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Comparative Study
. 2001 Nov 17;323(7322):1155-8.
doi: 10.1136/bmj.323.7322.1155.

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

J E Potter  1 , E Berquó, I H Perpétuo, O F Leal, K Hopkins, M R Souza, M C Formiga
Affiliations
Comparative Study

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

J E Potter et al. BMJ. .

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.

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Figures

Figure 1
Figure 1
Preference for type of delivery at first interview, according to parity and previous delivery, by sector
Figure 2
Figure 2
Caesarean section rates for women who preferred vaginal delivery in first and second interviews, by sector, parity, and previous birth experience
See this image and copyright information in PMC

References

    1. Murray SF. Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. BMJ. 2000;321:1501–1505. - PMC - PubMed
    1. Graham WJ, Hundley V, McCheyne AL, Hall MH, Gurney E, Milne J. An investigation of women's involvement in the decision to deliver by caesarean section. Br J Obstet Gynaecol. 1999;106:213–220. - PubMed
    1. Paterson-Brown S, Fisk NM. Caesarean section: every woman's right to choose? Curr Opin Obstet Gynecol. 1997;9:351–355. - PubMed
    1. Mould TA, Chong S, Spencer JA, Gallivan S. Women's involvement with the decision preceding their caesarean section and their degree of satisfaction. Br J Obstet Gynaecol. 1996;103:1074–1077. - PubMed
    1. Roberts CL, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. BMJ. 2000;321:137–141. - PMC - PubMed

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