Rates, Trends and Determinants of Cesarean Section Deliveries in El Salvador: 1998 to 2008

Abstract

University of Washington Abstract Rates, Trends and Determinants of Cesarean Section Deliveries in El Salvador: 1998-2008 Susan Strom Chair of the Supervisory Committee: Branko Kopjar Associate Professor, Health Services Background: Rates of cesarean section births have been rising since the 1990s in virtually all developed countries and increasingly in middle-income countries as well. In over 50% of countries worldwide, rates now exceed the World Health Organization's recommended upper limit of 15% of births by cesarean section. Just as the cesarean section birth rate varies between countries, it also varies between sub-populations within countries. Excessively high rates of cesarean section births do not increase health benefits and actually increase maternal and infant morbidity and mortality. They also divert health care resources from other medical priorities in resource-poor countries. Objectives: The objectives of this study are to evaluate the over-all rate and change over time of cesarean section deliveries in El Salvador from 1998 to 2008, to identify and describe cesarean section rates among sub-populations within El Salvador, and to examine factors and determinants related to cesarean section deliveries and their change over time. Methods: This study is a retrospective analysis of observational, cross-sectional, population-based survey data collected in 1998, 2003 and 2008 in El Salvador. We investigated associations between sociodemographic and reproductive characteristics using bivariate and logistic regression analyses and calculated odds ratios, examined associations for confounding and evaluated interactions between age, area, socioeconomic status, number of children and religion and their effects on cesarean section birth rates. Results: The over-all cesarean section birth rate increased from 15.7% to 24.9% between 1998 and 2008 respectively. During this time, women became more educated and their socioeconomic status improved. Women living in urban areas, of high socioeconomic status, more educated and delivering in private facilities had higher rates of cesarean deliveries, approaching 50% among this sub-population of women. Conclusion: Although there were multiple statistically significant determinants related to the changes in cesarean section birth rates between 1998 and 2008, the shift from births taking place in private homes to births occurring in medical facilities was the major factor accounting for the increase in cesarean section birth rates among Salvadoran women.