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Rates and implications of caesarean sections in Latin America: ecological studyCommentary: all women should have a choiceCommentary: increase in caesarean sections may reflect medical control not women's choiceCommentary: “health has become secondary to a sexually attractive body”

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7222.1397 (Published 27 November 1999) Cite this as: BMJ 1999;319:1397

Abstract

Objectives: To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables.

Design: Descriptive and ecological study.

Setting: 19 Latin American countries.

Main outcome measures: National estimates of caesarean section rates in each country.

Results: Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (rs=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region.

Conclusions: The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets.

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

Footnotes

    • Accepted 13 July 1999

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

    1. José M Belizán, director (belizanj{at}clap.ops-oms.org)a,
    2. Fernando Althabe, researcher in perinatologya,
    3. Fernando C Barros, Pan American Health Organisation consultanta,
    4. Sophie Alexander, lecturerb
    1. a Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clínicas s/n, 11000 Montevideo, Uruguay
    2. b Ecole de Santé Publique, Université Libre de Bruxelles, Campues Erasme CP 595 808, Brussels, Belgium
    3. Princeton University Department of English, Princeton, NJ, USA
    4. Center for Population and Development Studies, Harvard School of Public Health, Harvard, USA
    5. PO Box 569, Blackwood SA 5051, Australia
    1. Correspondence to: J M Belizán
    • Accepted 13 July 1999

    Abstract

    Objectives: To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables.

    Design: Descriptive and ecological study.

    Setting: 19 Latin American countries.

    Main outcome measures: National estimates of caesarean section rates in each country.

    Results: Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (rs=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region.

    Conclusions: The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets.

    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

    Footnotes

    • Funding Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation.

    • Competing interests None declared.

    • Accepted 13 July 1999

    Commentary: all women should have a choice

    1. Elaine Showalter, professor of English (112075.445{at}compuserve.com),
    2. Anne Griffin, research assistant
    1. a Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clínicas s/n, 11000 Montevideo, Uruguay
    2. b Ecole de Santé Publique, Université Libre de Bruxelles, Campues Erasme CP 595 808, Brussels, Belgium
    3. Princeton University Department of English, Princeton, NJ, USA
    4. Center for Population and Development Studies, Harvard School of Public Health, Harvard, USA
    5. PO Box 569, Blackwood SA 5051, Australia
    1. Correspondence to: E Showalter

      Footnotes

      • Competing interests None declared.

        Commentary: increase in caesarean sections may reflect medical control not women's choice

        1. Arachu Castro, David E Bell research fellow (acastro{at}hsph.harvard.edu)
        1. a Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clínicas s/n, 11000 Montevideo, Uruguay
        2. b Ecole de Santé Publique, Université Libre de Bruxelles, Campues Erasme CP 595 808, Brussels, Belgium
        3. Princeton University Department of English, Princeton, NJ, USA
        4. Center for Population and Development Studies, Harvard School of Public Health, Harvard, USA
        5. PO Box 569, Blackwood SA 5051, Australia

          Footnotes

          • Competing interests None declared.

            Commentary: “health has become secondary to a sexually attractive body”

            1. Hilda Bastian, consumer health advocate (hilda.bastian{at}flinders.edu.au)
            1. a Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clínicas s/n, 11000 Montevideo, Uruguay
            2. b Ecole de Santé Publique, Université Libre de Bruxelles, Campues Erasme CP 595 808, Brussels, Belgium
            3. Princeton University Department of English, Princeton, NJ, USA
            4. Center for Population and Development Studies, Harvard School of Public Health, Harvard, USA
            5. PO Box 569, Blackwood SA 5051, Australia

              Footnotes

              • Competing interests None declared.

              • website extra Further details of sources of data for each country are available on the BMJ's website www.bmj.com

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