Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery.

BACKGROUND Spain has become a principal destination for immigrants and delivery is the major reason for hospitalization in this population. However, research about inequities between native and immigrant women regarding the quality of the care received during pregnancy and delivery is still scarce. One of the indicators used to evaluate the quality of the obstetric care is the rate of caesarean sections (CSs). METHODS A cross-sectional study of 215 379 single deliveries from Spanish and immigrant women from Latin America, East Europe and Maghreb was carried out in Spain in 2005-06. Prevalence of CS according to maternal and neonatal characteristics was calculated by geographical origin. Two associations were explored by means of multiple logistic regression analysis. First, the association between geographical origin and the risk of CS in public or private hospitals separately, and, second, the risk of CS for women from the same geographical origin depending on whether they delivered at public or private hospitals. RESULTS Overall, the risk of CS was lower for immigrants as a whole than for native women (odds ratio (OR) = 0.83 95% confidence interval (CI) = 0.80-0.85), but the risk varied markedly by area of origin, being higher for Latin Americans (OR = 1.09 95% CI = 1.05-1.13) and lower for East Europeans (OR = 0.61 95% CI = 0.57-0.66) and Maghrebians (OR = 0.60 95% CI =0.57-0.63). Public hospitals followed the overall pattern of risk. CS risk was higher in private than in public hospitals for all groups. However, the increase in risk was higher for immigrant than for natives. CONCLUSION Immigrants in Spain are a heterogeneous population regarding the risk of CS. Geographical origin and type of hospital are key aspects underlying such a risk.