Papers

Unwanted caesarean sections among public and private patients in Brazil: prospective study

Joseph E Potter, professor, ^a Elza Berquó, professor, ^b Ignez H O Perpétuo, professor, ^c Ondina Fachel Leal, professor, ^d Kristine Hopkins, research associate, ^a Marta Rovery Souza, researcher, ^b Maria Célia de Carvalho Formiga, researcher. ^e

^a University of Texas at Austin, Population Research Center, 1800 Main Building, Austin, TX 78712, USA, ^b University of Campinas, Nucleus for Population Studies, Caixa Postal 6166, Campinas, SP 13081-970, Brazil, ^c Federal University of Minas Gerais, CEDEPLAR, 832 Rua Curitiba, MG 30170-120, Brazil, ^d Federal University of Rio Grande do Sul, Postgraduate Program in Social Anthropology, Avenue Bento Goncalves 9500, Porto Alegre, RS 91509-500, Brazil, ^e Federal University of Rio Grande do Norte, Department of Statistics, Caixa Postal 1615, Natal, RN 59072-970, Brazil

Correspondence to: J Potter joe{at}prc.utexas.edu

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.