http://bmj.com/cgi/content/abstract/323/7322/1155
BMJ 2001;323:1155-1158 ( 17 November )
Joseph E Potter
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@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.
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What is already known on this topic 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 Contrary to popular belief, middle and upper class women
in Brazil do not want to deliver by caesarean section |
Read all Rapid Response
responses
A change of public opinion about caesaren sections
in Brazil
Luis G. A. Quadros, Researcher,
Gynaecology Department , Federal University of São Paulo, Brazil
bmj.com, 16 Nov 2001 [Response]
From the Wall Street Journal about c-sections in
Brazil
Leilah McCracken, childbirth
researcher, writer , Vancouver, Canada V5Z 2B6
bmj.com, 16 Nov 2001 [Response]
Promoting normality in childbirth.
Richard Johanson and Mary Newburn
BMJ 2001 323: 1142-1143.
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