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”

Sources, type of data, and estimations of national rates for each Latin American country

Argentina

Sources—Maternal-Infant Program, Ministry of Health, Province of Buenos Aires. Centro Rosarino de Estudios Perinatales (World Health Organisation). Unión Obrera de la Construcción de la República Argentina / Obra Social del Personal de la Construcción (Building Operators Union). Private Health Insurance Company of Buenos Aires.

Type of data—Caesarean section rates from all deliveries in public hospitals of Buenos Aires Province during 1996 (19.4%). Caesarean section rates from all deliveries in public and private hospitals of Rosario, Province of Santa Fe, during 1997. Caesarean section rates from 6635 deliveries of women belonging to the social security system of the Building Operators Union during 1997 (700 000 affiliates), assisted in public or private hospitals (caesarean section rates of 20.9% and 35.8% respectively). Caesarean section rates from 1715 deliveries of women belonging to a private health insurance company of Buenos Aires City (100 000 affiliates).

Estimation of national rates—The lowest rates provided for each sector was used for the estimation (15% for public and 35.8% for private sector). Each sector accounts for 50% of the total number of deliveries in the country.

Bolivia

Source—Data from the 1994 Demographic Health Survey, Pan American Health Organisation focal point report of institutional deliveries.

Type of data—Estimates of national caesarean section rates.

Brazil

Sources—Ministerio da Saúde. DATASUS. Assistência à saúde prestada pelo SUS em 1994, 1997. Partos Hospitalares. Brasilia: Coordenaçao de Informaçoes em Saúde. Gerência Técnica de Disseminaçao de Informaçoes 1995, 1998.

Type of data—Caesarean section rates from 2 718 265 deliveries assisted in public and private hospitals during 1997.

Estimation of national rates—Based on institutional rates and proportion of institutional deliveries.

Chile

Sources—National rate provided by Pan American Health Organization office. Caesarean section rates by sector were obtained from Murray and Serani Praderas.[7]

Type of data—National.

Colombia

Sources—1995 Demographic Health Survey and data from the Latin American Caesarean Section Study.

Type of data—National estimate and caesarean section rates from 76 348 deliveries assisted in 18 hospitals (nine public, three from social security system, and 6 private) in six cities during 1996 and 1997.

Costa Rica

Sources—Caja Costarricense de Seguro Social. Sección Información Biomédica. El parto por cesárea en la Caja Costarricense de Seguro Social 1993. Costa Rica Seguro Social, 1995 (Serie Estadística de la Salud No 6).

Type of data—Caesarean section rates of 76 622 institutional deliveries in the social security system during 1993.

Estimation of national rates—The caesarean section rate of the social security system (93.5% of all country births) was assumed representative of national rates.

Cuba

Sources—National Statistics Office, Ministry of Public Health.

Type of data—Caesarean section national rates from all deliveries during 1997.

Ecuador

Sources—Ministry of Public Health, National Institute of Statistics and Census.

Type of data—Caesarean section national rates and caesarean sections from 95 400 deliveries in public hospitals during 1996.

El Salvador

Sources—Ministry of Public Health and Social Security Institute.

Type of data—Caesarean section rates from all deliveries assisted in public and social security hospitals* during 1996. These sectors cover 91% of the institutional births. The remaining 9% correspond to private and hospitals run by non-governmental organisations, from which data are not available.

Estimation of national rates—Based on institutional rates and proportion of institutional deliveries

Guatemala

Source—National caesarean section statistics, Ministry of Public Health and Public Assistance.

Type of data—National data from 370 021 live births during 1997.

Haiti

Sources—Data from the 1994/5 demographic health survey and statistical report of the Ministry of Public Health and Population.

Type of data—Estimates of national caesarean section rates from demographic health survey and data from 24 279 public institutional deliveries in 1995.

Honduras

Sources—National survey of epidemiology and family health, 1996

Type of data—Caesarean section rates in a national sample of 1972 women aged 15- 49 years.

Mexico

Sources—National health system report, 1996. Comité Promotor por una Maternidad sin Riesgos en México. Cesáreas, tendencias y perspectivas. México: INPer, 1996.

Type of data—Caesarean section rates for all 1 520 258 deliveries in public and social security hospitals during 1996. Caesarean section rates from 14 463 deliveries in nine private hospitals in Mexico City during 1995.

Estimation of national rates—Mexico had an estimated 2 338 000 deliveries in 1996, of which 84% were institutional (1 964 000); 1 520 200 were well documented as public sector births, with a caesarean section rate of 27.4% (416 000). The remaining 443 600 births are estimated to correspond to the private sector, which had a caesarean section rate of 59% (261 700). The estimated number of caesarean sections in 1996 was 677 800.

Panama

Sources—Data from the project "epidemiology of caesarean section in Latin America."[14]

Type of data—Caesarean section rates reports from 39 266 deliveries (63% of the country births) in six public and social security hospitals during 1996.

Estimation of national rates—Based on institutional rates and the proportion of institutional deliveries.

Paraguay

Sources—Direction of Family Health, Ministry of Public Health and Social Welfare.

Type of data—Number of caesarean sections (14 272) from 58 551 deliveries assisted in public hospitals, 5932 deliveries assisted in one main hospital of the social security system, and 4114 deliveries assisted in one private non-profit hospital.

Estimation of national rates—Based on institutional rates and proportion of institutional deliveries.

Peru

Sources—Data from the 1996 demographic health survey and report from the maternal-perinatal programme, Ministry of Health.

Type of data—Estimates of national caesarean section rates of 254 553 public institutional deliveries during 1997.

Dominican Republic

Source—1996 demographic health survey.

Type of data—Caesarean section national rate.

Uruguay

Source—Statistical division, Ministry of Public Health.

Type of data—National. caesarean section rates from the 58 862 total number of births during 1996.

Venezuela

Source—Perinatal and reproductive statistics, Ministry of Health

Type of data—National, 1995.