# Association between location of prenatal care services and non-consented cesarean sections in Mexico: A secondary analysis of the National Survey on the Dynamics of Household Relationships 2016

## TL;DR

This study explores how the location of prenatal care in Mexico is linked to non-consented cesarean sections, a form of obstetric violence.

## Contribution

The study identifies prenatal care location as a risk factor for non-consented C-sections in Mexico, stratified by Indigenous belonging.

## Key findings

- Women receiving prenatal care in private settings had higher odds of non-consented C-sections.
- Combining public and private prenatal services increased the risk of non-consented C-sections.
- Indigenous and non-Indigenous women both faced higher risks with private prenatal care.

## Abstract

Mexico has one of the world’s highest rates of cesarean section (C-section). Little is known about Mexico’s frequency of and risk factors for non-consented C-sections, a form of obstetric violence. We examined the prevalence of sociodemographic and obstetric-specific characteristics of Mexican women who delivered via C-section, as well as the association between the location of prenatal care services and experiencing a non-consented C-section.

We conducted a secondary analysis of data collected from Mexico’s 2016 National Survey on the Dynamics of Household Relationships (ENDIREH 2016) of women who reported a C-section during their latest delivery. Adjusted logistic regressions were calculated to explore the associations between the location of prenatal care services and experiencing a non-consented cesarean delivery, stratifying by Indigenous belonging.

The sample size for this analysis was 10,256 ENDIREH respondents, with 9.1% not consenting to a C-section. ENDIREH respondents between the ages of 26 and 35 years old, living in urban settings, living in Central or Southern Mexico, and married or living with a partner experienced a higher prevalence of non-consented C-sections. For both women who identified as Indigenous and those who did not, the odds of experiencing a non-consented C-section were higher when receiving prenatal services in private settings. Receiving more than one type of prenatal service was also associated with increased odds of non-consented C-sections, while ENDIREH 2016 respondents who did not identify as Indigenous and received prenatal care at the State Institute for Social Security and Services for State Workers facility had lower odds of experiencing a non-consented C-section.

This analysis indicates that receiving prenatal care at a private facility or a combination of public and private services increases the risk of experiencing a non-consented C-section in Mexico. Additional research is required to further understand the factors associated with non-consented C-sections in Mexico.