Socioeconomic Determinants of Planned and Emergency Cesarean Section Births in Mexico


Mexico’s rapid increase in Cesarean section (C-section) births in the past 20 years parallels a trend occurring in other low- and middle-income countries across the globe, exceeding what is considered medically necessary. Although existing research has highlighted how social forces shape the role of “demand” factors related to women’s preference for C-section births and “supply” factors in health care settings where women give birth, it does not differentiate these births according to whether they were planned earlier in pregnancy or emergency C-sections initiated while a woman was in labor. The objective of this study is to assess the socioeconomic determinants of planned and emergency C-section births. In this study, we use nationally representative data from the 2014 Encuesta Nacional de la Dinámica Demográfica (ENADID) to examine determinants of planned and emergency C-section births for women who experienced their first birth within the past 5 years (N = 8710). Logistic regression analysis is employed to examine predictors of planned and emergency C-section births separately. Of the births in our sample, 49.2% were vaginal, 18.5% were planned C-sections, and 32.4% were emergency C-sections. We find that wealth and birth location are significant predictors of planned, but not emergency C-sections. Socioeconomic factors are important determinants of planned C-section births and represent a pathway through which social influence should be examined in the future when looking at the adaptation of surgical births in populations and health care system efforts to reduce the C-section rate.

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  1. 1.

    The analytic sample with emergency C-sections as the dependent variable (n = 7101) includes emergency C-section births (n = 2819) and vaginal births (n = 4282). The analytic sample with planned C-sections as the dependent variable (n = 5891) includes planned C-section births (n = 1609) and vaginal births (n = 4282)


  1. 1.

    Suárez-López L, Campero L, EDl V-S, Rivera-Rivera L, Hernández-Serrato MI, Walker D, et al. Características sociodemográficas y reproductivas asociadas con el aumento de cesáreas en México. Salud Publica Mex. 2013;55:S225–S34.

    Article  Google Scholar 

  2. 2.

    Guendelman S, Gemmill A, Thornton D, Walker D, Harvey M, Walsh J, et al. Prevalence, disparities, and determinants of primary Cesarean births among first-time mothers in Mexico. Health Aff. 2017;36(4):714–22.

    Article  Google Scholar 

  3. 3.

    Boerma T, Ronsmans C, Melesse DY, Barros AJ, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–8.

    Article  Google Scholar 

  4. 4.

    World Health Organization. Infant and Young Child Fact Sheet. 2018. Accessed November 8 2018.

  5. 5.

    Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. Geneva, Switzerland: World Health Organization; 2010.

    Google Scholar 

  6. 6.

    Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. Jama. 2015;314(21):2263–70.

    CAS  Article  Google Scholar 

  7. 7.

    Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study.(Clinical report). Br Med J. 2007;335(7628):1025.

    Article  Google Scholar 

  8. 8.

    Patel RR, Peters TJ, Murphy DJ. Prenatal risk factors for caesarean section. Analyses of the ALSPAC cohort of 12 944 women in England. Int J Epidemiol. 2005;34(2):353–67.

    Article  Google Scholar 

  9. 9.

    Copelli FHS, Rocha L, Zampieri MFM, Gregório VRP, Custódio ZAO. Determinants of women’s preference for cesarean section. Texto Contexto-Enfermagem. 2015;24(2):336–43.

    Article  Google Scholar 

  10. 10.

    Belizán JM, Althabe F, Barros FC, Alexander S. Rates and implications of caesarean sections in Latin America: ecological study. BMJ (Clin Res Ed). 1999;319(7222):1397–400.

    Article  Google Scholar 

  11. 11.

    Aranda-Neri JC, Suárez-López L, DeMaria LM, Walker D. Indications for cesarean delivery in Mexico: evaluation of appropriate use and justification. Birth. 2017;44(1):78–85.

    Article  Google Scholar 

  12. 12.

    Potter JE, Hopkins K. Fau ́ndes A, Perpe ́tuo I. Women’s Autonomy and scheduled Cesarean sections in Brazil: a cautionary tale. Birth. 2008;35(1):33–40.

    Article  Google Scholar 

  13. 13.

    Soto-Vega E, Urrutia-Osorio M, Arellano-Valdez F, López I, Hernández H. The epidemic of the Cesarean section in private hospital in Puebla, México. Obstet Gynecol Int J. 2015;2(6):00058.

    Article  Google Scholar 

  14. 14.

    Heredia-Pi I, Servan-Mori EE, Wirtz VJ, Avila-Burgos L, Lozano R. Obstetric care and method of delivery in Mexico: results from the 2012 National Health and Nutrition Survey. PLoS One. 2014;9(8):e104166.

    Article  Google Scholar 

  15. 15.

    McCourt C, Weaver J, Statham H, Beake S, Gamble J, Creedy DK. Elective cesarean section and decision making: a critical review of the literature. Birth. 2007;34(1):65–79.

    Article  Google Scholar 

  16. 16.

    Guazo D. México: Una epidemia llamada cesárea. Fundación MEPI 2014. p. Accessed 15 Jan 2020

  17. 17.

    Barber SL. Mexico’s conditional cash transfer programme increases cesarean section rates among the rural poor. Eur J Pub Health. 2009;20(4):383–8.

    Article  Google Scholar 

  18. 18.

    Puentes-Rosas E, Gómez-Dantés O, Garrido-Latorre FJSM. Caesarean sections in Mexico: tendencies, levels and associated factors. Salud Publica Mex. 2004;46(1):16–22.

    Article  Google Scholar 

  19. 19.

    Gonzalez-Perez GJ, Vega-Lopez MG, Cabrera-Pivaral C, Muñoz A, Valle A. Caesarean sections in Mexico: are there too many? J Health Pol Syst Res. 2001;16(1):62–7.

    CAS  Google Scholar 

  20. 20.

    Aguirre R, Antón J-I, Triunfo P. Análisis de las cesáreas en Uruguay por tipo de centro hospitalario. GACETA Sanitaria. 2018.

  21. 21.

    Eufrásio LS, Souza DE, Fonsêca AMC, Viana ESR. Brazilian regional differences and factors associated with the prevalence of cesarean sections. Fisioterapia em Movimento. 2018;31.

  22. 22.

    Esquivel G, Cruces G. The dynamics of income inequality in Mexico since NAFTA [with Comment]. Economía. 2011;12(1):155–88.

    Article  Google Scholar 

  23. 23.

    Canedo AP, Angel JL. Aging and the hidden costs of going home to mexico. J Cross Cult Gerontol. 2019;34(4):417–37.

    Article  PubMed  Google Scholar 

  24. 24.

    Han L, Saavedra-Avendano B, Lambert W, Fu R, Rodriguez MI, Edelman A, et al. Emergency contraception in Mexico: trends in knowledge and ever-use 2006-2014. Matern Child Health J. 2017;21(11):2132–9.

    Article  PubMed  Google Scholar 

  25. 25.

    Puig A, Pagán JA, Wong R. Assessing quality across healthcare subsystems in Mexico. J Ambul Care Manag. 2009;32(2):123–31.

    Article  Google Scholar 

  26. 26.

    Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35:80–94.

    Article  Google Scholar 

  27. 27.

    Vallejos Parás A, Espino y Sosa S, Jaimes Betancourt L, Zepeda Tena C, Cabrera Gaytán DA, Arriaga Nieto L, et al. Obstetrician’s attitudes about delivery through cesarean section: a study in hospitals at Mexico City. Perinatología y Reproducción Humana. 2018;32(1):19–26.

    Article  Google Scholar 

  28. 28.

    Barraza-Lloréns M, Panopoulou G, Díaz BY. Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006. Rev Panam Salud Publica. 2013;33(2):122–30.

    Article  Google Scholar 

  29. 29.

    Brugha R, Pritze-Aliassime S. Promoting safe motherhood through the private sector in low-and middle-income countries. Bull World Health Organ. 2003;81:616–23.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Ruiz-Sandoval JL, Briseño-Godínez ME, Chiquete-Anaya E, Arauz-Góngora A, Troyo-Sanromán R, Parada-Garza JD, et al. Public and private hospital care disparities of ischemic stroke in Mexico: results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study. J Stroke Cerebrovasc Dis. 2018;27(2):445–53.

    Article  PubMed  Google Scholar 

  31. 31.

    Giménez V, Keith JR, Prior D. Do healthcare financing systems influence hospital efficiency? A metafrontier approach for the case of Mexico. Health Care Manag Sci. 2019;22(3):549–59.

    Article  PubMed  Google Scholar 

  32. 32.

    Servan-Mori E, Torres-Pereda P, Orozco E, Sosa-Rubí SG. An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010. Int J Equity Health. 2014;13(1):21.

    Article  Google Scholar 

  33. 33.

    Montenegro RA, Stephens C. Indigenous health in Latin America and the Caribbean. Lancet. 2006;367(9525):1859–69.

    Article  Google Scholar 

  34. 34.

    Chu S, Kim S, Schmid C, Dietz P, Callaghan W, Lau J, et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev. 2007;8(5):385–94.

    CAS  Article  Google Scholar 

  35. 35.

    Almeida S, Bettiol H, Barbieri MA, Silva AAM, Ribeiro VS. Significant differences in cesarean section rates between a private and a public hospital in Brazil. Cadernos Saude Publ. 2008;24:2909–18.

    Article  Google Scholar 

  36. 36.

    Barros AJ, Santos IS, Matijasevich A, Domingues MR, Silveira M, Barros FC, et al. Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off. Rev Saude Publica. 2011;45(4):635–43.

    Article  Google Scholar 

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Author information




The first author conceptualized the research project and study design and drafted the “Introduction” and “Discussion” sections. The second author analyzed the data and wrote the “Methods” and “Results” sections. Both authors edited the manuscript.

Corresponding author

Correspondence to Heather B. Edelblute.

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This project is a secondary analysis of an existing data set. Since the data for this study are publicly available at, no ethics committee approval was required. This project meets the ethical standards the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The data are deidentified data from a publicly available data set. No informed consent was required to conduct this research project according to the ethical standards the institutional and national research committees of the authors.

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Edelblute, H.B., Altman, C.E. Socioeconomic Determinants of Planned and Emergency Cesarean Section Births in Mexico. SN Compr. Clin. Med. (2021).

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  • Cesarean section births
  • Maternal and child health
  • Health care delivery
  • Birth
  • Latin America