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

PLOS ONE RESEARCH ARTICLE 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 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Marian Marian ID1,2*, Ramona L. Pérez ID3 1 Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States of America, 2 San Diego State University School of Public Health, San Diego, CA, United States of America, 3 Department of Anthropology, San Diego State University, San Diego, CA, United States of America * OPEN ACCESS Citation: Marian M, Pérez RL (2024) Association between location of prenatal care services and nonconsented cesarean sections in Mexico: A secondary analysis of the National Survey on the Dynamics of Household Relationships 2016. PLoS ONE 19(5): e0303052. https://doi.org/10.1371/ journal.pone.0303052 Editor: Thales Philipe Rodrigues da Silva, Universidade Federal de Sao Paulo, BRAZIL Received: December 6, 2023 Abstract Background Mexico has one of the world’s highest rates of cesarean section (C-section). Little is known about Mexico’s frequency of and risk factors for non-consented C-sections, a form of obstetric violence. We examined the prevalence of sociodemographic and obstetric-specific characteristics of Mexican women who delivered via C-section, as well as the association between the location of prenatal care services and experiencing a non-consented Csection. Accepted: April 18, 2024 Methods Published: May 14, 2024 We conducted a secondary analysis of data collected from Mexico’s 2016 National Survey on the Dynamics of Household Relationships (ENDIREH 2016) of women who reported a C-section during their latest delivery. Adjusted logistic regressions were calculated to explore the associations between the location of prenatal care services and experiencing a non-consented cesarean delivery, stratifying by Indigenous belonging. Copyright: © 2024 Marian, Pérez. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The dataset analyzed during the current study is publicly available in the INEGI ENDIREH 2016 repository, http://en.www.inegi.org.mx/programas/ endireh/2016/#open_data. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Results The sample size for this analysis was 10,256 ENDIREH respondents, with 9.1% not consenting to a C-section. ENDIREH respondents between the ages of 26 and 35 years old, living in urban settings, living in Central or Southern Mexico, and married or living with a partner experienced a higher prevalence of non-consented C-sections. For both women who identified as Indigenous and those who did not, the odds of experiencing a non-consented C-section were higher when receiving prenatal services in private settings. Receiving more than one type of prenatal service was also associated with increased odds of nonconsented C-sections, while ENDIREH 2016 respondents who did not identify as PLOS ONE | https://doi.org/10.1371/journal.pone.0303052 May 14, 2024 1 / 16 PLOS ONE Secondary analysis on the association between prenatal care services and non-consented C-sections in Mexico Indigenous and received prenatal care at the State Institute for Social Security and Services for State Workers facility had lower odds of experiencing a non-consented C-section. Conclusions This analysis indicates that receiving prenatal care at a private facility or a combination of public and private services increases the risk of experiencing a non-consented C-section in Mexico. Additional research is required to further understand the factors associated with non-consented C-sections in Mexico. Background Every woman has the right to a pregnancy and childbirth process that is dignified and respectful. Evidence worldwide shows a persistent occurrence of obstetric violence in health care facilities [1,2]. Obstetric violence is the abuse, neglect, or mistreatment, including non-consented care, during the childbirth process [3,4]. This type of violence is a global issue, affecting women on all continents. Recent studies report a prevalence of various forms of obstetric violence that ranges between 18% and 75% in Brazil and Ethiopia, respectively, while in 12 European countries, on average, 12% of women suffered abuse and 24% expressed not being treated with dignity during delivery [5–7]. Obstetric violence could have immediate and longterm physical and psychological consequences in the life of the mother, such as pain and suffering from denial of pain relief medication or an episiotomy without anesthesia, sleeping problems, post-traumatic stress symptoms, and feelings of dehumanization that could result in distorted body perception and fear of future childbirths [8]. Non-consented care, which is the absence of an information process that enables a female patient to provide informed consent for a childbirth procedure, is one of the seven categories of disrespectful and abusive care during childbirth, a concept usually used interchangeably with obstetric violence [3]. The number of cesarean sections (C-sections) completed around the world continues to increase, with more than 20% of all births conducted through this surgical procedure [9]. In Egypt, Turkey, Brazil, the Dominican Republic, and Cyprus, the number of C-sections is higher than the number of vaginal deliveries.[10] In the Latin American and Caribbean region, C-sections make up more than 40% of the deliveries [10]. A study using the Robson classification, a system that classifies all deliveries into one of ten groups and compares C-section rates by type of facility and over time, two World Health Organization’s (WHO) multi-country surveys, found an increase in C-sections in 20 out of 21 countries from 2004 to 2010 [11,12]. It is expected that the number will increase to 29% by 2030, with the highest rates between 50% and 63% in Western and Eastern Asia, Latin America, and the Caribbean [9,10]. Globally, it has also been found that for-private health facilities perform more C-sections than non-profit ones, while women with private insurance also have higher rates of C-section deliveries compared to women with public health insurance [13,14]. While a C-section is a life-saving procedure when medically necessary, women and infants are at risk of short- and long-term health problems when C-sections are performed unnecessarily [9,15]. Since 1985, the WHO has provided a recommendation on the number of C-sections for every country [16]. This suggests (...truncated)