Objective To provide an update on economic related inequalities in caesarean section rates within countries.
Design Secondary analysis of demographic and health surveys and multiple indicator cluster surveys.
Setting 72 low and middle income countries with a survey conducted between 2010 and 2014 for analysis of the latest situation of inequality, and 28 countries with a survey also conducted between 2000 and 2004 for analysis of the change in inequality over time.
Participants Women aged 15-49 years with a live birth during the two or three years preceding the survey.
Main outcome measures Data on caesarean section were disaggregated by asset based household wealth status and presented separately for five subgroups, ranging from the poorest to the richest fifth. Absolute and relative inequalities were measured using difference and ratio measures. The pace of change in the poorest and richest fifths was compared using a measure of excess change.
Results National caesarean section rates ranged from 0.6% in South Sudan to 58.9% in the Dominican Republic. Within countries, caesarean section rates were lowest in the poorest fifth (median 3.7%) and highest in the richest fifth (median 18.4%). 18 out of 72 study countries reported a difference of 20 percentage points or higher between the richest and poorest fifth. The highest caesarean section rates and greatest levels of absolute inequality were observed in countries from the region of the Americas, whereas countries from the African region had low levels of caesarean use and comparatively lower levels of absolute inequality, although relative inequality was quite high in some countries. 26 out of 28 countries reported increases in caesarean section rates over time. Rates tended to increase faster in the richest fifth (median 0.9 percentage points per year) compared with the poorest fifth (median 0.2 percentage points per year), indicating an increase in inequality over time in most of these countries.
Conclusions Substantial within country economic inequalities in caesarean deliveries remain. These inequalities might be due to a combination of inadequate access to emergency obstetric care among the poorest subgroups and high levels of caesarean use without medical indication in the richest subgroups, especially in middle income countries. Country specific strategies should address these inequalities to improve maternal and newborn health.

中文翻译：

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国内剖宫产率不平等：对 72 个低收入和中等收入国家的观察性研究

目的提供有关各国剖宫产率经济相关不平等的最新情况。
设计人口和健康调查和多指标类集调查的二次分析。
设置72 个在 2010 年至 2014 年期间进行调查以分析不平等的最新情况的低收入和中等收入国家，以及在 2000 年至 2004 年期间进行调查以分析不平等随时间变化的 28 个国家。
参与者调查前两三年内有过活产的 15-49 岁女性。
主要观察指标剖腹产数据按基于资产的家庭财富状况进行分类，并针对五个亚组分别呈现，从最贫穷到最富有的五分之一。使用差异和比率测量来测量绝对和相对不平等。最贫穷和最富有的五分之一人口的变化速度是用过度变化的衡量标准来比较的。
结果全国剖宫产率从南苏丹的 0.6% 到多米尼加共和国的 58.9% 不等。在国家范围内，最贫穷的五分之一的剖宫产率最低（中位数为 3.7%），而最富有的五分之一的剖宫产率最高（中位数为 18.4%）。在 72 个研究国家中，有 18 个国家报告说，最富有和最贫穷的五分之一之间存在 20 个百分点或更高的差异。美洲地区的国家剖腹产率最高，绝对不平等程度最高，而非洲地区的国家剖腹产使用率低，绝对不平等程度相对较低，尽管在一些国家的相对不平等程度相当高国家。28 个国家中有 26 个报告剖腹产率随着时间的推移而增加。最富有的五分之一（中位数为 0.
结论剖腹产在国内仍然存在巨大的经济不平等。这些不平等可能是由于最贫困的亚组无法获得紧急产科护理，而最富有的亚组，尤其是在中等收入国家，剖腹产使用率很高而没有医疗指征。国家具体战略应解决这些不平等现象，以改善孕产妇和新生儿健康。