Inequalities in caesarean section: influence of the type of maternity care and social class in an area with a national health system.

ABSTRACT

OBJECTIVE: To analyse the impact of social class inequalities and type of maternity unit in the use of caesarean sections (CSs) among residents in an urban area of Southern Europe. DESIGN: This was a cross-sectional study. The study population consisted of 2186 women resident in Barcelona city who gave birth to an infant without any birth defect during 1994-2003. The dependent variable was the type of delivery. Maternal age, social class and type of maternity unit (public or private) were independent variables. Maternal age-adjusted logistic regression models were used. RESULTS: 30% of deliveries ended in CS; 70% of less privileged women delivered in public maternity units and 72% of more privileged women delivered in private centres. A relationship between CS and social class was observed (OR 1.4; 95% CI 1.1 to 1.7), but disappeared when the analysis was done separately for each stratum of type of maternity unit (both ORs 1.0). In contrast, a relationship between CS and type of maternity unit was found (OR 2.3; 95% CI 1.9 to 2.7), which persisted when the analysis was done separately for each stratum of social class. CONCLUSION: Although strongly related to higher social class, the main determinant of the high proportion of CSs was delivering in private maternity units.