Cesarean section rate differences by migration indicators

• Published in: Archives of gynecology and obstetrics 2013-04, Vol.287 (4), p.633-639
• Main Authors: Gagnon, Anita J., Van Hulst, Andrea, Merry, Lisa, George, Anne, Saucier, Jean-François, Stanger, Elizabeth, Wahoush, Olive, Stewart, Donna E.
• Format: Article
• Language: English
• Subjects: Canada; Cesarean section; Cesarean Section - statistics & numerical data; Cities - statistics & numerical data; Emigrants and Immigrants - statistics & numerical data; Endocrinology; Female; Gynecology; Health risk assessment; Human Genetics; Humans; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Migration; Obstetrics/Perinatology/Midwifery; Political asylum; Pregnancy; Refugees; Refugees - statistics & numerical data
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-012-2609-7

Purpose To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators? Methods Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed. Results Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p  = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p  = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8–27.3). Cesarean section rates of African women were consistently high (31–33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %). Conclusion Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.