TY - JOUR
T1 - Prevalence, disparities, and determinants of primary cesarean births among first-time mothers in Mexico
AU - Guendelman, Sylvia
AU - Gemmill, Alison
AU - Thornton, Dorothy
AU - Walker, Dilys
AU - Harvey, Michael
AU - Walsh, Julia
AU - Perez-Cuevas, Ricardo
N1 - Publisher Copyright:
© 2017 Project HOPE - The People-to-People Health Foundation, Inc.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.
AB - Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.
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U2 - 10.1377/hlthaff.2016.1084
DO - 10.1377/hlthaff.2016.1084
M3 - Article
C2 - 28373338
AN - SCOPUS:85017164757
SN - 0278-2715
VL - 36
SP - 714
EP - 722
JO - Health Affairs
JF - Health Affairs
IS - 4
ER -