Factors associated with high rates of caesarean section in Brazil between 1991 and 2006

To assess trends in caesarean sections in Brazil, identify associated factors and evaluate changes in these factors over time.

Nationally representative data from the 1996 Demographic and Health Survey (n = 4918) and the 2006 Brazilian National Survey (n = 6125) were analysed using binomial logistic regression to assess variations in caesarean sections. Univariate logistic regression and multivariate analysis were used to select variables for predicting caesarean sections and assess potential factors associated with them.

Caesarean sections increased from 33% in 1991 to 40% in 2006 and were significantly more common among older, highly educated, wealthy women living in the South, who had received antenatal care and been delivered by private caregivers. Wealthy, educated women were significantly less likely to have a caesarean section in 2006 than in 1991. Women living in urban areas and in the South had higher odds of caesarean sections in 1991, but not in 2006.

Caesarean section rates in Brazil increased by seven percentage points from 1991 to 2006, but factors associated with high rates changed over time. The odds of caesarean sections decreased for wealthy, educated women over time. By 2006, region and urban versus rural residence were no longer significantly associated with caesarean sections.