The Role of Nonclinical Factors in Cesarean Section Rates in Brazil

Kristine Hopkins, University of Texas at Austin
Ernesto F. Amaral, University of Texas at Austin

This study explores the role of nonclinical factors in cesarean section rates in Brazil. Brazil has one of the highest cesarean section rates (37%) in the world. These rates, in turn, are extraordinarily high in private hospitals (over 70%) while in public hospitals they are typically in the 20 to 30 percent range. In analyzes using the 1998 Brazilian household survey (PNAD), we find that while education and income level have a very strong positive association with cesarean rates in Brazil, most of that effect disappears in a multivariate model that includes type of hospital. Where a women delivers, then, is the strongest predictor of whether it will be a surgical delivery or not, regardless of her individual characteristics. Policies that attempt to bring down the cesarean rate in Brazil will need to focus less on women’s characteristics and more on the structural conditions in which Brazilian women give birth.