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Inequalities in caesarean section: influence of the type of maternity care and social class in an area with a national health system
  1. Joaquin Salvador1,
  2. Gemma Cano1,
  3. Maica Rodriguez-Sanz1,
  4. Anna Lladonosa2,
  5. Carme Borrell1
  1. 1 Agència de Salut Pública de Barcelona, Spain;
  2. 2 Adknoma, Spain
  1. E-mail: cborrell{at}


Objective: To analyse the impact of social class inequalities and type of maternity unit in the use of caesarean sections (CS) among residents in an urban area of Southern Europe.

Design: This was a cross-sectional study. The study population was composed of 2,186 women resident in Barcelona city who gave birth to an infant without any birth defect during the period 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: Thirty percent of deliveries ended in CS. Seventy percent 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: 1.1-1.7), but disappeared when the analysis was done separately for each stratum of type of maternity unit (both OR=1.0). On the other hand, a relationship between CS and type of maternity unit was found (OR=2.3; 95%CI: 1.9-2.7), 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 CS was delivering in private maternity units.

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