Abstract

SOUZA JUNIOR, Julio César de; KUNKEL, Nádia; GOMES, Marcius de Almeida  and  FREITAS, Paulo Fontoura. Inverse equity and inequalities in the use of technology in childbirth, in Santa Catarina, Brazil, 2000 to 2004. Rev. Bras. Saude Mater. Infant. [online]. 2007, vol.7, n.4, pp.397-403. ISSN 1806-9304.  https://doi.org/10.1590/S1519-38292007000400007.

OBJECTIVES: to investigate changes over time and factors associated with caesarean section rates in the State of Santa Catarina, Brazil, between 2000 and 2004. METHODS: data from the Live Births National Information System for the State of Santa Catarina were used. The variables analyzed were maternal age and literacy, ethnicity/skin color of the newborn, duration of gestation and number of prenatal consultations. Crude and adjusted prevalence rates were estimated for each of the variables using Poisson regression. RESULTS: rates for the period were three times higher of those accepted by the World Health Organization and increased from 43.3% in 2000 to 50.6% in 2004. For the whole period (2000-2004) prevalence rates, both crude and adjusted, were found to be positively associated with higher maternal literacy (PR_adj=1.50; 95%CI: 1.47-1,52), older age (PR_adj=2.10; 95%CI: 2.05-2.15), greater number of prenatal consultations (PR_aj=1.27; 95%CI: 1.26-1.29), pre-term (PR_adj=1.10; 95%CI: 1.06-1.13) and post-term deliveries (PR_adj=1.22; 95%CI: 1.14-1.30), and protection for the indigenous (PR_adj=0.79; 95%CI: 0.75-0.85) and "non-white" newborns (PR_adj=1.10; CI95%: 1.06-1.14). A significant decrease in the adjusted prevalence ratios (PRs) when comparing the extremes in the period (2000 and 2004) appeared for all variables and categories. CONCLUSIONS: the caesarean section rates were well above those justified for medical reasons alone. The decrease in the caesarean section PRs when comparing extremes during the period calls attention to a reduction in the effects of the "inverse equity" probably connected to a higher access to childbirth technology among women of lower socio-economic status, at least partly attributable to more liberal use of this technology in obstetrical practice, including more widespread medical recommendation of caesarean section.

Keywords : Cesarean Section; Risk factors; Health inequalities; Socioeconomic factors; Ethnic groups; Educational status; Maternal age; Women's health; Indigenous population.

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