CESAREAN BIRTH TRENDS IN CHILE, 1986 TO 1994

Background: Despite indications of high cesarean section rates in vari ous parts of Latin America, relatively few comprehensive studies of na tional birth intervention trends have been conducted in that continent . Recent national statistics suggest that Chile may now have the highe st reported cesarean section rate in the world. This paper examines ce sarean birth trends in Chile with reference to changing patterns in he alth care financing. Methods: The growth in the national cesarean birt h rate is analyzed, with reference to regional patterns, differences a ccording to insurance coverage, and recent shifts in the financing pat tern of health care provision, using insurance fund data and hospital reporting systems data for both public and private sector care from th e mid-1980s to mid-1990s. Results: Chile had a cesarean birth rate of 37.2 percent for the 301,955 births covered by either the National Hea lth Fund or private health insurance in 1994. This was a one-third inc rease from the 1986 rate of 27.7 percent. The private health insurance sector revealed consistently far higher cesarean section rates than t he National Health Fund sector (59% vs 28.8% in 1994); intrasectoral r ates remained fairly stable over the 8-year period. Conclusions: The o verall increase in Chile's cesarean section rate correlates with the g rowth in the proportion of all births whose care was privately insured during these years (from 7.5% to 24.8%). This change may be partly ex plained by the doubling (to 32%) of the percentage of women with a per sonal obstetrician rather than a ''duty'' practitioner attending the b irth of their baby.