Spatial and Time Trends of Cesarean Section Deliveries Across Brazil: A Birth Registry Study

Abstract

AbstractBackground: In 1996, Brazil had the highest rates of cesarean section deliveries in the world at 36.4%. The rate of cesarean deliveries in Brazil remains high. As of 2021, rates exceeded the World Health Organization’s recommendation that 10% or less of deliveries across a population occur via c-section. Cesarean delivery when it is not necessary to protect the life and health of the mother or the baby can cause complications for pre and postnatal care. The excessive use of cesarean delivery methods is driven by political, social and clinical factors. It is well documented that cesarean delivery rates are high in Brazil, but there still exists gaps in the literature about factors driving cesarean delivery rates and potential predictors of high cesarean rates in Brazil since 1996. With this context, the aims of this study were 1) to compare cesarean section rates and vaginal delivery rates across different states in Brazil from 1996 to 2021 and 2) describe the trends of cesarean rates and vaginal deliveries at the regional level from 1996 to 2021. Methods: We conducted a longitudinal, ecological cohort study based on publicly available data from the Brazil Live Birth Information System, which is a subset of the Brazilian Ministry of Health Data Repository. Data from 1996 to 2021 was used in the study. Data was analyzed at the state and regional level using RStudio 2023.12.1. Rates of cesarean deliveries and vaginal deliveries were recorded and analyzed. Results: A total of 71,400,688 million records were analyzed in the study. Time trends since 1996 show a decrease in vaginal deliveries and an increase in cesarean deliveries for all five geographic regions in Brazil (Figure 1). The South and Southeast regions of Brazil had the highest discrepancies between cesarean rates and vaginal deliveries, with gaps as large as 20% (Figure 1). The North and Northeast regions showed similar trends of increasing cesarean section rates and declining vaginal delivery rates (Figure 1). The North region, however, had the lowest rates of cesarean deliveries compared to the other regions in 2021 at 52%. In contrast, the South region of Brazil had the highest rates of cesarean deliveries in 2021 at 64%. An analysis of cesarean rates at the state level revealed similar trends. A majority of the Brazilian states experienced declining vaginal birth rates and increasing cesarean rates from the years 1996-2021 (Figure 2). A notable exception is the state of Amazonas (Figure 2). The state experiences minor increases in cesarean deliveries, and vaginal births still accounted for 58% of total births in the state in 2021. Conclusion: Cesarean section delivery rates have been increasing across Brazil from 1996 to 2021. The southern regions in Brazil are experiencing a sharper increase in cesarean rates than the northern regions. There are discrepancies in the increase in cesarean rates that suggest different political,social, and health systems factors are contributing to rising cesarean deliveries in different states in Brazil. This information can guide local and national health policies and programs related to maternal and neonatal care.