Rates and implications of caesarean sections in Latin America: ecological study

BMJ 1999;319:1397-1402 ( 27 November )

Papers

José M Belizán, director, ^a Fernando Althabe, researcher in perinatology, ^a Fernando C Barros, Pan American Health Organisation consultant, ^a Sophie Alexander, lecturer. ^b

^a Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clínicas s/n, 11000 Montevideo, Uruguay, ^b Ecole de Santé Publique, Université Libre de Bruxelles, Campues Erasme CP 595 808, Brussels, Belgium

Correspondence to: J M Belizán belizanj{at}clap.ops-oms.org

Objectives: To estimate the incidences of caesarean sectionsin Latin American countries and correlate these with socioeconomic,demographic, and healthcarevariables.
Design: Descriptive and ecologicalstudy.
Setting: 19 Latin Americancountries.
Main outcome measures: National estimates of caesarean section ratesin eachcountry.
Results: Seven countries had caesarean section ratesbelow 15%. The remaining 12 countries had rates above 15% (range16.8% to 40.0%). These 12 countries account for 81% of the deliveriesin the region. A positive and significant correlation was observedbetween the gross national product per capita and rate of caesareansection (rs=0.746), and higher rates were observed inprivate hospitals than in public ones. Taking 15% as a medicallyjustified accepted rate, over 850 000 unnecessary caesarean sectionsare performed each year in theregion.
Conclusions: The reported figures represent an unnecessaryincreased risk for young women and their babies. From the economicperspective, this is a burden to health systems that work withlimitedbudgets.

Key messages

12 of the 19 Latin American countries studied had caesarean section rates above 15%, ranging from 16.8% to 40%
These12 countries account for 81% of the deliveries in the region
Better socioeconomic conditions were associated with higher caesarean section rates
Over 850 000 unnecessary caesarean sections are performed each year in Latin America
Reduction of caesarean section rates will need concerted action from public health authorities, medical associations, medical schools, health professionals, the general population, and the media

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