Rates and implications of caesarean sections in Latin America: ecological study Commentary: all women should have a choice Commentary: increase in caesarean sections may reflect medical control not women's choice Commentary: "health has become secondary to a sexually attractive body"

Abstract

Abstract Objectives: To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables. Design: Descriptive and ecological study. Setting: 19 Latin American countries. Main outcome measures: National estimates of caesarean section rates in each country. Results: Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (rs=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region. Conclusions: The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets. Key messages 12 of the 19 Latin American countries studied had caesarean section rates above 15%, ranging from 16.8% to 40% These12 countries account for 81% of the deliveries in the region Better socioeconomic conditions were associated with higher caesarean section rates Over 850 000 unnecessary caesarean sections are performed each year in Latin America Reduction of caesarean section rates will need concerted action from public health authorities, medical associations, medical schools, health professionals, the general population, and the media