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Cesarean sections in Brazil: will they ever stop increasing?

Fernando C Barros1, Alicia Matijasevich2, Ana Goretti K Maranhão3

  • 1Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil.

Revista Panamericana De Salud Publica = Pan American Journal of Public Health
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Summary

Cesarean delivery rates in Brazil significantly increased from 2000 to 2011, with higher rates among educated, white, older women. Despite interventions, cesarean rates show little impact.

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Area of Science:

  • Public Health
  • Epidemiology
  • Maternal Health

Background:

  • Cesarean delivery rates have been rising globally.
  • Understanding trends and risk factors in Brazil is crucial for public health policy.
  • Previous efforts to curb cesarean rates in Brazil have shown limited success.

Purpose of the Study:

  • To analyze trends and geographic distribution of cesarean deliveries in Brazil between 2000 and 2011.
  • To identify individual and ecological risk factors associated with cesarean deliveries.
  • To evaluate the impact of interventions aimed at reducing cesarean delivery rates.

Main Methods:

  • Observational study utilizing nationwide data from the Unified Health System (DATASUS).
  • Individual-level analysis considering maternal education, age, parity, and skin color.
  • Ecological analysis examining health facility density and poverty levels across 431 health districts.

Main Results:

  • Cesarean rates rose from 37.9% in 2000 to 53.9% in 2011, reaching 55.8% in preliminary 2012 data.
  • Higher cesarean rates were observed in wealthier areas, among women with higher education, white skin color, older age, and nulliparous women.
  • Increased health facility density correlated positively with cesarean rates, while higher poverty rates correlated negatively.

Conclusions:

  • The strong association with maternal education and facility density suggests many cesareans are not medically necessary.
  • Launched policies and programs to counteract rising cesarean rates have had minimal impact.
  • Further research and targeted interventions are needed to address the non-medically indicated cesarean deliveries in Brazil.