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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