases in the rate of cesarean deliveries; it is important that policy makers address the increasing number of avoidable cesarean deliveries in India.

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Section: Discussionsupporting

confidence: 92%

“… 33 In addition, other studies’ results are consistent with our finding that the place of delivery (ie, public vs private facility) is the most important structural factor in the outcome of birth by vaginal or cesarean delivery. 16 , 34 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

et al. 2020

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“…Similar characteristics, including higher education T A B L E 1 (Continued) and urbanicity, have been found to be risk factors for cesarean delivery elsewhere in Latin America. 29,30 Some researchers have argued that these sociodemographic trends reflect a shift toward a "culture of cesareans," 25 in which upper-class women increasingly have cesarean deliveries based on their perception of cesareans as modern, predictable, and safe. 25,32 Other research from Brazil, however, has shown that the majority of pregnant women do not believe that cesarean deliveries are safer 23 and that most women report wanting to deliver naturally.…”

Section: Discussionmentioning

confidence: 99%

Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades

Jahnke

Houck

Bentley

et al. 2019

Birth

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Background: Ecuador’s caesarean delivery rate far exceeds that recommended by the Pan American Health Organization (PAHO) and the World Health Organization (WHO). Using data from three iterations of Ecuador’s nationally representative, population-based survey Encuesta Nacional de Salud y Nutrición (ENSANUT/ENDEMAIN), spanning 23 years, this study aims to compare mode of delivery outcomes by sociodemographics and labor and delivery (L&D) care institution in light of Ecuador’s major healthcare reform over the past two decades. Methods: Using data from the 1994, 2004, and 2012 iterations of the dataset, descriptive statistics were used to demonstrate trends in caesarean delivery based on province, year, and institution of L&D care. Logistic regression was used to test the odds of caesarean delivery based on institution of L&D care, sociodemographics, and pregnancy and birth complications. Predicted probabilities were derived from this model. Results: Ecuador’s rate of caesarean delivery increased from 22% in 1989 to 41% in 2012. Each year, the predicted probability of delivering by caesarean is highest in private institutions and those covered by insurance, and from 2008 to 2012, the predicted probability of delivering by caesarean in private centers is significantly higher than that in public centers. Sociodemographic characteristics also predicted risk of caesarean delivery. Conclusions: In order to decrease the adverse effects of caesarean delivery for women and their babies, caesarean delivery without medical indication should be reduced. Future research should investigate how mothers perceive delivering by caesarean and how medical indication is defined and used within health centers.

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“…As previously discussed, women from higher socioeconomic groups usually use services in private hospitals. These facilities tend to have higher rates of cesarean sections (Hopkins et al 2014). Higher levels of vaginal delivery are observed at the public sector (Hopkins et al 2014), where women tend to be from lower socioeconomic groups.…”

Section: Discussionmentioning

confidence: 99%

“…These facilities tend to have higher rates of cesarean sections (Hopkins et al 2014). Higher levels of vaginal delivery are observed at the public sector (Hopkins et al 2014), where women tend to be from lower socioeconomic groups. Thus, the 1997 family planning law seems to be preventing women from lower socioeconomic groups to have access to sterilization, creating inequalities in the access to contraception by socioeconomic status (Potter et al 2003).…”

Section: Discussionmentioning

confidence: 99%

Profile of female sterilization in Brazil

Amaral¹

2018

Preprint

Self Cite

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1) Background: This study analyzes the profile of female sterilization in Brazil by age, parity, type of delivery, place of delivery, color/race, region of residence, years of schooling, marital status, number of unions, and desired number of children reported by women; (2) Methods: The descriptive analysis is based on the most recent Brazilian database on reproductive health: the 2006 Brazilian National Survey on Demography and Health of Women and Children (PNDS). This dataset has information on the history of pregnancies with live births from January 2001 to July 2007; (3) Results:The study suggests that (a) women with high levels of sterilization, high percentages of more than one pregnancy in the period, and larger parity than the desired number of children tend to have high parity, be black, brown, or indigenous, reside in the North or Northeast, have low levels of education, and have two or more unions; and (b) women with high levels of sterilization, low percentages of more than one pregnancy in the period, and lower parity than the desired number of children tend to have cesarean sections, give birth utilizing private health care obtained through a private insurance plan or direct out-of-pocket payment at private hospitals, and be married. (4) Conclusions: The 1997 family planning law could be altered in order to allow female sterilization in conjunction with childbirth, as a way to attend the demand of Brazilian women in public hospitals. Policies are necessary not only to regulate the public sector, but also to aim better services at private institutions. Female sterilization should be discussed in the context of fertility below the replacement level, as one of its associated factors.

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The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008

Abstract: Background-High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals.

Cited by 4 publications

References 15 publications

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades

Profile of female sterilization in Brazil

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