Determinantes Del Auge De Las Cesáreas En Uruguay (2002-2024)

This study analyses the determinants of the increase in the caesarean section rate in Uruguay over the period 2002-2024, during which this mode of delivery rose from 26.5% to 52.7% of births, a level well above the recommendations of the World Health Organization. To this end, we use administrative data from a hospital birth registry and apply the decomposition techniques proposed by Kitagawa and Oaxaca-Blinder, which allow us to disentangle changes associated with maternal composition from those linked to clinical and organisational practice. The first approach suggests that the marked rise in caesarean sections in Uruguay is largely driven by the growth of planned caesareans and labour inductions, as well as by the mechanical effect associated with previous caesarean deliveries. In turn, the Oaxaca–Blinder decomposition shows that more than half of the cumulative increase is not explained by observable maternal or pregnancy characteristics. Changes in maternal age, multiparity, and the proportion of mothers with a prior caesarean are the most relevant observable determinants of the historical increase. By contrast, rising educational attainment moderates the growth of caesarean deliveries. From a policy perspective, we recommend targeting performance goals towards the safe reduction of primary caesarean sections among nulliparous women with a single, cephalic fetus at term; conducting clinical audits; and strengthening the model of care (midwifery-led care, continuous support, and rational use of induction), supported by real-time information systems that enable timely monitoring.