Description
For the past several decades, cesarean section rates in Mexico have continued to rise in the wake of the Millennium Development Goals’ push to reduce maternal mortality. In Mexico, nearly half of all births are performed via cesarean delivery. The choice of prenatal care provider and approach represents a significant area of reproductive autonomy for women and potentially reduces reliance on cesarean delivery. Leveraging data from the 2016 Encuesta Nacional sobre la Dinámica de las Relaciones en los Hogares (ENDIREH), this thesis explores the relationship between the modality of prenatal care and odds of cesarean delivery among 23,150 birthing women who participated in the survey. The present study situates the problem of overreliance on cesarean deliveries within Mexico's historical and structural contexts while also providing a theoretical framework for understanding the phenomenon within the contexts of medical anthropology and social epidemiology. Statistical models were generated using logistic regression coupled with a purposeful model selection approach to account for other significant predictors and confounders influencing the relationship. Among women who received most of their prenatal care from a midwife or healer, the odds of cesarean delivery were 95% (95% CI: 0.02, 0.14) lower than women who received no prenatal care. Comparatively, women who received their prenatal care from an IMSS clinic were 1.5 (95% CI: 1.01, 2.25) times as likely to deliver by cesarean section, and those who received care from a private provider were 2.99 (95% CI: 2.02, 4.52) times as likely to deliver by cesarean section compared to women with no prenatal care. Other statistically significant predictors included marital status, the highest level of education attempted, location of residence (urban, urban complement, or rural), age, gravidity in the last five years, and the number of live births in the past five years. Additional prospective research studies accompanying women along their prenatal and obstetric journey are essential to further investigating the policy-based components that favor biomedical approaches over alternative care providers like midwives and traditional healers.
