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Are Brazilian women really choosing to deliver by cesarean?

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  • Hopkins, Kristine

Abstract

Brazil has among the highest cesarean section rates in the world, with 36% of women in the country delivering surgically. Women, especially those who deliver in private hospitals with cesarean rates in the 80-90% range, are often portrayed as actively choosing to deliver surgically. Doctors typically promote this view, also common in the popular understanding of the phenomenon, that it is women's demand for a cesarean that is behind the high rates. Academic analyses tend to present a more balanced view with doctors' motives for wanting to perform cesareans included alongside descriptions of women's motives for the procedures. What is typically missing from such analyses is a discussion of the power differences between women and doctors. Doctors clearly have more decision-making power in the hospital birthing situation, and their medical expertise and authority is often marshaled to convince a woman to "choose" a cesarean. Using data collected from a postpartum survey, participant observation in hospital obstetrics wards, and in-depth interviews, I offer evidence which refutes many of the hypotheses associated with why women might prefer to deliver by cesarean. I also show that the majority of women surveyed in two cities in Brazil, particularly first-time mothers, do not seek to deliver by cesarean. Through an analysis of conversations between doctors and women during labor and delivery, and through women's narratives of their delivery experiences, I also show some of the mechanisms that doctors use in order to induce so-called demand for surgical delivery and argue that they are very active participants in the ongoing construction of the culture of cesarean section in Brazil.

Suggested Citation

  • Hopkins, Kristine, 2000. "Are Brazilian women really choosing to deliver by cesarean?," Social Science & Medicine, Elsevier, vol. 51(5), pages 725-740, September.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:5:p:725-740
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    Citations

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    Cited by:

    1. Hopkins, Kristine & Maria Barbosa, Regina & Riva Knauth, Daniela & Potter, Joseph E., 2005. "The impact of health care providers on female sterilization among HIV-positive women in Brazil," Social Science & Medicine, Elsevier, vol. 61(3), pages 541-554, August.
    2. Kabakian-Khasholian, Tamar & Kaddour, Afamia & DeJong, Jocelyn & Shayboub, Rawan & Nassar, Anwar, 2007. "The policy environment encouraging C-section in Lebanon," Health Policy, Elsevier, vol. 83(1), pages 37-49, September.
    3. Guccio, C. & Lisi, D., 2014. "Social interactions in inappropriate behavior for childbirth services: Theory and evidence from the Italian hospital sector," Health, Econometrics and Data Group (HEDG) Working Papers 14/28, HEDG, c/o Department of Economics, University of York.
    4. Guccio, Calogero & Lisi, Domenico, 2016. "Thus do all. Social interactions in inappropriate behavior for childbirth services in a highly decentralized healthcare system," Regional Science and Urban Economics, Elsevier, vol. 61(C), pages 1-17.
    5. Leone, Tiziana & Padmadas, Sabu S. & Matthews, Zoë, 2008. "Community factors affecting rising caesarean section rates in developing countries: An analysis of six countries," Social Science & Medicine, Elsevier, vol. 67(8), pages 1236-1246, October.
    6. Bryant, Joanne & Porter, Maree & Tracy, Sally K. & Sullivan, Elizabeth A., 2007. "Caesarean birth: Consumption, safety, order, and good mothering," Social Science & Medicine, Elsevier, vol. 65(6), pages 1192-1201, September.
    7. Litorp, Helena & Mgaya, Andrew & Mbekenga, Columba K. & Kidanto, Hussein L. & Johnsdotter, Sara & Essén, Birgitta, 2015. "Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting," Social Science & Medicine, Elsevier, vol. 143(C), pages 232-240.
    8. Leone, Tiziana, 2014. "Demand and supply factors affecting the rising overmedicalization of birth in India," LSE Research Online Documents on Economics 58646, London School of Economics and Political Science, LSE Library.

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