Rise in caesarean births in Chile [letter]

Chile has one of the highest rates of cesarean section births in the world and the fact that the numbers are increasing has been attributed to the increase in the progressive privatization of the health sector. However at one of the largest private hospitals in the country cesarean section rates have declined from 33.7% in 1994 to 29% in 1995 and 28.1% in 1996. The rate of cesarean sections at this hospital is also affected by the increased incidence of multiple pregnancies which result from the assisted fertilization program and by referrals from tertiary care facilities. However the rate of cesareans performed by non-staff obstetricians rose from 54.9% to 57.1% over the period 1994-96. This reflects the fact that most private maternity care is provided by public-sector physicians as a means of augmenting their incomes. The hospitals where these physicians practice do not interfere with their behavior. Rather than being related to funding source the cesarean rate is related to providers accountability and public awareness of the guaranteed good results which follow. The rate of cesarean section delivery can be reversed through implementation of increased control of resources which improves access patient satisfaction and efficiency.