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

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7322.1155 (Published 17 November 2001) Cite this as: BMJ 2001;323:1155
  1. Joseph E Potter, professor (joe{at}prc.utexas.edu)a,
  2. Elza Berquó, professorb,
  3. Ignez H O Perpétuo, professorc,
  4. Ondina Fachel Leal, professord,
  5. Kristine Hopkins, research associatea,
  6. Marta Rovery Souza, researcherb,
  7. Maria Célia de Carvalho Formiga, researchere
  1. a University of Texas at Austin, Population Research Center, 1800 Main Building, Austin, TX 78712, USA
  2. b University of Campinas, Nucleus for Population Studies, Caixa Postal 6166, Campinas, SP 13081-970, Brazil
  3. c Federal University of Minas Gerais, CEDEPLAR, 832 Rua Curitiba, MG 30170-120, Brazil
  4. d Federal University of Rio Grande do Sul, Postgraduate Program in Social Anthropology, Avenue Bento Goncalves 9500, Porto Alegre, RS 91509-500, Brazil
  5. e Federal University of Rio Grande do Norte, Department of Statistics, Caixa Postal 1615, Natal, RN 59072-970, Brazil
  1. Correspondence to: J Potter
  • Accepted 13 September 2001

Abstract

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.

What is already known on this topic

What is already known on this topic In Brazil, one quarter of all women deliver in the private sector

The rate of caesarean deliveries in the private sector is extremely high (70%) and more than twice that in the public sector, where rates have recently fallen due to a new policy

Previous studies in which women were interviewed after birth showed that a substantial proportion of private patients who have caesarean sections would have preferred normal delivery

What this study adds

What this study adds In two antenatal interviews, preferences regarding type of delivery were nearly identical among public and private patients and strongly favoured vaginal births

Contrary to popular belief, middle and upper class women in Brazil do not want to deliver by caesarean section

Footnotes

  • Funding The study was supported by grants from the US National Institutes of Health (R01-HD33761) and the United Nations Population Fund, Brazil Office (BRA98/01).

  • Competing interests None declared.

  • Accepted 13 September 2001
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