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Variations in first‐time caesarean birth between Eastern African immigrants and Australian‐born women in public care: A population‐based investigation in Victoria
Author(s) -
Belihu Fetene B.,
Small Rhonda,
Davey MaryAnn
Publication year - 2017
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12491
Subject(s) - immigration , demography , population , obstetrics , medicine , gender studies , geography , sociology , archaeology
Background Caesarean section (CS) rates are known to vary by country, migration status and social group. However, little population‐based, confounder adjusted evidence exists on caesarean rate for African immigrants in Australia. Aim To investigate disparities in first‐time caesarean, mainly unplanned caesarean in labour for women born in Eritrea, Ethiopia, Somalia and Sudan relative to Australian‐born women in public care. Methods A population‐based study of 237 943 Australian and 4057 Eastern African singleton births between 1999 and 2007, was conducted using Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis by parity, adjusting for confounders selected a priori, was performed for first‐time unplanned caesarean in labour and overall caesarean. Results Primiparae born in each of the Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea adjusted odds ratio (OR adj ) 2.04 95% CI (1.41, 2.97), Ethiopia OR adj 2.08 95% CI (1.62, 2.68), Somalia OR adj 1.62 95% CI (1.25, 2.10) and Sudan OR adj 1.39 95% CI (1.03, 1.87). Similarly, multiparae from Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea OR adj 2.13 95% CI (1.15, 3.97), Ethiopia OR adj 2.05 95% CI (1.38, 3.03), Somalia OR adj 2.16 95% CI (1.69, 2.77) and Sudan OR adj 1.81 95% CI (1.32, 2.49). The odds of any first‐time caesarean (planned or unplanned) were elevated for primiparae born in all countries except Sudan and for multiparae born in Ethiopia and Somalia. Conclusions We observed substantial variations in a first‐time CS between Eastern African and Australian‐born women in Victoria, Australia. However, these disparities were unexplained by socio‐demographic and clinical risks, suggesting the potential importance of other factors such as communication difficulties, support systems for immigrant pregnant women and possible differences in care.