Healthcare, socioeconomic and obstetric factors associated with the excess of cesarean sections in 880,000 births from the city of Rio de Janeiro, Brazil

Objective

A study conducted in Rio de Janeiro aimed to identify the factors contributing to the high rate of cesarean deliveries in the city, which is over three times higher than the World Health Organization recommended. However, the city has a role in strategies and policies to empower primary care and to organize delivery care.

Methods

We conducted a cross-sectional study using the Live Birth Information System from 2012 to 2021. We chose variables related to healthcare, socioeconomic, and obstetric factors and performed a binary logistic regression to estimate the association between each variable and the type of delivery.

Results

Among 880,182 births that occurred over ten years, we found 54.29 % of cesarean sections. The overall accuracy of the final model was 87.8 %. Although the healthcare, socioeconomic and obstetric dimensions contribute to explaining the excess of cesarean sections, obstetric factors were surprisingly less predictive than variables associated with the context of life and healthcare. The most impressive association was the type of hospital and the occurrence of cesarean sections (OR = 9.81, CI 95 % 9.66–9.97). Compared to the series’s first year, 2021 represented a 26 % lower chance of having a cesarean section in Rio de Janeiro (OR = 0.74, CI 95 % 0.72–0.76), probably due to the implementation of primary care and comprehensive obstetric care policies.

Conclusion

The search for an adequate cesarean section rate requires a delicate balance between maternal-fetal safety, patient autonomy, and ensuring that cesarean sections are not performed excessively without medical justification.