High Within-Country Economic Inequality in C-Section Rates

In low-, middle-income countries, C-section rates are lowest in poorest fifth, highest in richest fifth

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FRIDAY, Jan. 26, 2018 (HealthDay News) -- In low- and middle-income countries, there is considerable within-country economic inequality in the rates of cesarean section, according to a study published online Jan. 24 in The BMJ.

Adeline Adwoa Boatin, M.D., from Massachusetts General Hospital in Boston, and colleagues conducted a secondary analysis of demographic and health surveys to provide an update on economic-related inequalities in cesarean section rates among women aged 15 to 49 years. The latest situation of inequality was assessed in 72 low- and middle-income countries with a survey conducted between 2010 and 2014; the change in inequality over was time was assessed for 28 countries that also had a survey conducted between 2000 and 2004.

The researchers found that there was variation in national cesarean section rates from 0.6 percent in South Sudan to 58.9 percent in the Dominican Republic. Cesarean section rates were lowest and highest for the poorest and richest fifth within countries (median, 3.7 and 18.4 percent, respectively). A difference of 20 percentage points or more between the richest and poorest fifth was reported for 18 out of 72 countries. Countries from the region of the Americas had the highest cesarean section rates and the greatest levels of absolute inequality, while countries from the African region had low levels of cesarean use and comparatively lower levels of absolute inequality. Increases in cesarean section rates over time were reported in 26 out of 28 countries; rates tended to increase faster in the richest versus the poorest fifth.

"Substantial within country economic inequalities in cesarean deliveries remain," the authors write. "Country-specific strategies should address these inequalities to improve maternal and newborn health."

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Updated on May 28, 2022

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