Recent trends in cesarean section reduction in extreme south of Brazil: a reality only in the public sector?

Abstract

This study aimed to describe changes in cesarean section (C-section) prevalence from 2007 to 2019, in public and private sectors, according to maternal characteristics. We included all puer-peral women who gave birth in Rio Grande, Rio Grande do Sul, Brazil, at years 2007, 2010, 2013, 2016 and 2019. A questionnaire was applied up to 48 hours after delivery. We assessed C-section rates over time and described the prevalence according to independent variables. Poisson regression was used. A total of 12.415 puerperal women were in-cluded. The prevalence of C-section increased between 2007-2013 (from 51.2% to 61.2%) and de-creased between 2013-2019 (48.9% in 2019). This decrease was observed only in the public sector and was higher among the youngest (-10.0 percentual points) and high educated women (-10.3 percen-tual points). While in the private sector C-section occurrence increased even more (95.7% in 2019). In the public sector, women that were older, with a partner, primiparous, who performed prenatal care in the private system and with adequate prenatal assistance presented higher prevalence of C-section. In the private sector the prevalence was high independently of the maternal characteris-tics. In order to reduce C-section rates, efficient delivery care policies mainly focused on the private sector are necessary.