Ronsmans Carine, Holtz Sara, Stanton Cynthia
Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
Lancet. 2006 Oct 28;368(9546):1516-23. doi: 10.1016/S0140-6736(06)69639-6.
Little is known about socioeconomic differences in access to life-saving obstetric surgery, yet access to a caesarean for women is essential to achieve low levels of maternal mortality. We examined population-based caesarean rates by socioeconomic groups in various developing countries.
We used data from 42 Demographic and Health Surveys in sub-Saharan Africa, south and southeast Asia, and Latin America and the Caribbean. We report caesarean rates by wealth quintile and the absolute and relative difference between the richest and poorest quintiles. We also categorise the sample into richer and poorer halves and examine caesarean rates within rural areas.
Caesarean rates were extremely low among the very poor: they were below 1% for the poorest 20% of the population in 20 countries and were below 1% for 80% of the population in six countries. Only in five countries did the very poor have caesarean rates exceeding 5%. At the other extreme are seven countries, mostly in Latin America, where caesareans are far in excess of the suggested maximum threshold of 15% for at least 40% of the population.
In the poorest countries-mostly in sub-Saharan Africa-large segments of the population have almost no access to potentially life-saving caesareans, whereas in some mid-income countries more than half the population has rates in excess of medical need. These data deserve the immediate attention of policymakers at national and international levels.
关于获得挽救生命的产科手术方面的社会经济差异，我们知之甚少，然而对于女性而言，能够进行剖宫产手术对于实现低孕产妇死亡率至关重要。我们研究了不同发展中国家按社会经济群体划分的基于人群的剖宫产率。
我们使用了来自撒哈拉以南非洲、南亚和东南亚以及拉丁美洲和加勒比地区的42项人口与健康调查的数据。我们报告了按财富五分位数划分的剖宫产率以及最富有和最贫穷五分位数之间的绝对和相对差异。我们还将样本分为较富裕和较贫穷的两半，并研究农村地区的剖宫产率。
极贫困人口的剖宫产率极低：在20个国家中，最贫穷的20%人口的剖宫产率低于1%，在6个国家中，80%的人口的剖宫产率低于1%。只有5个国家的极贫困人口的剖宫产率超过5%。在另一个极端，有7个国家，大多在拉丁美洲，至少40%的人口的剖宫产率远远超过建议的最高阈值15%。
在最贫穷的国家——大多在撒哈拉以南非洲——很大一部分人口几乎无法获得可能挽救生命的剖宫产手术，而在一些中等收入国家，超过一半的人口的剖宫产率超过了医疗需求。这些数据值得国家和国际层面的政策制定者立即关注。
