International Journal of Epidemiology, Vol 28, 687-694, Copyright © 1999 by International Epidemiological Association
UA Gomes, AA Silva, H Bettiol and MA Barbieri
BACKGROUND: Brazil has the highest caesarean section (CS) rate in the world
(36.4% in 1996). METHODS: Risk factors for increasing CS rate were studied
in two population-based cohorts of singleton live births in families
residing in the municipality of Ribeirao Preto, State of Sao Paulo,
Southeast Brazil. The first comprised births from June 1978 to May 1979
(6750 births-one-year survey) and the second births from May to August 1994
(2846 births-4-month survey). Multiple unconditional logistic regression
modelling was used to control for confounding. RESULTS: The CS rate rose
from 30.3% in 1978-1979 to 50.8% in 1994. In 1978-1979, socioeconomic,
reproductive and demographic variables, and health service factors were
associated with CS rate. In 1994, only reproductive, demographic and health
service factors remained associated, e.g. hour of delivery (from 7 a.m. to
12 p.m.), attendance by the same physician for prenatal care and delivery,
> or =4 prenatal visits, maternal age > or =30 years, 1-3 previous
live births and birthweight 3500-3999 g. CONCLUSION: Caesarean section in
Brazil is widely performed for non-medical reasons in which physician
convenience plays an important role. There is an urgent need for public
health interventions to reduce the CS rate in Brazil, mainly directed
towards cultural beliefs and physician behaviour.
ARTICLES
Risk factors for the increasing caesarean section rate in Southeast Brazil: a comparison of two birth cohorts, 1978-1979 and 1994
Departamento de Medicina Social, Faculdade de Medecina de Ribeirao Preto, Universidade de Sao Paulo, Brazil.
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