PURPOSE: to generate knowledge in order to allow of the determination the factors affecting the high incidence of caesarean section and its relation to sterilization. METHODS: the multicentric study on reproductive health in Brazil, carried out from 1998 to 2000, included the States of Rio Grande do Norte, Minas Gerais, São Paulo, and Rio Grande do Sul. It was characterized as a longitudinal study, where the women, proceeding from public as well as private health services, were interviewed at three moments: at the beginning of pregnancy (until the 22nd week of gestation), at the end of pregnancy (between 30 and 40 days before the probable date of childbirth) and after delivery (between 15 and 45 days after childbirth). The interviewed women complied with the following eligibility criteria: to have 18 to 40 years of age, to live in Natal and plan to deliver the baby in Natal. At the first moment, 433 women were interviewed, 380 at the second moment and 269 at the third moment. The data were submitted to the chi-square test, with the level of significance set at 0.05, just to assure the relation between the variable years of schooling (0 to 8 and 9 or +) and the representative variables for reproductive health. RESULTS: the result disclosed a statistically significant relationship (p<0.05) between the variables: years of schooling, parity, type of service used, social class, job status, and prenatal consultations. It was found that a higher educational level is predominant among those women who searched for private services, coming from higher social classes and large number of prenatal visits. Although without statistical significance, having a for the women coming from this type of service, a higher number of caesarean section5 was observed, probably due to an easy doctor-patient interaction, while the planned caesarean section was frustrated for 43% of those women coming from public health services, as well as the wish to have a tubal ligation at childbirth (57%). CONCLUSIONS: These results show up the great differentials between the private and public services, with a clear favoritism for the private sector, demonstrating clearly that the practical obstetrics in Brazil needs a change and an improvement both for those women with access to the private service, who obtain the accomplishment of the caesarean section without consistent medical indications, and those with access to the public service, who face difficulties in accomplishing this procedure, even with consistent medical indications, in order to provide equality in the reproductive rights of those women.
Caesarean section; Reproductive medicine; Sterilization; Contraception; Incidence; Multicenter studies
