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Unwanted caesarean sections among public and private patients in Brazil: prospective study
J E Potter1, E Berquó, I H Perpétuo
1University of Texas at Austin, Population Research Center, Austin, Texas, USA.
Objective:
To assess and compare the preferences of pregnant women in the public and private sector regarding delivery in Brazil.
Design:
Face to face structured interviews with women who were interviewed early in pregnancy, about one month before the due date, and about one month post partum.
Setting:
Four cities in Brazil.
Participants:
1612 pregnant women: 1093 public patients and 519 private patients.
Main Outcome Measures:
Rates of delivery by caesarean section in public and private institutions; women's preferences for delivery; timing of decision to perform caesarean section.
Results:
1136 women completed all three interviews; 476 women were lost to follow up (376 public patients and 100 private patients). Despite large differences in the rates of caesarean section in the two sectors (222/717 (31%) among public patients and 302/419 (72%) among private patients) there were no significant differences in preferences between the two groups. In both antenatal interviews, 70-80% in both sectors said they would prefer to deliver vaginally. In a large proportion of cases (237/502) caesarean delivery was decided on before admission: 48/207 (23%) in women in the public sector and 189/295 (64%) in women in the private sector.
Conclusions:
The large difference in the rates of caesarean sections in women in the public and private sectors is due to more unwanted caesarean sections among private patients rather than to a difference in preferences for delivery. High or rising rates of caesarean sections do not necessarily reflect demand for surgical delivery.
