Association between location of prenatal care services and non-consented cesarean sections in Mexico: a secondary analysis of the National Survey on the Dynamics of Household Relationships 2016

Abstract

Background Mexico has one of the world’s highest rates of cesarean section (C-section), which is part of the growing problem with obstetric violence the country faces. Little is known about Mexico’s frequency of and risk factors for non-consented C-sections, a form of obstetric violence. We examined the association between the location of prenatal care services and receiving a non-consented C-section. Methods We used the 2016 Mexico National Survey on the Dynamics of Household Relationships (ENDIREH 2016) to conduct secondary data analysis with a sample of 10,306 women who reported a C-section during their latest pregnancy. We conducted multivariable logistic regression to examine the relationship between location of prenatal care service and receiving a non-consented cesarean delivery between 2011 and 2016 among Mexican women of reproductive age. Results Of all women, 9.8% of respondents who had C-sections were not informed that it was necessary, while 9.2% did not give permission for this procedure. The odds of having a non-consented cesarean were higher for women who received prenatal services in private settings, an IMSS facility, an ISSSTE facility, or more than one type of facility, compared to a public community health center. Among participants who reported Indigenous belonging, receiving prenatal services at a private or ISSSTE facility was also associated with non-consented cesarean delivery. Additionally, when comparing all public prenatal care locations with private, we found that receiving prenatal care at a private facility or at both public and private settings, were associated with increased odds of non-consented cesarean delivery. Similar results were observed for participants not of Indigenous belonging, while only private setting was associated with increased odds of non-consented C-sections for respondents of Indigenous belonging. Conclusions This analysis indicates that receiving prenatal care at an ISSSTE, IMSS, private facility, or a combination of public and private services increases the risk of non-consented C-section in Mexico. These findings recommend the need to implement actions to improve the functioning of prenatal and delivery care in the different health systems to prevent mistreatment during C-section procedures. Additional research is required to further understand the factors associated with non-consented C-sections in Mexico.