Současná Evropa 2019, 2019(1):4-15

Rising Caesarean Section Rates in the Czech Republic and Brazil – Determinants And Costs Estimation Analysis

Marie Kalkusová, Tereza De Castro

The rising proportion of caesarean births beyond the World Health Organization 15% threshold level has been a worldwide trend consecutively creating an additional financial burden to health care systems. The Czech Republic used to report low Caesarean Section (CS) rates; nevertheless, since 2004, it has surpassed the recommended level. Currently, it belongs among countries with a 25 to 30% rate. On the contrary, Brazil has been the world's leading country in CS birth rates (57% of deliveries), reaching alarming numbers already in the 1980s. The aim of this paper is firstly to seek the reasoning behind significantly higher numbers of CS rates in Brazil compared to the Czech Republic since the millennia by explaining trends and mindset of social classes, and secondly to estimate extra costs related to a rising number of CS births in Brazil in comparison to the Czech Republic. Since public birth institutions in Brazil lack a decent public recognition, the low and growing middle-income class - characterized with medium/higher education and with a slightly higher average age of the mother at pregnancy - prefer CS deliveries (if affordable) whereas, high-income class mothers prefer to pay for natural births. Brazilian women with the highest education also tend to require natural birth due to more heightened awareness related to CS risks. Simultaneously, the occurrence of CS in the Czech Republic increases with education, reflecting more years spent studying, hence the last age of mothers-to-be. As per results of cost estimation, the extra expenditure related to CS in the Czech Republic for years 2000-2013 are relatively negligible (0.0564% of the Czech 2014 GDP); however, the total costs for the same year corresponds to 0.71% of Brazilian 2014 GDP. If managed to decrease the excess number of CS deliveries, these funds could be reallocated to other health fields, which lack capital support.

Keywords: Czech Republic, Brazil, Caesarean section, cost, social classes

Published: December 17, 2020  Show citation

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Kalkusová, M., & De Castro, T. (2019). Rising Caesarean Section Rates in the Czech Republic and Brazil – Determinants And Costs Estimation Analysis. Contemporary Europe, 2019(1), 4-15
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    References

    1. BÉHAGUE, Dominique P, VICTORA, Cesar G, BARROS Fernando C., 2002. Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. BMJ (Clinical research ed) [online]. 324(7343), 942-945 [Accessed 6 February 2017]. DOI: 10.1136/bmj.324.7343.942 Go to original source...
    2. Berquó, Elza, 1993. Brasil, um Caso Exemplar-anticoncepção e parto cirúrgicos-à espera de uma ação exemplar. Revista Estudos Feministas [online]. 1(2), 366 [Accessed 5 February 2017]. DOI: https://doi.org/10.1590/%25x Go to original source...
    3. BETRÁN, Ana Pilar, TORLONI, Maria Regina, ZHANG, Jun, YE, Jiangfeng, MIKOLAJCZYK, Rafael, DENEUX-THARAUX, Catherine, OLADAPO, Olufemi T, SOUZA, Joao Paulo, Tunçalp, Özge, VOGEL, Joshua, Gülmezoglu, Ahmet Metin, 2015. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health [online]. 12(1),57 [Accessed 6 February 2017]. DOI: 10.1186/s12978-015-0043-6 Go to original source...
    4. BETRÁN, Ana, YE, Jianfeng, MOLLER, Ann-Beth, ZHANG, Jun, GÜLMEZOGLU, Ahmet, TORLONI, Maria, 2016. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PloS one [online]. 11(2) [Accessed 6 February 2017]. DOI: 10.1371/journal.pone.0148343 Go to original source...
    5. DATASUS, 2017. Datasus Tecnologia da Informacao a Servico do SUS [online]. [Accessed 2 February 2017]. Available at: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc%2Fcnv%2Fnvuf.def
    6. DIAS, Marcos, DOMINGUES, Rosa, PEREIRA, Ana Paula, FONSECA, Sandra, 2008. Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro. Ciênc. saúde coletiva [online]. 13(5), 1521-1534 [Accessed 6 February 2017]. ISSN 1413-8123. Available at: http://dx.doi.org/10.1590/S1413-81232008000500017. Go to original source...
    7. Faúndes, Aníbal, Cecatti, José Guilherme, 1991. A Operação Cesárea no Brasil. Incidência, Tendências, Causas, Conseqüências e Propostas de Ação. Cadernos de SaúdePública [Online]. [Accessed 9 February 2017]. Available at: http://www.scielo.br/scielo.php?script=sci_arttextπd=S0102-311X1991000200003
    8. Gibbons, Luz, Belizán, José, Lauer, Jeremy, Betrán, Ana, Merialdi, Mario, Althabe, Fernando, 2010. The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage HEALTH SYSTEMS FINANCING. World Health Report [online]. 30 [Accessed 8 February 2017]. Available at: https://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf
    9. HE, Zhifei, CHENG, Zhaohui, WU, Tailai Wu, et al., 2016. The Costs and Their Determinant of Cesarean Section and Vaginal Delivery: An Exploratory Study in Chongqing Municipality, China. Journal of Biomedicine and Biotechnology [online]. [Accessed 7 February 2017]. DOI: https://doi.org/10.1155/2016/5685261 Go to original source...
    10. Henderson, Jane, McCandlish, Rona, Kumiega, Lesley, Petrou, Stavros, 2001. Systematic review of economic aspects of alternative modes of delivery. British Journal of Obstetrics and Gynaecology [online]. 108(2) [Accessed 7 February 2017]. DOI: 10.1111/j.1471-0528.2001.00044.x Go to original source...
    11. HOU, Xiaohui, Rakhshani Noor Sabah, Iunes, Roberto, 2014. Factors associated with high Cesarean deliveries in China and Brazil - A call for reducing elective surgeries in moving towards Universal Health Coverage. Journal of Hospital Administration [online]. 3(5) [Accessed 6 February 2017]. DOI: 10.5430/jha.v3n5p67 Go to original source...
    12. HOVORKA, Jiří, 2011. Kolik stojí porod? In: Měšec.cz [Online]. 17.8.2011 [Accessed 10 August 2018]. Available at: https://www.mesec.cz/clanky/kolik-stoji-porod/Interview with medical practitioners, obstetricians, from Prague's hospitals. Prague 16. 7. 2017
    13. Kolářová, Marta, 2008. Perception of Social Classes and Class Identification in the Czech Republic. Pp. 76-83 in Šafr, Jiří, Julia Häuberer (eds.). Social Distances and Stratification: Social Space in the Czech Republic. Sociologické studie / Sociological Studies 08:4. Praha: Sociologický ústav AV ČR, v.v.i. 108 s. ISBN 978-80-7330-159-0
    14. Mardešićová, Nicole, Velebil, Petr, 2010. Epidemiologie císařských řezů. In: Zdravi.euro.cz [Online]. 5.2.2010 [Accessed 10 August 2017]. Available at: https://zdravi.euro.cz/clanek/postgradualni-medicina/epidemiologie-cisarskych-rezu-449539
    15. McCallum, Cecilia, 2005. Explaining caesarean section in Salvador da Bahia, Brazil. Sociology of Health and Illness [online]. 27(2) [Accessed 5 February 2017]. ISSN 0141-9889. DOI: 10.1111/j.1467-9566.2005.00440.x Go to original source...
    16. Mitteroecker, Philipp, Huttegger, Simon M., Fischer, Barbara, Pavlicev, Mihaela, 2016. Proceedings of the National Academy of Sciences [online]. 113(15), 14680-14685 [Accessed 7 February 2017]. DOI: 10.1073/pnas.1612410113 Go to original source...
    17. Murray, Susan F, 2000. Relation between private health insurance and high rates of caesarean section in Chile: qualitative and quantitative study. BMJ [online]. 321, 1501-1505 [Accessed 8 February 2017]. DOI: https://doi.org/10.1136/bmj.321.7275.1501 Go to original source...
    18. Ncube, Mthuli, Shimeles, Abebe, 2015. The Making of Middle Class in Africa: Evidence from DHS Data. Journal of Development Studies [online]. 51(2) [Accessed 18 July 2017]. DOI: 10.1080/00220388.2014.968137 Go to original source...
    19. Oduro, Abena, Baah-Boateng, William. Boakye-Yiadom, Louis. Measuring the Gender Asset Gap in Ghana. Accra: Woeli Publishing Services and University of Ghana, 2011. ISBN: 978-9988-8510-6-4
    20. OECD, 2017. Health at a Glance 2017: OECD Indicators [Online]. [Accessed 11 October 2017]. Available at: http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en
    21. Osava, Ruth Hitomi, Silva, Floria Maria, Tuesta, Esteban Fernandes, Oliveira, Sonia Maria Junqueira, Amaral, Maria Clara Estanislau, 2011. Cesarean sections in a birth center. Rev Saude Publica [online]. 45(6), 1036-43 [Accessed 2 February 2017]. DOI: 10.1590/s0034-89102011000600005 Go to original source...
    22. Pavlíková, Markéta, 2015. Analýza dat o rodičkách z registu NRS. [Online]. [Accessed 10 August 2017]. Available at: http://www.biostatisticka.cz/wp-content/prilohy/Anal%C3%BDza%20dat%20o%20rodi%C4%8Dk%C3%A1ch%20z%20registru%20NRC.pdf
    23. Potter, Joseph E., Berquó, Elza, Ignez, H.O. Peprétuo, Leal, Ondina Fachel, Hopkins, Kristine, Souza, Marta Rovery, and deCarvalho Formiga, Maria Célia, 2001. Unwanted caesarean sections among public andprivate patients in Brazil: prospective study. British Medical Journal [online], 323(7322), 1155-1158 [Accessed 5 February 2017]. DOI: 10.1136/bmj.323.7322.1155 Go to original source...
    24. Queiroz, Maria Veraci, Jacobina e Silva, Nara Suelene, Jorge, Maria Salete, Moreira, Thereza Maria, 2005. Incidence and features of cesarean section and natural childbirth: a comparative study. Revista Brasileira de Enfermagem [online]. 58(6), 687-691 [Accessed 29 January 2017]. DOI: 10.1590/s0034-71672005000600011 Go to original source...
    25. Ronsmans, Carine, Holtz, Sara, Stanton, Cynthia, 2006. Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet [online]. 368(9546), 1516-1523. DOI: 10.1016/S0140-6736(06)69639-6 Go to original source...
    26. Torloni, Maria Regina, Daher, Silvia, Betrán, Ana Pilar, Widmer, Mariana, MONTILLA, Pilar, Souza, Joao Paulo, MERIALDI, Mario, 2011. Portrayal of caesarean section in Brazilian women's magazines: a 20 year review. BMJ [online]. 342, d276 [Accessed 10 February 2017]. DOI: https://doi.org/10.1136/bmj.d276 Go to original source...
    27. UZIS, 2017. Institute of Health Information and Statistics of the Czech Republic. [Online]. [Accessed 11 October 2017]. Available at: www.uzis.cz
    28. Vogel, Joshua P, Betrán, Ana Pilar, Vindevoghel, Nadia, Souza, João Paulo, Torloni, Maria Regina, Zhang, Jun, et al., 2015. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. The Lancet Global health [online]. 3(5),e260-70. [Accessed 7 February 2017]. DOI: 10.1016/S2214-109X(15)70094-X Go to original source...
    29. World Health Organization, 1985. Appropriate Technology for Birth. The Lancet [Online]. 326 (8452),436-437 [Accessed 6 February 2017]. DOI: https://doi.org/10.1016/S0140-6736(85)92750-3 Go to original source...

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