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Int J Gynaecol Obstet. 2014 Sep;126(3):265-71. doi: 10.1016/j.ijgo.2014.03.030. Epub 2014 May 15.

A comparison of trends in cesarean delivery in Paraguay between 1995 and 2008.

Author information

  • 1Travel Medicine Northwest, Bellingham, USA.
  • 2Northwest Center for Public Health Practice, Department of Health Services, University of Washington, Seattle, USA.
  • 3School of Public Health, University of Washington, Seattle, USA.
  • 4Centro Paraguayo de Estudios de Población, Asunción, Paraguay.
  • 5Department of Pediatrics, University of Washington, Seattle, USA; Department of Global Health and Health Services, University of Washington, Seattle, USA. Electronic address: ddenno@u.washington.edu.



To identify maternal factors associated with the rise in the cesarean delivery rate in Paraguay.


Retrospective analysis of the 1995 and the 2008 National Survey on Demographic and Sexual and Reproductive Health data using multivariable logistic regression.


In 2008, 1094 (37.3%) deliveries were cesarean compared with 781 (19.3%) in 1995. Home births had decreased by 72.9%, accounting for 33.3% of the change in the proportion of cesarean deliveries. Private facilities were associated with an increased odds ratio of cesarean delivery of 2.60 (95% confidence interval [CI], 2.02-3.34) and 4.89 (95% CI, 3.67-6.51) in 1995 and 2008, respectively, and accounted for 32.8% of the increase in cesarean deliveries between 1995 and 2008. Cesarean delivery was also associated with a prior cesarean, insurance status, and maternal higher educational and economic status.


Between 1995 and 2008 the cesarean delivery rate in Paraguay almost doubled. More than one-third of deliveries were cesarean. Shifts toward facility- (particularly private) based deliveries and repeat cesarean for women with a previous cesarean influenced this increase. Practice guidelines, regulation, and oversight of facilities, along with education and information for pregnant women, are needed to curb unnecessary and potentially harmful surgical delivery interventions.

Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.


Cesarean; Epidemiology; Health surveys; Infant mortality; Maternal mortality; Paraguay; Pregnancy complications; Reproductive health

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