Sylvia Guendelman (
Alison Gemmill is a PhD candidate in demography at the University of California, Berkeley.
Health Aff (Millwood). 2017 Apr 1;36(4):714-722. doi: 10.1377/hlthaff.2016.1084.
Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.
墨西哥的剖宫产率在美洲位居第二，仅次于巴西。有过剖宫产史的女性再次行剖宫产的可能性非常高，但关于初次剖宫产（即首次剖宫产）的驱动因素的证据却很少。我们利用 2014 年墨西哥出生证明数据，对至少怀孕 37 周后分娩的 600124 名初次分娩的母亲进行了人群水平的数据分析，研究了初次剖宫产的流行情况及其决定因素。我们发现，这些女性的剖宫产率非常高，达到 48.7%，而且不同保险类型之间存在很大差异。2003 年为以前未投保的人推出并逐步在全国推广的公共医疗保险计划 Seguro Popular 的参保人剖宫产率为 40%，而通过公务员社会保险研究所投保的女性剖宫产率为 78%。在调整了协变量后，Seguro Popular 参保人初次剖宫产的风险仍然较低。对于所有初次分娩的母亲来说，私立分娩机构的初次剖宫产率尤其高。要降低墨西哥的剖宫产率，需要在不同类型的保险和分娩机构采取干预措施，还需要有针对性的公共卫生宣传。
