Trend of socioeconomic inequalities in caesarean section rates: an analysis for Brazil from 2000 to 2021

Purpose This study investigated socioeconomic inequalities in caesarean section rates among Brazilian women from 2000 to 2021, in a context where Brazil’s high caesarean rate may indicate both overuse among privileged groups and limited access for disadvantaged women when the procedure is clinically necessary. We quantified inequality over time using concentration indices, decomposed these inequalities into their main contributing factors and examined regional heterogeneity across areas with distinct levels of economic development. Design/methodology/approach Socioeconomic inequality was measured using concentration indices, followed by a decomposition analysis to identify the factors that contribute to the observed inequality. A heterogeneity assessment was also conducted across Brazil’s regions, which have distinct levels of economic development. Findings Results show a favourable concentration pattern for women with higher education levels, both in Brazil and its regions. However, despite the correction used, there is a reduction in socioeconomic inequalities in caesarean section. The Northeast and South regions had the greatest socioeconomic inequalities at the beginning of the period. The decomposition of inequalities indicated that schooling, number of pregnancies, maternal age, and number of prenatal consultations were the main contributing factors. Originality/value To the best of our knowledge, this is the first national-level study in Brazil to assess socioeconomic inequalities in using caesarean sections through concentration indices and decomposition methods. This study provides robust evidence to support the development of public policies aimed at reducing prevalence and socioeconomic disparities by clarifying the magnitude of the problem and its underlying drivers.