Matshidze K P, Richter L M, Ellison G T, Levin J B, McIntyre J A
Centre for Epidemiological Research in Southern Africa, Medical Research Council, Pretoria, South Africa.
Ethn Health. 1998 Feb-May;3(1-2):71-9. doi: 10.1080/13557858.1998.9961850.
The aim of this study was to assess the effect of 'population group' classification, as a specific instance of 'racial' categorization, on caesarean section rates in South Africa.
Information on 'population group' classification ('Black, 'Coloured', 'Indian', or 'White', as defined under apartheid legislation) and place of delivery, together with basic obstetric, sociodemographic and perinatal data, were extracted from the birth notification forms of 5456 children who made up the birth cohort of the Birth to Ten longitudinal study. This cohort included all births that occurred to mothers resident in Soweto-Johannesburg during a 7-week period in 1990.
After accounting for differences in maternal age, gravidity, birth weight and gestational age at delivery, the rate of caesarean sections at private facilities was more than twice that at public facilities. Although there were significant differences in the utilisation of private facilities by women from different 'population groups', there was an independent effect of 'population group' classification on caesarean section rates: caesarean section rates among women classified as 'White' and 'Coloured' were significantly higher (95% confidence intervals for odds ratios: 1.40-2.42 and 1.05-1.81, respectively) than among women classified as 'Black'.
'Population group' differences in caesarean section rates among South African women are not explained by differences in demographic risk factors for assisted delivery, nor by differences in access to private health care. Instead, the differences in section rates may reflect the effect of bias in clinical decision-making, and/or differences among women from different 'population groups' in their attitude towards assisted delivery, and their capacity to negotiate with clinicians.
本研究旨在评估作为“种族”分类具体实例的“人群组”分类对南非剖宫产率的影响。
从构成“从出生到十岁”纵向研究出生队列的5456名儿童的出生通知表中提取关于“人群组”分类（根据种族隔离立法定义的“黑人”“有色人种”“印度人”或“白人”）、分娩地点以及基本产科、社会人口统计学和围产期数据。该队列包括1990年为期7周内在索韦托 - 约翰内斯堡居住的母亲所发生的所有分娩。
在考虑了产妇年龄、妊娠次数、出生体重和分娩时孕周的差异后，私立医疗机构的剖宫产率是公立医疗机构的两倍多。虽然来自不同“人群组”的女性在私立医疗机构的利用率存在显著差异，但“人群组”分类对剖宫产率有独立影响：被归类为“白人”和“有色人种”的女性的剖宫产率显著高于被归类为“黑人”的女性（优势比的95%置信区间分别为1.40 - 2.42和1.05 - 1.81）。
南非女性剖宫产率的“人群组”差异既不能用辅助分娩的人口统计学风险因素差异来解释，也不能用获得私立医疗保健的差异来解释。相反，剖宫产率的差异可能反映了临床决策中的偏见影响，和/或不同“人群组”女性在对辅助分娩的态度以及与临床医生协商能力方面的差异。
